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An intact subscapularis tendon and compensatory teres minor hypertrophy yield lower failure rates for non-operative treatment of irreparable, massive rotator cuff tears

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To investigate whether subscapularis integrity and compensatory teres, minor hypertrophy is associated with maintaining relatively good function and tolerable pain levels during non-operative treatment.

Methods

This study included 108 patients with irreparable, massive rotator cuff tears involving at least two tendons and stage III or IV muscle hypotrophy and fatty infiltration on oblique sagittal magnetic resonance imaging, in which even a partial repair does not seem feasible. All supraspinatus and infraspinatus muscles were grade IV; if the subscapularis was involved, only stage III or IV was included. Patients were divided into two groups: group A consisted of 67 patients with both an intact subscapularis and teres minor hypertrophy; group B consisted of 41 patients lacking either one or both. The Visual Analogue Scale pain score, the American Shoulder and Elbow Surgeons score, the University of California at Los Angeles shoulder score, and active range of motion (ROM) were assessed.

Results

During the follow-up period, failure of non-operative treatment was found in 29 (43%) patients in group A and 28 (68%) in group B (p = 0.012). Conversion to surgery was noted in 26 (39%) patients in group A and 27 (66%) in group B (p = 0.006). Among the remaining nonsurgical patients, there were no significant differences in clinical outcomes between the groups except ROM in internal rotation at final follow-up.

Conclusions

Although conservative treatment was not always successful in patients with irreparable, massive cuff tears, patients with both an intact subscapularis tendon, and teres minor hypertrophy experienced significantly lower incidences of failure and conversion to surgery, since force couple is maintained in the setting of minimal arthritis.

Level of evidence

III.

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Funding

The authors received no financial support related with the current study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Severance Hospital, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 03722, Republic of Korea

    Tae-Hwan Yoon, Sung-Jae Kim, Chong-Hyuk Choi, Soon-Phil Yoon & Yong-Min Chun

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  1. Tae-Hwan Yoon
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  2. Sung-Jae Kim
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  3. Chong-Hyuk Choi
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  4. Soon-Phil Yoon
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Correspondence to Yong-Min Chun.

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The study was approved by the Ethical committee of the institution.

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Yoon, TH., Kim, SJ., Choi, CH. et al. An intact subscapularis tendon and compensatory teres minor hypertrophy yield lower failure rates for non-operative treatment of irreparable, massive rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 27, 3240–3245 (2019). https://doi.org/10.1007/s00167-019-05403-8

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