Systematic Review Of Arthroscopic Reconstruction Of Isolated Subscapularis Tendon Tear: Results, Role Of Coracoplasty And Management Of The Biceps Tendon
Sanatorio Allende, Córdoba, Córdoba, ARGENTINA
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Summary: This systematic review report good outcomes of arthroscopic repair of isolated subscapular tendon tears with a 86 to 100% healing on MRI and suggest that management of the long head of the biceps tendon with tenotomy or tenodesis is necessary while the coracoplasty as an associated procedure it is not frequently done.
To systematically review the literature to identify all studies reporting outcomes of arthroscopically repaired isolated subscapular tendon tears, the frequency and management of associated long head of biceps pathology, and the MRI integrity of subscapular tendon reconstruction. Methods: A systematic literature review in spanish and english language using the PubMed/MEDLINE, EMBASE y LILACS databases with the term of: “Arthroscopic reconstruction of isolated subscapular tendon tears”. Only studies evaluating the techniques, outcomes, management of the long head of the biceps tendon, management of the coracoid and MRI integrity of the reconstruction of isolated subscapularis repair were included. Descriptive analysis was provided for the available literature. Results: In the initial search of the literature, we obtained 155 articles. We eliminated 108 articles in the evaluation of the titles because they were not related to the purpose of the study. We evaluated 47 articles by the abstracts, and we considered 23 articles for evaluation reading the full text. After applying the inclusion and exclusion criteria, we considered 7 articles to include in this systematic review. The studies were done in between 2003 to 2013, 207 patients with a mean age of 51 years old. A traumatic injury was the most frequently mechanism reported. All studies had a minimum follow-up of 24 months with an average follow-up of 38.85 months (24-131 months). Improvements in patient outcome scores were substantial after arthroscopic subscapularis repair. Six of the 7 studies evaluated 100% of their patients with MRI preoperatively. In the postoperative, 4 studies evaluated 100% of the patients with MRI, while in the remaining three studies they evaluated 86%, 77% and 71% of the patient with postoperative MRI. Excellent MRI tendon to bone integrity with 86 to 100% healing. With regard to coracoplasty, only the comparative study by Kim et al performed coracoplasty systematically in one of the study groups comparing results with a comparative group without coracoplasty did not find significant differences in functional outcomes or tendon integrity of the reconstruction in the MRI evaluation. The rest of the included studies did not perform coracoplasty. Of the 207 patients evaluated in the 7 studies, 6 studies clearly mention the behavior in relation to the long head of the biceps tendon. Tenotomy was performed in 96 patients, tenodesis in 51 and in 34 patient no surgical procedure was performed. In the remaining cases the management of the biceps tendon were not specify. Conclusions: The result of our systematic review of arthroscopic subscapular repair supports our hypothesis that it is a good treatment option with favorable clinical results. The pathology of long head of the biceps tendon is related to lesions of the subscapularis in 31 to 56% of cases, so it is recommended to perform tenotomy or tenodesis. In relation to coracoplaty most of the studies in this systematic review do not consider coracoplasty necessary as an associated procedure in the arthroscopy reconstruction of the subscapularis tears.
Level of Evidence: IV
Type of study: Systematic review
Key words: Arthroscopic Reconstruction Subscapular Tendon; Isolated Tear
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