Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical and Structural Outcomes of Arthroscopic Intraarticular Knotless Fixation for Upper Subscapularis Tendon Tears: A Preliminary Report

  • Cho, Nam Su (Shoulder & Elbow Clinic, Department of Orthopedic Surgery, College of Medicine, Kyung Hee University) ;
  • Shim, Hee Seok (Shoulder & Elbow Clinic, Department of Orthopedic Surgery, College of Medicine, Kyung Hee University) ;
  • Nam, Ju Hyun (Shoulder & Elbow Clinic, Department of Orthopedic Surgery, College of Medicine, Kyung Hee University) ;
  • Rhee, Yong Girl (Shoulder & Elbow Clinic, Department of Orthopedic Surgery, College of Medicine, Kyung Hee University)
  • Received : 2015.09.27
  • Accepted : 2015.12.24
  • Published : 2016.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: A novel technique for the repair of tears of the upper subscapularis tendon-intraarticular knotless fixation-has been introduced recently. The purpose of this study was to evaluate the clinical and structural outcomes of arthroscopic intraarticular knotless fixation for the treatment of upper subscapularis tendon tears. Methods: We retrospectively analyzed the clinical and radiological outcomes of 27 patients who underwent arthroscopic intraarticular knotless fixation for upper subscapularis tendon tears. Finally, a total of 10 patients who could participate in at least a 6 month follow-up of magnetic resonance imaging evaluation and in a least 1-year follow-up on an outpatient basis were enrolled in our study. The mean age at the time of operation was 60.7 years, and the mean duration of follow-up was 14.7 months. Two patients had concomitant tears of the supraspinatus tendon and 8 patients had concomitant tears of the supraspinatus and the infraspinatus tendons. Results: The clinical and radiological outcomes improved after the patients had undertaken arthroscopic intraarticular knotless fixation. The mean visual analogue scale score for pain during motion improved from 6.7 preoperatively to 1.4 at the final follow-up (p<0.001). The mean Constant score improved from 59.3 preoperatively to 79.6 at the final follow-up, and the mean the University of California at Los Angeles score, from 21.7 to 30.2, respectively (p<0.001 and p<0.001). The upper subscapularis tendon tear was healed in every patient except one (90%), for the patient had suffered from a postoperative trauma that resulted in a retear. Conclusions: We found that arthroscopic intraarticular knotless fixation gives good clinical and structural outcomes for the repair of upper subscapularis tendon tears. Arthroscopic intraarticular knotless fixation provided such a reliable and efficient restoration of the subscapularis tendon footprint that we anticipate it will become a widely-used procedure for upper subscapularis tendon tears.

Keywords

References

  1. Arai R, Sugaya H, Mochizuki T, Nimura A, Moriishi J, Akita K. Subscapularis tendon tear: an anatomic and clinical investigation. Arthroscopy. 2008;24(9):997-1004. https://doi.org/10.1016/j.arthro.2008.04.076
  2. Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R. Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am. 2007;89(6):1184-93. https://doi.org/10.2106/00004623-200706000-00005
  3. Ticker JB. Subscapularis and biceps tendon pathology encountered during arthroscopic posterosuperior rotator cuff repair. Paper presented at: Arthroscopy Association of North America 26th Annual Meeting; 2007 Apr 26-29; San Francisco (CA).
  4. Walch G, Nove-Josserand L, Boileau P, Levigne C. Subluxations and dislocations of the tendon of the long head of the biceps. J Shoulder Elbow Surg. 1998;7(2):100-8. https://doi.org/10.1016/S1058-2746(98)90218-X
  5. Barth JR, Burkhart SS, De Beer JF. The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear. Arthroscopy. 2006;22(10):1076-84. https://doi.org/10.1016/j.arthro.2006.05.005
  6. Yoo JC, Rhee YG, Shin SJ, et al. Subscapularis tendon tear classification based on 3-dimensional anatomic footprint: a cadaveric and prospective clinical observational study. Arthroscopy. 2015;31(1):19-28. https://doi.org/10.1016/j.arthro.2014.08.015
  7. Burkhart SS, Tehrany AM. Arthroscopic subscapularis tendon repair: Technique and preliminary results. Arthroscopy. 2002;18(5):454-63. https://doi.org/10.1053/jars.2002.30648
  8. Bennett WF. Arthroscopic repair of isolated subscapularis tears: A prospective cohort with 2-to 4-year follow-up. Arthroscopy. 2003;19(2):131-43. https://doi.org/10.1053/jars.2003.50053
  9. Adams CR, Schoolfield JD, Burkhart SS. The results of arthroscopic subscapularis tendon repairs. Arthroscopy. 2008; 24(12):1381-9. https://doi.org/10.1016/j.arthro.2008.08.004
  10. Burkhart SS, Brady PC. Arthroscopic subscapularis repair: surgical tips and pearls A to Z. Arthroscopy. 2006;22(9):1014-27. https://doi.org/10.1016/j.arthro.2006.07.020
  11. Denard PJ, Burkhart SS. A new method for knotless fixation of an upper subscapularis tear. Arthroscopy. 2011;27(6):861-6. https://doi.org/10.1016/j.arthro.2010.11.010
  12. Gilmer BB, Crall TS, Guttmann D. Knotless arthroscopic repair of subscapularis tendon tears using looped suture. Arthrosc Tech. 2015;4(3):e267-71. https://doi.org/10.1016/j.eats.2015.02.009
  13. Bartl C, Salzmann GM, Seppel G, et al. Subscapularis function and structural integrity after arthroscopic repair of isolated subscapularis tears. Am J Sports Med. 2011;39(6):1255-62. https://doi.org/10.1177/0363546510396317
  14. Sakurai G, Ozaki J, Tomita Y, Kondo T, Tamai S. Incomplete tears of the subscapularis tendon associated with tears of the supraspinatus tendon: cadaveric and clinical studies. J Shoulder Elbow Surg. 1998;7(5):510-5. https://doi.org/10.1016/S1058-2746(98)90204-X
  15. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;(214): 160-4.
  16. Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. Endresult study of factors influencing reconstruction. J Bone Joint Surg Am. 1986;68(8):1136-44. https://doi.org/10.2106/00004623-198668080-00002
  17. Gusmer PB, Potter HG, Donovan WD, O'Brien SJ. MR imaging of the shoulder after rotator cuff repair. AJR Am J Roentgenol. 1997;168(2):559-63. https://doi.org/10.2214/ajr.168.2.9016248
  18. Ticker JB, Burkhart SS. Why repair the subscapularis? A logical rationale. Arthroscopy. 2011;27(8):1123-8. https://doi.org/10.1016/j.arthro.2011.03.001
  19. Kelly BT, Williams RJ, Cordasco FA, et al. Differential patterns of muscle activation in patients with symptomatic and asymptomatic rotator cuff tears. J Shoulder Elbow Surg. 2005;14(2): 165-71. https://doi.org/10.1016/j.jse.2004.06.010
  20. Kuechle DK, Newman SR, Itoi E, Morrey BF, An KN. Shoulder muscle moment arms during horizontal flexion and elevation. J Shoulder Elbow Surg. 1997;6(5):429-39. https://doi.org/10.1016/S1058-2746(97)70049-1
  21. Keating JF, Waterworth P, Shaw-Dunn J, Crossan J. The relative strengths of the rotator cuff muscles. A cadaver study. J Bone Joint Surg Br. 1993;75(1):137-40.

Cited by

  1. A Novel Retensioning Technique for Arthroscopic Repair of PASTA Lesions: A Clinical and Radiologic Outcome Study of 24 Shoulders vol.9, pp.3, 2016, https://doi.org/10.1177/2325967120986884