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

Abstract

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.

Keywords: Constant score; arthroscopy; rotator cuff; subscapularis repair; subscapularis tendon tears.

Figure 1

Magnetic resonance images of subscapular tears highlighted by the white arrow. A–C – Acute traumatic isolated subscapularis tear (Lafosse IV) and perilesional oedema. D–F – Subscapularis (Lafosse II) and supraspinatus tears in degenerated tendons with marked muscular hypotrophy

Figure 2

Arthroscopic images of subscapularis tendon tears (highlighted by the arrows) classified according to Lafosse. A – Lafosse II, B – Lafosse III, C – Lafosse IV

Figure 3

Bear-hug test setup: test was performed with the palm of the involved side placed on the opposite shoulder. A dynamometer was connected with an armband to the patient’s wrist. The patient was then asked to hold that position (resisting internal rotation) as the physician tried to pull the patient’s hand from the shoulder with an external rotation force applied perpendicularly to the wrist. The minimal force required to lift the palm from the shoulder was read on the dynamometer

Figure 4

Clinical outcomes. A – Bear-hug test, B – Constant score, C – NRS and D – DASH score of enrolled patients

Figure 5

Clinical outcomes. A – Bear-hug test, B – constant score, C – NRS and D – DASH score of enrolled patients divided according to isolated or multiple lesions

Figure 6

Correlations between age and Constant score. A – Pre-operative constant score was negatively correlated with age (r = –0.37, p = 0.007). B – Post-operative constant score was negatively correlated with age (r = –0.39, p = 0.0003)