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Arthroscopic subscapularis tendon repair yielded good results in most patients
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ORLANDO — Arthroscopic rotator cuff repair of subscapularis tendon tears resulted in high patient satisfaction and significant improvements in function at long-term follow-up, according to a study presented at the Arthroscopy Association of North America 2012 Annual Meeting.
“Arthroscopic rotator cuff repair that includes repair of subscapularis tendons can lead to good or excellent results in the majority of cases and improvement of this is maintained in the long-term,” Patrick J. Denard, MD, said during his presentation.
Denard and colleagues conducted a retrospective review of all primary arthroscopic repairs of subscapularis tears performed at their institution during a 4-year period. Of 239 repairs, they found 79 patients with complete data and a minimum 7-year follow-up. All of the repairs were performed with double-loaded suture anchors and a mean of 1.3 anchors were used per repair. Half of the patients underwent a coracoplasty, Denard of Southern Oregon Orthopedics, Medford, Oregon and the Department of Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, said. Mean follow-up was 9 years.
The investigators observed significant improvements in UCLA and American Shoulder and Elbow Surgeons (ASES) scores. The UCLA scores increased from 16.5 preoperatively to 30.1 postoperatively, while ASES scores improved from 40.8 to 88.5. Using UCLA scores, the investigators categorized 83.3% as good or excellent after their surgeries. They found 10.1% showed fair results and 7.6% had poor results. In addition, 92.4% of patients returned to sports or activities and 92.4% reported satisfaction with their results.
There were two complications in the study group. One patient needed a closed reduction after sustaining a fall and another patient underwent two revision rotator cuff repairs after sustaining two postoperative traumas, Denard said.
The investigators compared the results of the study with a 5-year follow-up conducted by their colleague Stephen S. Burkhart, MD. In that study, Burkhart and colleagues found an ASES score of 91 and UCLA score of 32 at final follow-up. Eighty percent of the patients showed good to excellent results.
“In conjunction with the current study, we believe this follow-up study now supports the conclusion of long-term outcome of arthroscopic rotator cuff repair of subscapularis tendon tears is durable,” Denard said. “The strengths of this study are similar to the strengths of the previous with a large cohort size [and] length of follow-up. [The] limitations are also similar, [as well as] the retrospective design and the fact that we did not analyze preoperative radiographic factors.” – by Renee Blisard Buddle
References:
- Denard PJ, Jiwani A, Lädermann A, Burkhart S. Long-term outcomes of arthroscopic subscapularis tendon repairs. Paper #SS-12. Presented at the Arthroscopy Association of North America 2012 Annual Meeting. May 17-19. Orlando.
- Burkhart SS, Tehrany AM. Arthroscopic subscapularis tendon repair: Technique and preliminary results. Arthroscopy. 2002; 18(5):454-463.
For more information:
- Patrick J. Denard, MD, can be reached at Southern Oregon Orthopedics, 2780 E. Barnett Rd., Ste. 200, Medford, OR 97504; email: pjdenard@gmail.com.
- Disclosure: Denard has no relevant financial disclosures.
Perspective
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William N. Levine, MD
The authors have taken a cohort of patients who underwent arthroscopic subscapularis repair and followed them through a longer period of time than the initial 5-year study. Longitudinal studies like these are invaluable to determine durability of the intervention and, in this study, the authors have shown that this procedure does seem to hold up with time.
Unfortunately, given the retrospective nature of the study, further conclusions cannot be rendered. For example, should we perform a coracoplasty at the time of a subscapularis repair? Half of the patients underwent coracoplasty, so it would be critical to understand how their results compared to the non-coracoplasty group. Furthermore, while patient satisfaction was high (~92%), the results according to the UCLA rating system showed 17% fair and poor outcomes. Further sub-group analysis would be helpful to better understand what led to these poor outcomes.
As always, retrospective chart-review studies are always limited in their ability to extrapolate too much, but in general, it would appear based on the results of this study that arthroscopic subscapularis repair is a durable operation that leads to high patient satisfaction.
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