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Subscapularis Repair in Reverse Total Shoulder Arthroplasty: Differences in Outcomes Based on Preoperative Quality of Subscapularis Tendon

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Abstract

Purpose

This study examines the influence of preoperative fatty infiltration (FI) of the subscapularis tendon (SBS) on outcomes following reverse total shoulder arthroplasty (rTSA) with SBS repair.

Methods

A cohort of 161 rTSA patients with SBS repair, followed for a mean of 45.3 months, was divided into three groups based on FI: Group A (intact upper and lower portions, n = 85), Group B (intact lower portions, n = 44), and Group C (fatty infiltrated in both portions, n = 32). The mean age was 74.5 years (range: 65–95).

Results

Preoperative FI displayed significant disparity among the groups: Group A (1.18 ± 0.60), Group B (2.95 ± 0.56), and Group C (4.0 ± 0.00) (p < .001). Group A exhibited a more positive trend in activities of daily living, particularly in toileting ability (81% in Group A, 68% in Group B, and 72% in Group C), although without statistical significance (p = 0.220). Complication rates varied: Group A had seven acromial fractures (8%), three cases of instability (3%), and six instances of scapular notching (7%). Group B experienced four acromial fractures (9%) and four cases of scapular notching (9%), while Group C had only one case of scapular notching (3%) (p = 0.733).

Conclusion

In cases characterized by favorable preoperative SBS quality, there was an elevation in functional internal rotation (IR) post-surgery, accompanied by an increased incidence of postoperative complications. Hence, careful consideration is advised when determining the necessity for SBS repair.

Level of Evidence

Level III, retrospective comparative study.

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Data Availability

Data and materials are not included for personal identifier as subjected by the centre’s International Review Board ethical standards and approval.

Code Availability

Not applicable.

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Acknowledgements

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital #23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 130-872, Republic of Korea

    Sung-Min Rhee

  2. Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-dong, Deokyang-gu, Goyang-si, Gyeonggi-do, 412-270, Republic of Korea

    Joon Woo Lee, Jong Ung Lee, Cheol-Hwan Kim, Se Yeon Kim, Hyun Joo Ham, Radhakrishna Kantanavar & Yong-Girl Rhee

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  1. Sung-Min Rhee
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by S-MR, JUL, CHK, SYK, HJH, RK, YGR. The first draft of the manuscript was written by S-MR and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Yong-Girl Rhee.

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This study was approved by our institutional review board (Kyung Hee University Hospital, KHUH 2021-12-061).

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Rhee, SM., Lee, J.W., Lee, J.U. et al. Subscapularis Repair in Reverse Total Shoulder Arthroplasty: Differences in Outcomes Based on Preoperative Quality of Subscapularis Tendon. JOIO (2024). https://doi.org/10.1007/s43465-024-01139-x

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