Repair of Lafosse I subscapularis lesions brings no benefit in anterosuperior rotator cuff reconstruction
- 121 Downloads
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.
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.
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.).
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
KeywordsShoulder Anterosuperior rotator cuff lesion Partial subscapularis tear Lafosse I Arthroscopic repair Functional outcomes Patient-reported outcomes
Constant-Murley shoulder score
Magnetic resonance image
Numeric rating scale
Oxford shoulder score
Range of motion
Subjective shoulder value
The authors would like to thank M. Wilhelmi, PhD (medical writer at Schulthess Clinic) for the editing and final preparation of this manuscript.
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.
No external funding was used.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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 was obtained from all individual participants included in the study.
- 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.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
- 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
- 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
- 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.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
- 13.Fox JA, Noerdlinger MA, Romeo AA (2002) Arthroscopic subscapularis repair. Oper Tech Orthop 12(3):209–217Google Scholar
- 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
- 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.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
- 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.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.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.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.Hartzler RU, Burkhart SS (2018) Management of subscapularis tendon tears. Oper Tech Sports Med 26(1):10–23Google Scholar
- 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.Imhoff AB, Ticker JB, Fu FH (2003) An atlas of shoulder arthroscopy. Informa Healthcare press, London, p 384Google Scholar
- 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.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
- 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
- 37.Patte D (1990) Classification of rotator cuff lesions. Clin Orthop Relat Res 254:81–86Google Scholar
- 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
- 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.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
- 48.Wasserstein RL, Lazar NA (2016) The ASA’s statement on p-values: context, process, and purpose. Am Stat 70(2):129–133Google Scholar