Function of subscapularis after surgical treatment for recurrent instability of the shoulder using a bone-block procedure

Abstract

We compared the long-term function of subscapularis after the Latarjet procedure using two surgical approaches. We treated 102 patients (106 shoulders) with a mean age of 26.8 years (15 to 51) with involuntary unidirectional recurrent instability. The operation was carried out through an L-shaped incision with trans-section of the upper two-thirds of the muscle in 69 cases and with a subscapularis split in 37. All clinical results were assessed by the Rowe and the Duplay scores and the function of subscapularis by evaluating the distance and strength at the lift-off position. Bilateral CT was performed in 77 patients for assessment of fatty degeneration. The mean follow-up was 7.5 years (2 to 15) and 18% of cases were lost to follow-up. The mean Duplay score was 82 of 100 for the L-shaped incision group and 90 of 100 for those with a subscapularis split (p = 0.02). The mean fatty degeneration score was 1.18 after an L-shaped incision compared with 0.12 after subscapularis split (p = 0.001). The subscapularis split approach is therefore recommended.

Complications associated with open coracoid transfer procedures for shoulder instability

“…Three percent of cases (20 of 636) from 14 studies 1,5,6,9,13,[15][16][17]19,22,24,32,41,45 were revision procedures. Sixteen studies 4,12,29,31,33,36,39,[43][44][45]47,[49][50][51][52][53] (1058 cases) made no comment regarding whether the procedures were primary or revision cases. Metallic screw fixation was used in 29 studies, 1,[4][5][6]9,12,13,[15][16][17]19,22,24,29,[31][32][33]36,[42][43][44]…”

“…Sixteen studies 4,12,29,31,33,36,39,[43][44][45]47,[49][50][51][52][53] (1058 cases) made no comment regarding whether the procedures were primary or revision cases. Metallic screw fixation was used in 29 studies, 1,[4][5][6]9,12,13,[15][16][17]19,22,24,29,[31][32][33]36,[42][43][44][45][46][47][49][50][51][52][53] and bioabsorbable screws and plugs were used in 1 study. 39 Repeat surgery was documented in 81 cases (4.9 AE 1.0%), including for hardware problems in 50 and recurrent instability in 20.…”

Long-term subscapularis strength assessment after Bristow-Latarjet procedure: isometric study

“…25 Scheibel et al 25 investigated postoperative subscapularis muscle insufficiency after open shoulder stabilization using the L-shape tenotomy approach, and they reported clinical signs of subscapularis insufficiency in 53.8% of cases and MRI evidence of muscle atrophy and fatty infiltration, particularly of the upper part of the subscapularis muscle. Maynou et al 19 compared clinical scores and computer tomography (CT) assessment of the L-shape transection of the upper two-thirds of the subscapularis versus muscle split, and they found lesser clinical scores and lesser relative thickness of the subscapularis muscle in the L-shaped incision than in the split approach. Picard et al 20 assessed the anatomic and functional effects of the vertical section of the subscapularis muscle during the Latarjet procedure, and they showed that 50% of its strength and 50% of its thickness were lost after surgery.…”

Short-Term Results of Shoulder Instability Surgery

“…Subskapularis tendonunun diseksiyonu nedeniyle fibröz skar ve tendonda kısalma görülür ve bu da iç rotasyon gücünde azalmaya neden olur (9,10).…”