How much do subscapularis tendon tears affect superior glenohumeral stability and can they affect the outcomes of arthroscopic superior capsule reconstruction? A new study has evidence and, yes, even answers.
How Impactful are Subscapularis Tendon Tears?
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Secondary#shoulderpain#subscapularistendontear#superiorglenohumeralstability
Arthroscopic superior capsule reconstruction (SCR) restores shoulder superior stability, muscle balance and function in patients with irreparable posterior-superior rotator cuff tears. When there is concomitant subscapularis tendon tear, however, the outcomes aren’t always certain.
In the study, “Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears: Comparison of Clinical Outcomes With and Without Subscapularis Tear,” published in the December 2020 issue of The American Journal of Sports Medicine, the researchers measured the effects of concomitant subscapularis tendon tear on clinical outcomes of SCR for irreparable posterior-superior rotator cuff tears.
For the study, they broke 193 patients into three groups: group 1 had no subscapularis tear (160 patients), group 2 had a reparable subscapularis tear that was repaired arthroscopically (26 patients), and group 3 had an irreparable subscapularis tear (7 patients).
All patients had undergone arthroscopic SCR using fascia lata autograft between 2007 and 2015. Important outcome measures included American Shoulder and Elbow Surgeons (ASES) and Japanese Orthopaedic Association (JOA) scores, Visual Analog Scale (VAS) score for pain, active shoulder range of motion, muscle strength, and acromiohumeral distance.
They were all evaluated before surgery and at final follow-up. Patients in groups 1 and 2 had improved ASES, JOA and VAS scores and shoulder range of motion and muscle strength after SCR with subscapularis repair (p < .001). Group 3 patients also had improved ASES, JOA and VAS scores (p < .001); however, shoulder range of motion and muscle strength did not improve significantly.
In addition, postoperative acromiohumeral distance was smaller in group 3 (5.7 ± 2.9 mm [mean ±SD]) than group 2 (9.1 ± 2.3 mm) (p = .002). Group 3 had a significantly higher rate of graft tear (p < .001) and postoperative infection (p < .001) than group 1.
The researchers wrote, “The presence of subscapularis tendon tear affects clinical outcomes and complication rates after SCR. The reparability of the subscapularis affects superior glenohumeral stability; therefore, an intact subscapularis or reparable subscapularis tendon tear is the best indication for arthroscopic in patients with irreparable posterior-superior rotator cuff tendon tears.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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