Isolated Subscapularis Repair in Irreparable Posterosuperior Massive Rotator Cuff Tears Involving the Subscapularis Tendon

Abstract

BACKGROUND: No previous study has examined whether isolated subscapularis tendon repair in irreparable posterosuperior massive rotator tears involving the subscapularis tendon in relatively young patients without arthritis can yield satisfactory outcomes.

HYPOTHESIS: We hypothesized that this procedure would produce favorable outcomes in patients who might otherwise be candidates for reverse arthroplasty.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: This retrospective study included 24 patients in their 50s and 60s, without shoulder arthritis, who underwent arthroscopic isolated subscapularis repair for an irreparable massive rotator cuff tear involving the subscapularis tendon. Preoperative and postoperative visual analog scale (VAS) pain scores, subjective shoulder values (SSVs), University of California at Los Angeles (UCLA) shoulder scores, American Shoulder and Elbow Surgeons (ASES) scores, subscapularis strength (modified bell-press test; maximum of 5), and shoulder active range of motion (ROM) were assessed. Postoperative magnetic resonance arthrography (MRA) was performed 6 months postoperatively to assess structural integrity of the repaired subscapularis.

RESULTS: At a mean 34.8 months (range, 24-49 months) of follow-up, VAS pain scores (improved from 7.1 to 2.5), SSVs (33.3 to 75.2), ASES scores (35.9 to 76.0), UCLA shoulder scores (11.6 to 24.8), subscapularis strength, and ROM were significantly improved compared with preoperative measurements ( P < .001). Subscapularis muscle strength improved from 3.7 to 4.2 ( P < .001). For active ROM, forward flexion and internal rotation improved significantly ( P < .001); however, external rotation exhibited no significant improvement. Follow-up MRA was performed in 22 patients (92%) and showed retear of the repaired subscapularis in 6 (27% of the 22).

CONCLUSION: Isolated repair of the subscapularis tendon in irreparable massive rotator cuff tears involving the subscapularis tendon yielded satisfactory short-term outcomes and structural integrity in patients in their 50s and 60s without arthritis. If patients with irreparable massive rotator cuff tears involving the subscapularis tendon are relatively young or have minimal concomitant arthritis, this repair can be worthwhile.