Arthroscopic Repair of Traumatic Isolated Subscapularis Tendon Lesions (Lafosse Type III or IV): A Prospective Magnetic Resonance Imaging–Controlled Case Series With 1 Year of Follow-Up

Grueninger, Patrick; Nikolić, Nikola; Schneider, J; Lattmann, Thomas; Platz, Andreas; Chmiel, Corinne; Meier, Christoph

doi:10.1016/j.arthro.2014.02.030

Cited by 41 publications

(27 citation statements)

References 21 publications

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“…Rerupture rate is also correlated with the delay between injury and surgery [4]. In post-traumatic SSC tendon tears, early arthroscopic repair (within an average of 3.7 months) leads to good functional results, a decrease in fatty degeneration and improvement of muscle mass on imaging [38]. …”

Section: Pathological Featuresmentioning

confidence: 99%

Multi-modal imaging of the subscapularis muscle

et al. 2016

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The subscapularis (SSC) muscle is the most powerful of the rotator cuff muscles, and plays an important role in shoulder motion and stabilization. SSC tendon tear is quite uncommon, compared to the supraspinatus (SSP) tendon, and, most of the time, part of a large rupture of the rotator cuff. Various complementary imaging techniques can be used to obtain an accurate diagnosis of SSC tendon lesions, as well as their extension and muscular impact. Pre-operative diagnosis by imaging is a key issue, since a lesion of the SSC tendon impacts on treatment, surgical approach, and post-operative functional prognosis of rotator cuff injuries. Radiologists should be aware of the SSC anatomy, variability in radiological presentation of muscle or tendon injury, and particular mechanisms that may lead to a SSC injury, such as coracoid impingement.Teaching Points• Isolated subscapularis (SSC) tendon tears are uncommon. • Classically, partial thickness SSC tendon tears start superomedially and progress inferolaterally. • Long head of biceps tendon medial dislocation can indirectly signify SSC tendon tears. • SSC tendon injury is associated with anterior shoulder instability. • Dynamic ultrasound study of the SSC helps to diagnose coracoid impingement.

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Section: Pathological Featuresmentioning

confidence: 99%

Multi-modal imaging of the subscapularis muscle

et al. 2016

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“…Furthermore, previous studies have reported good to excellent functional results with acceptable rates of tendon healing after arthroscopic repair in patients with Lafosse type III and IV isolated SSC or combined AS lesions. 21,33 Nonetheless, to the best of our knowledge, the optimal cutoff values for risk of retear of the repaired SSC in terms of tear dimensions (19-mm retraction and 16-mm superoinferior dimension) have not been previously reported.…”

Section: Discussionmentioning

confidence: 89%

Comparison of Functional and Radiological Outcomes of Tears Involving the Subscapularis: Isolated Subscapularis Versus Combined Anterosuperior Rotator Cuff Tears

Meshram

Rhee

Park

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Few studies have compared the clinical and radiological characteristics and outcomes in isolated subscapularis (SSC) and combined anterosuperior (AS) rotator cuff tears (RCTs). Furthermore, risk factors for retear after SSC repair and the effect of preoperative fatty degeneration require further evaluation.Purpose: To compare the functional and radiological outcomes of isolated SSC with combined AS RCTs after arthroscopic repair and to determine the risk factors for SSC retear in these 2 groups.Study Design: Cohort study; Level of evidence, 3.Methods: Data from 30 patients in the isolated SSC group were compared with data from 110 patients in the combined AS group. All patients underwent primary arthroscopic rotator cuff repair between 2010 and 2016. Clinical outcomes were assessed through use of the visual analog scale for pain, American Shoulder and Elbow Surgeons score, and Simple Shoulder Test at a mean followup of 26.7 months (range, 24-96 months). SSC tendon integrity was examined via magnetic resonance imaging, computed tomography arthrogram, or ultrasonography at least 1 year after surgery.Results: The isolated SSC group had a greater proportion of males and the patients were younger compared with the combined AS group (both P < .050). The incidence of trauma was high but not significantly different between groups (56.7% vs 40.9%; P ¼ .180). Clinical outcome measures and radiological outcomes in terms of retear were not statistically different between both groups (16.7% vs 8/5%; P ¼ .337). The optimal cutoff values for the risk of SSC tendon retear in both groups were 19-mm retraction and 16-mm superoinferior dimension (P ¼ .048). Unfavorable preoperative fatty degeneration of the SSC muscle (grades 3 and 4) was a significant risk factor for retear (odds ratio, 9.8; P < .001).Conclusion: Isolated SSC and combined AS RCTs were comparable except for patient age and sex; both had a high incidence of traumatic history. The current data suggest that the risk factors for retear after SSC repair in RCTs involving the SSC were tear size greater than 19 mm of retraction and unfavorable fatty degeneration (grade 3 or higher) of the SSC muscle.Recently, an increase has been noted in the number of studies focused on rotator cuff tears (RCTs) involving the subscapularis (SSC) muscle to enable a better understanding of the diagnosis, management, and outcomes. 35 The SSC is the largest rotator cuff tendon; it provides 50% of the rotator cuff force and plays an important role in shoulder stability and movements such as internal rotation, adduction, abduction, flexion, and extension. 13,20,25,43 Hence, restoring the function of the SSC muscle after a tear is crucial for normal shoulder function.The SSC muscle is reported to be involved in 78% of RCTs, most often in combination with other rotator cuff tendons. 40 The incidence of isolated SSC RCTs is reported to be 4%, 13 whereas combined RCTs involving the SSC and supraspinatus but without the infraspinatus (combined anterosuperior [AS]) are reported to accoun...

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“…3 These findings have been less reliably demonstrated in the SSc muscle. The majority of studies have found no progression of fatty infiltration after repair of SSc tendon 5,6,25 ; however, Grueninger et al 20,21 demonstrated significant improvements in SSc muscle fatty infiltration. After SSc tendon repair, higher retear rates have been correlated with higher grades of fatty infiltration 15,27,33 and, in some cases, larger tears.…”

Section: Discussionmentioning

confidence: 99%

Do Outcomes of Arthroscopic Subscapularis Tendon Repairs Depend on Rotator Cuff Fatty Infiltration?

Monroe¹,

Flores

Zhang

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Rotator cuff fatty infiltration has been correlated with poorer radiographic and clinical outcomes in supraspinatus and infraspinatus tendon repairs, but this has not been well-studied in subscapularis tendon repairs. Purpose: To evaluate the influence of preoperative rotator cuff fatty infiltration on postoperative outcomes for patients undergoing arthroscopic subscapularis tendon repair. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent arthroscopic subscapularis repair between 2010 and 2016 were retrospectively identified, and demographic data and surgical findings were recorded. The extent of fatty infiltration was determined on preoperative magnetic resonance imaging by the Fuchs modification of the Goutallier classification. At the most recent follow-up, patients completed the Patient-Reported Outcomes Measurement Information System for Upper Extremity (PROMIS-UE) computer adaptive test and a postoperative visual analog scale for pain. The distribution of fatty infiltration was compared between patients undergoing subscapularis tendon repair versus subscapularis tendon repair combined with a posterior cuff repair. Outcomes were compared for patients using Goutallier grade 0-1 versus grade ≥2 changes in each rotator cuff muscle. Multivariate linear regression analysis was performed to evaluate the influence of muscle quality, as well as demographic factors, on PROMIS-UE scores. Significance was defined as P < .05. Results: There were 140 shoulders included (mean age, 61.8 years; 42.1% female; mean follow-up, 51.7 months). The prevalence of Goutallier grade 2 changes or higher was significantly greater in patients with multitendon repair relative to isolated subscapularis tendon repair. For the overall group of all patients undergoing subscapularis tendon repair, whether in isolation or as part of a multitendon repair, PROMIS-UE scores were significantly lower for patients with infraspinatus muscle grade 2 or higher Goutallier changes relative to grade 0 or 1. After adjustment for age, body mass index, patient sex, and fatty infiltration in other rotator cuff muscles, poor infraspinatus muscle quality remained the only significant predictor for lower PROMIS-UE scores. Conclusion: Patients undergoing arthroscopic subscapularis tendon repair with poor infraspinatus muscle quality had worse patient-reported outcomes. This was true whether subscapularis tendon repair was isolated or was performed in conjunction with supraspinatus and infraspinatus tendon repairs.

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Arthroscopic Repair of Traumatic Isolated Subscapularis Tendon Lesions (Lafosse Type III or IV): A Prospective Magnetic Resonance Imaging–Controlled Case Series With 1 Year of Follow-Up

Cited by 41 publications

References 21 publications

Multi-modal imaging of the subscapularis muscle

Multi-modal imaging of the subscapularis muscle

Comparison of Functional and Radiological Outcomes of Tears Involving the Subscapularis: Isolated Subscapularis Versus Combined Anterosuperior Rotator Cuff Tears

Do Outcomes of Arthroscopic Subscapularis Tendon Repairs Depend on Rotator Cuff Fatty Infiltration?

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