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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 12, pp 4021–4031 | Cite as

Repair of Lafosse I subscapularis lesions brings no benefit in anterosuperior rotator cuff reconstruction

  • Barbara Wirth
  • Sebastian Kunz
  • Hans-Kaspar Schwyzer
  • Matthias Flury
  • Maximilian Lenz
  • Laurent AudigéEmail author
SHOULDER
  • 121 Downloads

Abstract

Purpose

Optimal management of partial anterosuperior rotator cuff tears is unknown. Our aim was to compare clinical and subjective outcomes of supraspinatus (SSP) repair patients treated with or without repair of an associated superior subscapularis (SSC) partial tear.

Methods

SSP repair patients with an associated partial (Lafosse I) tear of the superior SSC tendon were retrospectively examined. Baseline and operative data and the outcomes of shoulder range of motion (ROM), pain level, strength, Constant-Murley Score, complications at 6 months as well as patient-reported Oxford Shoulder Score, Subjective Shoulder Value, and satisfaction at 6- and 24-month post-surgery were compared between patients with and without a repaired SSC tear. Mixed models and propensity-score matching were used to adjust baseline group differences.

Results

Of 75 eligible patients, 34 had an SSC repair and were younger with better baseline function. Non-repair surgeries were significantly shorter by 34 min (95% CI 23–45; p < 0.001). There were no group differences in the clinical and patient-rated outcome scores at both follow-ups (n.s.) as well as in pain, muscle strength in abduction, ROM, the 6-month complication risk (risk difference − 1.9%), and satisfaction with postoperative shoulder condition (n.s.).

Conclusion

We could not show a functional or subjective benefit of repairing cranial partial tears of the SSC tendon over debridement only in the setting of an SSP reconstruction with 24 months of follow-up. A longer operative duration is expected if a partial SSC tear repair is performed.

Level of evidence

III.

Keywords

Shoulder Anterosuperior rotator cuff lesion Partial subscapularis tear Lafosse I Arthroscopic repair Functional outcomes Patient-reported outcomes 

Abbreviations

CMS

Constant-Murley shoulder score

MRI

Magnetic resonance image

NRS

Numeric rating scale

OSS

Oxford shoulder score

PS

Propensity score(s)

RC

Rotator cuff

ROM

Range of motion

SD

Standard deviation

SSC

Subscapularis

SSP

Supraspinatus

SSV

Subjective shoulder value

StdDiff

Standardized difference

Notes

Acknowledgements

The authors would like to thank M. Wilhelmi, PhD (medical writer at Schulthess Clinic) for the editing and final preparation of this manuscript.

Author contributions

BW carried out the surgeries, participated in the registry documentation, formulated the study question, participated in the study design, interpreted the results, and drafted the manuscript. SK performed intensive registry documentation and drafted the manuscript. H-KS carried out the surgeries and participated in the registry documentation, MF conceived the local register, carried out the surgeries, and participated in the registry documentation, ML reviewed carefully all patients for the occurrence of adverse events, LA conceived the local registry, participated in the study design and performed the statistical analyses and drafted the manuscript. All authors read and approved the final manuscript.

Funding

No external funding was used.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

167_2019_5681_MOESM1_ESM.docx (46 kb)
Supplementary file1 (DOCX 46 kb)
167_2019_5681_MOESM2_ESM.docx (186 kb)
Supplementary file2 (DOCX 186 kb)

References

  1. 1.
    Adams CR, Schoolfield JD, Burkhart SS (2010) Accuracy of preoperative magnetic resonance imaging in predicting a subscapularis tendon tear based on arthroscopy. Arthroscopy 26(11):1427–1433PubMedGoogle Scholar
  2. 2.
    Angst F, Schwyzer HK, Aeschlimann A, Simmen BR, Goldhahn J (2011) Measures of adult shoulder function: disabilities of the arm, shoulder, and hand questionnaire (DASH) and its short version (QuickDASH), shoulder pain and disability index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society standardized shoulder assessment form, constant (Murley) score (CS), simple shoulder test (SST), Oxford shoulder score (OSS), shoulder disability questionnaire (SDQ), and Western Ontario shoulder instability index (WOSI). Arthritis Care Res (Hoboken) 63(Suppl 11):S174–188Google Scholar
  3. 3.
    Audigé L, Flury M, Müller AM, ARCR CES Consensus Panel, Durchholz H (2016) Complications associated with arthroscopic rotator cuff tear repair: definition of a core event set by Delphi consensus process. J Shoulder Elbow Surg 25(12):1907–1917Google Scholar
  4. 4.
    Austin PC (2009) Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 28(25):3083–3107PubMedPubMedCentralGoogle Scholar
  5. 5.
    Bartl C, Salzmann GM, Seppel G, Eichhorn S, Holzapfel K, Wörtler K et al (2011) Subscapularis function and structural integrity after arthroscopic repair of isolated subscapularis tears. Am J Sports Med 39(6):1255–1262Google Scholar
  6. 6.
    Bennett WF (2001) Subscapularis, medial, and lateral head coracohumeral ligament insertion anatomy Arthroscopic appearance and incidence of “hidden” rotator interval lesions. Arthroscopy 17(2):173–180PubMedGoogle Scholar
  7. 7.
    Constant CR, Gerber C, Emery RJ, Søjbjerg JO, Gohlke F, Boileau P (2008) A review of the constant score: modifications and guidelines for its use. J Shoulder Elbow Surg 17(2):355–361PubMedGoogle Scholar
  8. 8.
    Cools AM, De Wilde L, Van Tongel A, Ceyssens C, Ryckewaert R, Cambier DC (2014) Measuring shoulder external and internal rotation strength and range of motion: comprehensive intra-rater and inter-rater reliability study of several testing protocols. J Shoulder Elbow Surg 23(10):1454–1461PubMedGoogle Scholar
  9. 9.
    Denard PJ, Burkhart SS (2013) Arthroscopic recognition and repair of the torn subscapularis tendon. Arthrosc Tech 2(4):e373–e379PubMedPubMedCentralGoogle Scholar
  10. 10.
    Edwards TB, Walch G, Sirveaux F, Molé D, Nové-Josserand L, Boulahia A et al (2005) Repair of tears of the subscapularis. J Bone Jt Surg Am 87(4):725–730Google Scholar
  11. 11.
    Flury M, Kolling C, Grobet C, Kunz SN, Audigé L (2014) Implementation of a local outcome register for arthroscopic rotator cuff tear repair. Obere Extremität 10(1):33–40Google Scholar
  12. 12.
    Flury MP, John M, Goldhahn J, Schwyzer HK, Simmen BR (2006) Rupture of the subscapularis tendon (isolated or in combination with supraspinatus tear): when is a repair indicated? J Shoulder Elbow Surg 15(6):659–664PubMedGoogle Scholar
  13. 13.
    Fox JA, Noerdlinger MA, Romeo AA (2002) Arthroscopic subscapularis repair. Oper Tech Orthop 12(3):209–217Google Scholar
  14. 14.
    Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 8(6):599–605Google Scholar
  15. 15.
    Gausden EB, McCarthy MM, Kontaxis A, Corpus KT, Gulotta LV, Kelly AM (2017) Subscapularis tendon loading during activities of daily living. J Shoulder Elbow Surg 26(2):331–336PubMedGoogle Scholar
  16. 16.
    Gerber C, Hersche O, Farron A (1996) Isolated rupture of the subscapularis tendon. J Bone Jt Surg Am 78(7):1015–1023Google Scholar
  17. 17.
    Gerber C, Krushell RJ (1991) Isolated rupture of the tendon of the subscapularis muscle Clinical features in 16 cases. J Bone Jt Surg Br 73(3):389–394Google Scholar
  18. 18.
    Gerber C, Sebesta A (2000) Impingement of the deep surface of the subscapularis tendon and the reflection pulley on the anterosuperior glenoid rim: a preliminary report. J Shoulder Elbow Surg 9(6):483–490PubMedGoogle Scholar
  19. 19.
    Gerhardt C, Bartl C, Voigt C, Lill H, Scheibel M, Frosch KH et al (2016) Recovery of subscapularis and shoulder function following arthroscopic treatment of isolated anterior and combined anterosuperior rotator cuff lesions. Arch Orthop Trauma Surg 136(1):75–81PubMedGoogle Scholar
  20. 20.
    Gilbart MK, Gerber C (2007) Comparison of the subjective shoulder value and the constant score. J Shoulder Elbow Surg 16(6):717–721Google Scholar
  21. 21.
    Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83Google Scholar
  22. 22.
    Habermeyer P, Magosch P, Pritsch M, Scheibel MT, Lichtenberg S (2004) Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. J Shoulder Elbow Surg 13(1):5–12Google Scholar
  23. 23.
    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381Google Scholar
  24. 24.
    Hartzler RU, Burkhart SS (2018) Management of subscapularis tendon tears. Oper Tech Sports Med 26(1):10–23Google Scholar
  25. 25.
    Huber W, Hofstaetter JG, Hanslik-Schnabel B, Posch M, Wurnig C (2004) The German version of the Oxford Shoulder Score–cross-cultural adaptation and validation. Arch Orthop Trauma Surg 124(8):531–536PubMedGoogle Scholar
  26. 26.
    Ide J, Tokiyoshi A, Hirose J, Mizuta H (2007) Arthroscopic repair of traumatic combined rotator cuff tears involving the subscapularis tendon. J Bone Jt Surg Am 89(11):2378–2388Google Scholar
  27. 27.
    Imhoff AB, Ticker JB, Fu FH (2003) An atlas of shoulder arthroscopy. Informa Healthcare press, London, p 384Google Scholar
  28. 28.
    Katthagen JC, Muller T, Jensen G, Voigt C, Lill H (2013) Anterosuperior rotator cuff tears: rupture configurations and results after arthroscopic therapy—a prospective study. Unfallchirurg 116(2):151–160PubMedGoogle Scholar
  29. 29.
    Katthagen JC, Vap AR, Tahal DS, Horan MP, Millett PJ (2017) Arthroscopic repair of isolated partial- and full-thickness upper third subscapularis tendon tears: minimum 2-year outcomes after single-anchor repair and biceps tenodesis. Arthroscopy 33(7):1286–1293PubMedGoogle Scholar
  30. 30.
    Kim SH, Oh I, Park JS, Shin SK, Jeong WK (2005) Intra-articular repair of an isolated partial articular-surface tear of the subscapularis tendon. Am J Sports Med 33(12):1825–1830PubMedGoogle Scholar
  31. 31.
    Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R (2007) Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Jt Surg Am 89(6):1184–1193Google Scholar
  32. 32.
    Lanz U, Fullick R, Bongiorno V, Saintmard B, Campens C, Lafosse L (2013) Arthroscopic repair of large subscapularis tendon tears: 2- to 4-year clinical and radiographic outcomes. Arthroscopy 29(9):1471–1478Google Scholar
  33. 33.
    Lee SH, Nam DJ, Kim SJ, Kim JW (2017) Comparison of clinical and structural outcomes by subscapularis tendon status in massive rotator cuff tear. Am J Sports Med 45(11):2555–2562PubMedGoogle Scholar
  34. 34.
    Leuven E, Sianesi B (2003) PSMATCH2: Stata module to perform full Mahalanobis and propensity score matching, common support graphing, and covariate imbalance testing [Internet]. Statistical Software Components S432001, Boston College Department of Economics, revised 01 Feb 2018. https://ideas.repec.org/c/boc/bocode/s432001.html. Accessed 11 Oct 2017
  35. 35.
    Lo IK, Burkhart SS (2003) The etiology and assessment of subscapularis tendon tears: a case for subcoracoid impingement, the roller-wringer effect, and TUFF lesions of the subscapularis. Arthroscopy 19(10):1142–1150PubMedGoogle Scholar
  36. 36.
    Malavolta EA, Chang VYP, de Castro MTBP, Andrade-Silva FB, Assunção JH, Gracitelli MEC et al (2019) Effect of subscapularis tears on functional scores of patients undergoing rotator cuff repair. Acta Ortop Bras 27(2):116–119PubMedPubMedCentralGoogle Scholar
  37. 37.
    Patte D (1990) Classification of rotator cuff lesions. Clin Orthop Relat Res 254:81–86Google Scholar
  38. 38.
    Pauzenberger L, Grieb A, Hexel M, Laky B, Anderl W, Heuberer P (2017) Infections following arthroscopic rotator cuff repair: incidence, risk factors, and prophylaxis. Knee Surg Sports Traumatol Arthrosc 25(2):595–601PubMedGoogle Scholar
  39. 39.
    Randelli P, Arrigoni P, Aliprandi A, Sdao S, Ragone V, D'Ambrosi R et al (2016) Repair versus shaving of partial-thickness articular-sided tears of the upper subscapularis tendon. A prospective randomized controlled trial. Joints 3(3):109–115PubMedPubMedCentralGoogle Scholar
  40. 40.
    Rodenbaum P, Rubin D (1984) Reducing bias in observational studies using subclassification on the propensity score. J Am Stat Assoc 79(387):516–524Google Scholar
  41. 41.
    Sakurai G, Ozaki J, Tomita Y, Kondo T, Tamai S (1998) Incomplete tears of the subscapularis tendon associated with tears of the supraspinatus tendon: cadaveric and clinical studies. J Shoulder Elbow Surg 7(5):510–515PubMedGoogle Scholar
  42. 42.
    Saltzman BM, Collins MJ, Leroux T, Arns TA, Griffin JW, Romeo AA et al (2017) Arthroscopic repair of isolated subscapularis tears: a systematic review of technique-specific outcomes. Arthroscopy 33(4):849–860PubMedGoogle Scholar
  43. 43.
    Sink EL, Leunig M, Zaltz I, Gilbert JC, Clohisy J, Academic Network for Conservational Hip Outcomes Research Group (2012) Reliability of a complication classification system for orthopaedic surgery. Clin Orthop Relat Res. 470(8):2220–2226PubMedPubMedCentralGoogle Scholar
  44. 44.
    Ticker JB, Burkhart SS (2011) Why repair the subscapularis? A logical rationale. Arthroscopy 27(8):1123–1128PubMedGoogle Scholar
  45. 45.
    van Kampen DA, Willems WJ, van Beers LW, Castelein RM, Scholtes VA, Terwee CB (2013) Determination and comparison of the smallest detectable change (SDC) and the minimal important change (MIC) of four-shoulder patient-reported outcome measures (PROMs). J Orthop Surg Res 8:40PubMedPubMedCentralGoogle Scholar
  46. 46.
    Walch G, Nove-Josserand L, Levigne C, Renaud E (1994) Tears of the supraspinatus tendon associated with “hidden” lesions of the rotator interval. J Shoulder Elbow Surg 3(6):353–360Google Scholar
  47. 47.
    Warner JJ, Higgins L, Parsons IM 4th, Dowdy P (2001) Diagnosis and treatment of anterosuperior rotator cuff tears. J Shoulder Elbow Surg 10(1):37–46PubMedGoogle Scholar
  48. 48.
    Wasserstein RL, Lazar NA (2016) The ASA’s statement on p-values: context, process, and purpose. Am Stat 70(2):129–133Google Scholar
  49. 49.
    Wellmann M (2016) Diagnostics and treatment of anterosuperior rotator cuff tears. Orthopade 45(2):130–135PubMedGoogle Scholar
  50. 50.
    Yoon JP, Chung SW, Kim SH, Oh JH (2013) Diagnostic value of four clinical tests for the evaluation of subscapularis integrity. J Shoulder Elbow Surg 22(9):1186–1192PubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  • Barbara Wirth
    • 1
  • Sebastian Kunz
    • 2
    • 3
  • Hans-Kaspar Schwyzer
    • 1
  • Matthias Flury
    • 1
    • 4
  • Maximilian Lenz
    • 1
    • 5
  • Laurent Audigé
    • 1
    • 2
    Email author
  1. 1.Shoulder and Elbow Surgery DepartmentSchulthess ClinicZurichSwitzerland
  2. 2.Research and Development DepartmentSchulthess ClinicZurichSwitzerland
  3. 3.Department of Orthopaedic Surgery and TraumatologyUniversity Hospital of BaselBaselSwitzerland
  4. 4.Center for Orthopaedics and NeurosurgeryIn-MotionWallisellenSwitzerland
  5. 5.Department of Orthopaedic and Trauma SurgeryUniversity Hospital of CologneCologneGermany

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