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

Authors
 Tae-Hwan Yoon  ;  Sung-Jae Kim  ;  Yun-Rak Choi  ;  Jin-Tae Cho  ;  Yong-Min Chun 
Citation
 AMERICAN JOURNAL OF SPORTS MEDICINE, Vol.49(14) : 3952-3958, 2021-12 
Journal Title
AMERICAN JOURNAL OF SPORTS MEDICINE
ISSN
 0363-5465 
Issue Date
2021-12
MeSH
Arthroscopy ; Humans ; Magnetic Resonance Imaging ; Range of Motion, Articular ; Retrospective Studies ; Rotator Cuff Injuries* / surgery ; Rotator Cuff* / diagnostic imaging ; Rotator Cuff* / surgery ; Treatment Outcome
Keywords
arthroscopy ; retear ; revision ; shoulder ; subscapularis
Abstract
Background: Concomitant full-thickness tear of the subscapularis tendon is often neglected during primary posterosuperior rotator cuff repair, and its significance has not been investigated by any previous clinical study.

Purpose: To investigate (1) the clinical and radiological outcomes of revision arthroscopic rotator cuff repair and (2) the number of neglected concomitant subscapularis full-thickness tears in the revision of posterosuperior rotator cuff retears and their structural integrity after repair.

Study design: Case series, Level of evidence, 4.

Methods: This study retrospectively examined 58 patients who underwent arthroscopic rotator cuff revision for a retear of a previously repaired posterosuperior rotator cuff. Preoperative and postoperative functional scores and active range of motion (ROM) were assessed. The initial and most recent follow-up magnetic resonance imaging scans before revision and arthroscopic findings at the time of primary repair were reviewed to determine whether the concomitant subscapularis tear was newly developed or preexisting. Final confirmation of the tendon's full-thickness tear was made during the revision procedure.

Results: At final follow-up, mean functional shoulder scores and ROM improved significantly compared with the preoperative values (P < .001). Among the 58 revision cases, 25 (43.1%) had a neglected full-thickness tear of the subscapularis tendon. The fatty infiltration grade of the neglected subscapularis tear progressed from a mean of 1.1 before primary repair to a mean of 1.6 before revision, and the change indicated statistically significant deterioration (P < .001). Despite clinical improvement after revision surgery, the retear rate was considerable in the re-repaired cuff tendons (37.9%) as well as for the repaired concomitant subscapularis tears (24%).

Conclusion: Among revision rotator cuff repairs, 43.1% had neglected subscapularis tears, and fatty infiltration of these initially neglected subscapularis tendons showed further progression at the time of revision. The retear rate after the repair of neglected subscapularis tears was higher than expected. Thus, detecting and treating subscapularis tear via meticulous preoperative evaluation and thorough inspection during primary arthroscopy are essential.
Full Text
https://journals.sagepub.com/doi/10.1177/03635465211047485
DOI
10.1177/03635465211047485
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sung Jae(김성재)
Yoon, Tae Hwan(윤태환) ORCID logo https://orcid.org/0000-0002-2859-5240
Chun, Yong Min(천용민) ORCID logo https://orcid.org/0000-0002-8147-6136
Choi, Yun Rak(최윤락)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/187541
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