Recovery of subscapularis and shoulder function following arthroscopic treatment of isolated anterior and combined anterosuperior rotator cuff lesions

Gerhardt, Christian; Bärtl, Christoph; Voigt, C.; Lill, Helmut; Scheibel, Markus; Frosch, Karl‐Heinz; Katthagen, J. Christoph

doi:10.1007/s00402-015-2334-3

Cited by 17 publications

(14 citation statements)

References 26 publications

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“…Furthermore, we compared the clinical outcomes in both groups using ASES and SST scores, unlike previous similar studies that used only the Constant score. 15,17,29 Finally, the unique findings of this study are the optimal cutoff values for the risk of retear of the repaired SSC in terms of tear dimensions, which have not been reported previously.…”

Section: Discussionmentioning

confidence: 48%

“…Tear characteristics in terms of tear retraction and superoinferior tear dimensions were worse in the isolated SSC group in the present study. In contrast, Gerhardt et al 17 reported that only a small number of patients with isolated SSC RCTs showed complete rupture of the SSC tendon (10.0%) compared with patients who had combined AS RCTs (22.9%). However, unlike our study, Gerhardt et al included patients with partial-thickness SSC tears for whom debridement was performed, which may have led to the difference in findings.…”

Section: Discussionmentioning

confidence: 90%

“…4,31,44 Moreover, because of the close proximity of the muscles in the rotator cuff, it is difficult to differentially diagnose isolated SSC and combined SSC RCTs; therefore, there is a need to evaluate the differences in their clinical and radiological characteristics as well as treatment outcomes. 15,17,29,43 Notably, many previous studies have reported an improvement in SSC function after both open and arthroscopic repair compared with the preoperative status in isolated SSC 3,6,22,27,39,41,45,52 and combined AS RCTs. 5,12,23 Furthermore, studies comparing the clinical outcomes in isolated SSC and combined AS RCTs have shown similar results after open repair.…”

mentioning

confidence: 99%

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Comparison of Functional and Radiological Outcomes of Tears Involving the Subscapularis: Isolated Subscapularis Versus Combined Anterosuperior Rotator Cuff Tears

Meshram

Rhee

Park

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Few studies have compared the clinical and radiological characteristics and outcomes in isolated subscapularis (SSC) and combined anterosuperior (AS) rotator cuff tears (RCTs). Furthermore, risk factors for retear after SSC repair and the effect of preoperative fatty degeneration require further evaluation.Purpose: To compare the functional and radiological outcomes of isolated SSC with combined AS RCTs after arthroscopic repair and to determine the risk factors for SSC retear in these 2 groups.Study Design: Cohort study; Level of evidence, 3.Methods: Data from 30 patients in the isolated SSC group were compared with data from 110 patients in the combined AS group. All patients underwent primary arthroscopic rotator cuff repair between 2010 and 2016. Clinical outcomes were assessed through use of the visual analog scale for pain, American Shoulder and Elbow Surgeons score, and Simple Shoulder Test at a mean followup of 26.7 months (range, 24-96 months). SSC tendon integrity was examined via magnetic resonance imaging, computed tomography arthrogram, or ultrasonography at least 1 year after surgery.Results: The isolated SSC group had a greater proportion of males and the patients were younger compared with the combined AS group (both P < .050). The incidence of trauma was high but not significantly different between groups (56.7% vs 40.9%; P ¼ .180). Clinical outcome measures and radiological outcomes in terms of retear were not statistically different between both groups (16.7% vs 8/5%; P ¼ .337). The optimal cutoff values for the risk of SSC tendon retear in both groups were 19-mm retraction and 16-mm superoinferior dimension (P ¼ .048). Unfavorable preoperative fatty degeneration of the SSC muscle (grades 3 and 4) was a significant risk factor for retear (odds ratio, 9.8; P < .001).Conclusion: Isolated SSC and combined AS RCTs were comparable except for patient age and sex; both had a high incidence of traumatic history. The current data suggest that the risk factors for retear after SSC repair in RCTs involving the SSC were tear size greater than 19 mm of retraction and unfavorable fatty degeneration (grade 3 or higher) of the SSC muscle.Recently, an increase has been noted in the number of studies focused on rotator cuff tears (RCTs) involving the subscapularis (SSC) muscle to enable a better understanding of the diagnosis, management, and outcomes. 35 The SSC is the largest rotator cuff tendon; it provides 50% of the rotator cuff force and plays an important role in shoulder stability and movements such as internal rotation, adduction, abduction, flexion, and extension. 13,20,25,43 Hence, restoring the function of the SSC muscle after a tear is crucial for normal shoulder function.The SSC muscle is reported to be involved in 78% of RCTs, most often in combination with other rotator cuff tendons. 40 The incidence of isolated SSC RCTs is reported to be 4%, 13 whereas combined RCTs involving the SSC and supraspinatus but without the infraspinatus (combined anterosuperior [AS]) are reported to accoun...

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Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 90%

mentioning

confidence: 99%

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Comparison of Functional and Radiological Outcomes of Tears Involving the Subscapularis: Isolated Subscapularis Versus Combined Anterosuperior Rotator Cuff Tears

Meshram

Rhee

Park

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…A significant association was found between the pattern of the tear (isolated or combined subscapularis), and the mean Constant-Dif, unlike Gerhardt et al and Miškulin et al [35,36]. The clinical improvement was greater in the C-STT group than in the I-STT group.…”

Section: Discussionmentioning

confidence: 75%

Medium- to long-term clinical and functional outcomes of isolated and combined subscapularis tears repaired arthroscopically

et al. 2021

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Introduction: The purpose of this study was twofold. First, the efficacy of arthroscopic repair in patients with full thickness, isolated subscapularis tendon tears (I-STTs) or combined subscapularis tendon tears (C-STTs) involving the rotator cuff tendons was evaluated. Second, the outcomes between these two groups were compared. The influence of age and gender on the cohort clinical outcomes was also analysed. Our hypothesis was that satisfactory functional results could be obtained arthroscopically in both groups without any influence of age or gender. Material and methods: Seventy-nine patients were enrolled: 15 with I-STTs and 64 with C-STTs. The clinical outcomes were assessed using Constant and Disabilities of the Arm, Shoulder and Hand (DASH) scores, Numeric Rating Scale (NRS) for pain and Visual Analogue Scale (VAS) for satisfaction. The subscapularis strength was assessed using a comparative dynamometric bear-hug test. Group outcomes were compared, including statistical analysis. Results: For each group, there were no differences regarding the subscapularis strength of the operated and non-operated shoulders. A comparison of the post-with the pre-operative outcomes showed an increase in the Constant score and a decrease in the NRS. Comparing the two groups, we found no difference in strength of the operated and non-operated shoulders, but a significant difference in relation to pre-operative Constant score and pre-operative NRS. Age was negatively correlated with both pre-operative and post-operative Constant scores. No association was found between gender and the outcomes, although the DASH score was higher in women. Conclusions: Arthroscopic repair of STTs provided functional restoration, pain relief and patient satisfaction in both groups. Age and gender did not affect the clinical outcomes achieved by arthroscopic STT repair.

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“…[4][5][6][7][8][9] 그동안 다른 회전근개에 비하여 견갑하건의 파열 빈도는 상당 히 낮은 것으로 보고되고 있었으며 이학적 검사로도 파열을 특이 적으로 구분하여 진단하기 어려운 점이 있어 그 임상적 중요도에 비해 간과된 경향이 있으나 최근 어깨관절에서 관절내시경을 이 용한 수술적 적용의 증가로 인하여 견갑하건의 파열, 특히 건 상 부에서의 관절면 측 부분 파열이 보다 많은 빈도로 관찰되면서 재조명되고 있다. [10][11][12][13] 현재까지는 견갑하건을 포함한 회전근개의 평가를 위한 검사 로는 여전히 자기공명영상이 표준적인 영상의학적 검사로 자리 잡고 있다. [14][15][16] 이후 변환기를 90도 회전시키면서 견갑하건에 대해서는 단축 Figure 1.…”

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Descriptive Study for Sonographic Morphology of the 1st Facet of Subscapularis Footprint

Sohn

Shon

2019

J Korean Orthop Assoc

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The purpose of this study was to document the sonographic morphology of the subscapularis footprint, particularly the 1st facet, of the non-pathologic subscapularis tendon and footprint, and analyze the correlation between the size of the 1st facet and the demographic variables. Materials and Methods: Between March 2015 and December 2017, retrospectively data analysis was performed for the ultrasound (US) scans of 115 consecutive shoulder (mean age 53.4 years, range 23-74 years) with non-pathologic subscapularis tendon and footprint. The sonographic findings of the 1st facet of the subscapularis footprint was a very unique, flat, broad, and plane angle in the upward direction, which were distinguished from the other facets. On US, the transverse (medio-lateral) and longitudinal (superior-inferior) length of the 1st facet on axis of the humerus shaft were recorded. The demographic variables, including age, site, body height, weight, body mass index (BMI), and arm length, were reviewed. Results: On US, the mean transverse length of the 1st facet was 12.75 mm (range 10.54-14.50 mm, standard deviation [SD] 0.712) and the mean longitudinal length was 12.22 mm (range 9.20-13.30 mm, SD 0.888). The transverse and longitudinal length of the size of the 1st facet were significantly greater in males than in females (p<0.001, p=0.001). Of the demographic data (body height, weight, BMI, arm length) that showed a significant positive linear correlation, the correlation with body height (transverse r=0.749, p<0.001; longitudinal r=0.642, p<0.001) showed the strongest relationship, and the correlation with the BMI was weakly related. The relationships between the size of the 1st facet to site/age were not statistically significant or appeared to have no linear correlation. Conclusion: The structural and morphologic features of the 1st facet of the subscapularis footprint on the US were identified. This will provide anatomic knowledge of an US examination for subscapularis tendon pathology.

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Recovery of subscapularis and shoulder function following arthroscopic treatment of isolated anterior and combined anterosuperior rotator cuff lesions

Abstract: Reconstruction of subscapularis lesions cannot provide full subscapularis function since a residual subscapularis insufficiency remains, other than in patients with small partial tears treated with debridement alone.

Cited by 17 publications

References 26 publications

Comparison of Functional and Radiological Outcomes of Tears Involving the Subscapularis: Isolated Subscapularis Versus Combined Anterosuperior Rotator Cuff Tears

Comparison of Functional and Radiological Outcomes of Tears Involving the Subscapularis: Isolated Subscapularis Versus Combined Anterosuperior Rotator Cuff Tears

Medium- to long-term clinical and functional outcomes of isolated and combined subscapularis tears repaired arthroscopically

Descriptive Study for Sonographic Morphology of the 1st Facet of Subscapularis Footprint

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