2015 ISAKOS Biennial Congress ePoster #2122

Long-Term Clinical and Radiological Results Following Arthroscopic Reconstruction of Isolated Subscapularis Tears: Preliminary Results

Gernot Seppel, MD, Munich GERMANY
Johannes E. Plath, MD, Augsburg, Deutschland GERMANY
Christopher Völk, Mr, Munich GERMANY
Wolfgang Seiberl, PhD, Munich GERMANY
Stefan Buchmann, MD, Munich, Bavaria GERMANY
Simone Waldt, MD, Munich GERMANY
Andreas B. Imhoff, MD, Prof. Emeritus, Sauerlach / Munich, Bavaria GERMANY
Sepp Braun, MD, PhD, Munich, Bavaria GERMANY
Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, GERMANY

FDA Status Cleared

Summary: To evaluate long-term clinical outcome and structural tendon integrity with magnetic resonance imaging after arthroscopic repair of isolated subscapularis tears.

Abstract:

Objectives:

Good clinical results are reported after arthroscopic repair of isolated subscapularis tears (Fox and Romeo II-IV) although a remaining partial muscular insufficiency is noticed in short-term follow up studies. Until now there is still a lack of long-term evaluation of postoperative subscapularis function. Do strength deficiencies and MRI-based atrophy of the upper subscapularis muscle persist in the long run?

Methods

In 15 patients (5 f; 10 m) with a mean age of 45.3 years at the time of operation, the postoperative function following all arthroscopic suture anchor repair was prospectively assessed by specific clinical tests (Belly Press and Lift Off) and standardized shoulder scores (Constant Score and Simple Shoulder Test (SST)). Muscle strength was rated and quantified by an electronic force measurement plate. Structural integrity of the reconstructed subscapularis was evaluated by MRI concerning fatty infiltration and muscular atrophy.

Results

The mean Constant Score increased from 46.1 points preoperatively to 75.4 points (p<0,05) after the average duration of 99.7 months of follow up. The mean value of the SST was 10.8 (8-12). By arthroscopic repair remarkable pain reduction could be achieved from VAS 6 preoperatively to VAS 2 postoperatively.
A positive Belly Press test as well as a positive Lift Off test could postoperatively be seen in 20% (3/15) of the patients. At the operated side, subscapularis strength in Belly Press - position (61.7 vs 80.9 N) was significantly (p<0,05) reduced compared to the contralateral side whereas Constant Score values of these patients did not differ significantly (p>0,05) from those with negative clinical tests. While external rotation was not significantly reduced in the affected shoulder, a restriction of active internal rotation of 10.5° could be seen (p<0.05). MRI revealed an atrophy of the subscapularis muscle especially the upper portion in 26,7% (4/15) of the patients. A re-tear could be found in one patient (6,7%). Furthermore only one patient (6,7%) showed an increased fatty infiltration in sense of Goutallier Stage III or IV.
13 out of 15 patients (86,7%) evaluated their postoperative subjective satisfaction with the operation result as “very satisfied” or “satisfied”.

Conclusion

Long term results following all arthroscopic repair of isolated subscapularis tears show good clinical results as well as remarkable improvement of shoulder function, although a persistent deficiency of the subscapularis can be detected.