Arthroscopic Revision Rotator Cuff Repair: The Role of Previously Neglected Subscapularis Tears

Yoon, Taekyung; Kim, Sung-Jae; Choi, Yun Rak; Cho, Jin-Tae; Chun, Yong-Min

doi:10.1177/03635465211047485

Cited by 18 publications

(17 citation statements)

References 44 publications

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“…Yoon TH et al found that SSC tendon tears combined with advanced fatty infiltration had a high retear rate of 78.6% despite clinical improvement through surgery [ 19 ]. Among arthroscopic revision rotator cuff repairs, 43.1% had neglected SSC tears, and fatty infiltration of these initially neglected SSC tendons showed further progression at the time of revision [ 20 ]. When the SSC tendon tears extended more than the upper 1/3 of the tendon, the failure rate of massive posterosuperior rotator cuff tear repair was significantly increased [ 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

Identifying key factors associated with subscapularis tendon tears and developing a risk prediction model to assist diagnosis

Wang

Xue

2022

BMC Musculoskelet Disord

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Background There are still some challenges in diagnosing subscapularis (SSC) tendon tears as accurately as posterosuperior rotator cuff tears on MRI. The omission of SSC tendon tear can lead to muscle atrophy, fatty infiltration, and increased tearing accompanied by aggravated shoulder pain and loss of function. An effective non-invasive evaluation tool will be beneficial to early identification and intervention. The study aims to identify sensitive predictors associated with SSC tendon tears and develop a risk prediction model to assist in diagnosis. Methods Data on 660 patients who received shoulder arthroscopic surgery with preoperative shoulder MRI were collected retrospectively. Of these, patients with SSC tendon tears were defined as the SSC tear group, and patients with intact SSC tendon were enrolled in the non-SSC tear group. Logistic regression analysis was used to identify the key predictors of SSC tendon tears which were then incorporated into the nomogram. Results Among 22 candidate factors, five independent factors including coracohumeral distance (CHD, oblique sagittal plane) (OR, 0.75; 95%CI, [0.67–0.84]), fluid accumulation (Y-face) (OR, 2.29; 95%CI, [1.20–4.38]), long head of biceps tendon (LHB) dislocation/subluxation (OR, 3.62; 95%CI, [1.96–6.68]), number of posterosuperior (PS) rotator cuff tears (OR, 5.36; 95%CI, [3.12–9.22]), and MRI diagnosis (based on direct signs) (OR, 1.88; 95%CI, [1.06–3.32]) were identified as key predictors associated with SSC tendon tears. Incorporating these predictors, the nomogram achieved a good C index with a good agreement on the risk estimation of calibration plots. Higher total points of the nomogram were associated with a greater risk of SSC tendon tears. Conclusion When evaluating the severity of SSC tendon injury, the combination of reliable predictors can improve the sensitivity and diagnostic performance of MRI. This model provides an individualized probability of risk prediction, which is convenient for clinicians to identify patients at high risk for SSC tendon tears to avoid missed diagnosis.

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Section: Introductionmentioning

confidence: 99%

Identifying key factors associated with subscapularis tendon tears and developing a risk prediction model to assist diagnosis

Wang

Xue

2022

BMC Musculoskelet Disord

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“…Intratendinous tear has not been introduced in the current classiications of SSC lesions [1][2][3]. Incomplete visualisation could lead to failure to diagnose SSC tears and subsequently have negative impacts on outcomes after rotator cuf repair [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

The prevalence, classification, radiological and arthroscopic findings of intratendinous subscapularis tears

Lin

Zhang

Cui

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeTo investigate the clinical characteristics of intratendinous subscapularis (inSSC) tears. MethodsRetrospectively, 69 patients with arthroscopically confirmed inSSC tears were identified from 2018 to 2019. Preoperatively and at final follow‐up, thorough physical examination was performed and clinical outcomes (American Shoulder and Elbow Surgeons [ASES] score; University of California, Los Angeles [UCLA] score; visual analogue scale [VAS] for pain; and Simple Shoulder Test [SST]) were recorded. Features of pre‐operative magnetic resonance image (MRI) such as high signalling within the tendon substance, communication to the bicipital groove and long head of biceps tendon (LHBT) lesions were investigated. Characteristics of arthroscopic view were investigated. Bear‐hug and internal rotation resistance test at 90° abduction and external rotation (IRRT90°) test were used to assess the SSC strength. ResultsThe mean follow‐up was 2.4 (2–3) years. The prevalence of arthroscopically confirmed inSSC tears was 69/675 (10.2%) among arthroscopic rotator cuff repairs. Pre‐operative physical examination found positive IRRT90° and bear‐hug test in 41/60 (68.3%) and 42/69 (60.8%) patients, respectively. The Cohen kappa coefficient was interpreted to be substantial for the evaluation of all MRI parameters. According to the conditions of LHBT, inSSC tears were classified into 3 types: type I: without LHBT subluxation and tear; type II: with LHBT subluxation or tears and type III: with LHBT dislocation. At final follow‐up, mean ASES, UCLA, VAS, and SST scores improved significantly from mean of 50.6 ± 14.7, 19.4 ± 3.07, 6.2 ± 2.0, and 6.1 ± 2.5 to mean of 90.7 ± 9.5, 32.2 ± 1.8, 1.4 ± 1.2 and 9.8 ± 2.2, respectively (P < 0.001). Bilateral symmetric strength was found by bear‐hug and IRRT90° test in all patients postoperatively. ConclusionUnderstanding features of pre‐operative MRI, physical examination and arthroscopic view is helpful to identify inSSC tears. Arthroscopic repair yielded satisfactory clinical outcomes in patients with inSSC tears. Level of evidenceLevel IV.

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“…2,10,15,16,20,35,37 To prevent missed partial subscapularis tears, careful preoperative evaluation by physical examination and imaging is essential. 58…”

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confidence: 99%

“…2,10,15,16,20,35,37 To prevent missed partial subscapularis tears, careful preoperative evaluation by physical examination and imaging is essential. 58 Several clinical tests have been described for the diagnosis of subscapularis tears, including the belly-press test, belly-off sign, internal rotational lag sign, Napoleon sign (modified belly-press test), liftoff test, bear-hug test, and scissor sign. 3,14,18,19,22,40,45,46 Among them, the belly-press test and bear-hug test have been reported to have good diagnostic accuracy for detecting upper one-third subscapularis tears.…”

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confidence: 99%

Diagnostic Performance of Belly-Press Angle in Predicting the Severity of Subscapularis Tear

Kim,

Park

et al. 2023

Am J Sports Med

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Background: Neglected partial subscapularis tears often cause functional impairment even after repair of the supraspinatus and infraspinatus tear is done. Numerous physical examinations for detecting partial subscapularis tears have been described in previous studies. Purpose: To analyze the relationship between the preoperative clinical features and the severity of a partial subscapularis tear and to provide diagnostic clues for patients requiring subscapularis repair. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: This retrospective study included 286 patients who underwent arthroscopic shoulder surgery between 2020 and 2022. Preoperative clinical features, including range of motion, functional scores, muscle strength ratio, modified belly-press test (measuring belly-press angle), and bear-hug test, were collected. Magnetic resonance imaging (MRI) evaluation was done according to the Yoo and Rhee classification. Types of subscapularis tear, supraspinatus lesion, and biceps lesion were recorded during arthroscopic surgery. A comparison of preoperative clinical features between the no-repair group (type 2A or less) and surgical repair group (type 2B or more) was done. The optimal cutoff value of the belly-press angle was determined and the diagnostic performance of the belly-press angle, bear-hug test, and MRI were evaluated using the receiver operating characteristic curve. Results: Among 286 patients, 189 (66.1%) had subscapularis tears with type 2A or more. There was a significant difference in muscle strength ratio of the belly-press ( P < .001), belly-press angle ( P < .001), and bear-hug test ( P < .001) between the no-repair group (type 2A or less) and the surgical repair group (type 2B or more). With a belly-press angle of 15° as a new cutoff value, the modified belly-press test showed 67.6% sensitivity, 73.9% specificity, and 69.6% accuracy in detecting type 2B or higher subscapularis tear. Conclusion: Patients with type 2A and 2B subscapularis tears (according to the Yoo and Rhee classification) showed differences in belly-press strength ratio, belly-press angle, and bear-hug test. The cutoff value of the 15° belly-press angle showed an accuracy of 69.6% in detecting subscapularis tears with type 2B or higher.

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Arthroscopic Revision Rotator Cuff Repair: The Role of Previously Neglected Subscapularis Tears

Cited by 18 publications

References 44 publications

Identifying key factors associated with subscapularis tendon tears and developing a risk prediction model to assist diagnosis

Identifying key factors associated with subscapularis tendon tears and developing a risk prediction model to assist diagnosis

The prevalence, classification, radiological and arthroscopic findings of intratendinous subscapularis tears

Diagnostic Performance of Belly-Press Angle in Predicting the Severity of Subscapularis Tear

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