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Orthopedic resident’s learning curve for arthroscopic subscapularis tendon repair: short-term clinical and radiographic outcomes

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Abstract

Background

Arthroscopic subscapularis (SSC) repair is a technically demanding procedure with a long learning curve. As effective completion of resident’s practical experience remains controversial, a prospective clinical study was performed to assess the functional and anatomical outcomes of subscapularis (SSC) arthroscopic repair by orthopedic residents. The pathological anatomy of the tears, the surgical approach and the difficulties encountered at the beginning of the learning curve were reported.

Materials and methods

Between June 2009 and June 2010, 30 patients with rotator cuff tear were preoperatively evaluated with clinical exam, Constant and UCLA scores. Surgery was performed under arthroscopy by a team of three orthopedic surgeons in training. A SSC tear, if present, was recorded and treated. The same clinical exam and functional scores were repeated at minimum 6 months of follow-up. Subscapularis strength recovery and tendon healing were investigated with arthromagnetic resonance imaging.

Results

A SSC tear was observed in 11 cases out of 30 and treated arthroscopically. The clinical scores improved in all patients: the average Constant score increased from 34 ± 14 to 77 ± 11 and the UCLA score from 11 ± 5 to 29 ± 3. The SSC tests were negative in all patients with the exception of one. Tendon healing was observed in 10 out of 11 cases.

Conclusions

Arthroscopic SSC repair performed by educated residents is possible and leads to good clinical and anatomical results. Surgery duration progressively improved as the learning curve advanced.

Level of evidence

Level 2.

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Authors and Affiliations

  1. Clinica Ortopedica, Università degli Studi di Padova, Via Giustiniani 2, Padua, Italy

    E. Visonà, G. Franceschi, A. Maron, A. Berizzi & R. Aldegheri

  2. Ospedali Riuniti Padova Sud - ULSS 6 EUGANEA, Via Albere 30, Schiavonia, PD, Italy

    E. Visonà & A. Maron

  3. Radiologia I, Ospedale di Padova, Via Giustiniani 2, Padua, Italy

    S. Vio

  4. Policlinico Abano Terme, Piazza C. Colombo 1, Abano Terme, Padova, Italy

    G. Franceschi

  5. Dipartimento di Scienza per la Salute, Università del Molise, Via De Sanctis, 86100, Campobasso, Italy

    K. Corona

  6. Casa di Cura Villa Betania, Via Piccolomini 27, 00165, Rome, Italy

    S. Cerciello

  7. Marrelli Hospital, Via Gioacchino da Fiore, 0962, Crotone, Italy

    S. Cerciello

  8. Unità di Chirurgia della Spalla e del Gomito, Ospedale D. Cervesi, Cattolica, RN, Italy

    G. Merolla

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  1. E. Visonà
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Correspondence to E. Visonà.

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Visonà, E., Vio, S., Franceschi, G. et al. Orthopedic resident’s learning curve for arthroscopic subscapularis tendon repair: short-term clinical and radiographic outcomes. Musculoskelet Surg 101 (Suppl 2), 145–151 (2017). https://doi.org/10.1007/s12306-017-0485-9

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