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Subscapularis re-tears associated with preoperative advanced fatty infiltration and greater subscapularis involvement, leading to inferior functional outcomes and decreased acromiohumeral distance

Authors
 Chul Kim  ;  Yun-Jae Lee  ;  Sung-Jae Kim  ;  Tae-Hwan Yoon  ;  Duseong Kim  ;  Yong-Min Chun 
Citation
 KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, Vol.29(8) : 2624-2630, 2021-08 
Journal Title
KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY
ISSN
 0942-2056 
Issue Date
2021-08
Keywords
Anterosuperior massive rotator cuff tear ; Partial repair ; Re-tear ; Subscapularis
Abstract
Purpose: This study aimed to investigate the influence of repaired subscapularis integrity on midterm results for anterosuperior massive rotator cuff tears (MRCTs) treated with partial rotator cuff repair.

Methods: This study included 57 patients who underwent arthroscopic partial repair for an anterosuperior MRCT. They were assigned to the healed subscapularis group (Group H 37 patients) or subscapularis re-tear group (Group R 20 patients). Preoperative and postoperative functional scores and active ranges of motion (ROMs) were assessed. Preoperative and 6-month follow-up magnetic resonance arthrography (MRA)/computed tomography arthrography (CTA) images were compared between groups.

Results: At the final follow-up, mean functional shoulder scores including ROMs improved significantly in both groups compared to preoperative values (p < 0.001), except for forward flexion and internal rotation in Group R. All final functional values and ROMs (excluding external rotation) were better in Group H than in Group R (p < 0.001). Preoperative stage of fatty infiltration in the subscapularis muscle was significantly worse in Group R (p < 0.001). On follow-up MRA/CTA, the immediate residual defect after partial repair increased in 81% (30/37; mean, 17.8 mm) of patients in Group H and 100% (mean 24.6 mm) in Group R (p < 0.001). At final follow-up, mean acromiohumeral distance significantly decreased from 8.2 to 6.0 mm in Group H (p < 0.001) and from 8.3 to 4.9 mm in Group R (p < 0.001). There was a significant difference in final acromiohumeral distance between groups (p < 0.001).

Conclusion: After a minimum 5-year follow-up after arthroscopic partial repair of anterosuperior MRCT, subscapularis re-tear was identified in 35% of patients (20/57) on early postoperative follow-up MRA/CTA. The subscapularis re-tear group exhibited more preoperative advanced fatty infiltration and greater extents of subscapularis involvement, which led to statistically inferior functional outcomes and decreased acromiohumeral distance at final follow-up. Nonetheless, in terms of a minimal clinically important difference, substantial clinical benefit, and patient-acceptable symptomatic state for clinical significance, there were no significant differences between the groups.

Level of evidence: III.
Full Text
https://link.springer.com/article/10.1007%2Fs00167-021-06527-6
DOI
10.1007/s00167-021-06527-6
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Yoon, Tae Hwan(윤태환) ORCID logo https://orcid.org/0000-0002-2859-5240
Lee, Yunjae(이윤재)
Chun, Yong Min(천용민) ORCID logo https://orcid.org/0000-0002-8147-6136
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/184745
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