Postoperative clinical outcomes and radiological healing according to deep and superficial layer detachment in first facet involving subscapularis tendon tear

Abstract

Background: Subscapularis tendon insertion at the first facet has separate layers (deep and superficial). The purpose of this study is to evaluate postoperative clinical outcomes and radiological healing according to each layer of detachment in the first facet involving subscapularis tendon tear. Methods: Eighty-three patients who underwent arthroscopic repair due to First facet involving the scapularis tendon tear accompanying small to medium sized posterosuperior cuff tear were classified into three groups (group A: deep layer partial detachment, group B: deep layer complete detachment, but no superficial layer detachment, and group C: deep layer and superficial layer complete detachment). Subscapularis tendon healing was evaluated using computed tomography arthrogram and clinical result was evaluated using American Shoulder and Elbow Surgeons (ASES) shoulder score, Constant score and University of California Los Angeles (UCLA) shoulder score. Results: Retear rate of the subscapularis tendon was 2.2%, 18.2%, and 33.3% in group A, group B, and group C, respectively. These rates showed statistically significant difference among the three groups, which were classified by deep and superficial layer detachment in the first facet (p=0.003). Group A showed significant difference in subscapularis tendon healing compared with group B and group C (p=0.018 and p<0.001, respectively), but there was no statistical difference between group B and group C (p=0.292). Regarding clinical outcomes, there was no significant difference among three groups in ASES and UCLA score at final follow-up (p=0.070 and p=0.106, respectively). Conclusions: Complete detachment of deep layer may be related with retear occurrence regardless with detachment of superficial layer, but clinical outcome may not be related with each layer detachment in the first facet involving subscapularis tendon tear.

Subscapularis Tendon Tears: How Best to Approach This Issue

“…Early detection and prompt repair of subscapularis tears before progression to complex, severe tears with fatty infiltration have been highlighted as a critical factor associated with better outcomes 31 . Outcomes of subscapularis repair are related to tear size and severity 32–34 . Despite age negatively correlating with Constant scores and overall shoulder function, clinical improvement postoperatively can still be achieved in older patients 35 …”

“…31 Outcomes of subscapularis repair are related to tear size and severity. [32][33][34] Despite age negatively correlating with Constant scores and overall shoulder function, clinical improvement postoperatively can still be achieved in older patients. 35…”

Arthroscopic Repair of Large Subscapularis Tear Over the First Facet

“…With improvements in shoulder arthroscopy, information about SSC has accumulated. 22,33,41 However, the consensus on large SSC tears and retears remains inconclusive 25,42 ; furthermore, long-term outcome studies of arthroscopic repair for large SSC tears are limited. 35 Previous studies have regarded large SSC tears as follows: (1) complete or full-thickness tears without a clear definition or (2) Lafosse type III and IV tears (upper two-thirds or whole SSC tears).…”

“…With improvements in shoulder arthroscopy, information about SSC has accumulated. 22,33,41 However, the consensus on large SSC tears and retears remains inconclusive 25,42 ; furthermore, long-term outcome studies of arthroscopic repair for large SSC tears are limited. 35…”

Subscapularis tendon tear involving the first facet

“…Based on this background, Kim et al [ 8 ] evaluated postoperative clinical outcomes and radiological healing of SSC tendon tears according to each layer of detachment in the first facet. This study showed that complete detachment of the deep layer may be related to high retear and low healing rates regardless of detachment of the superficial layer, but also that clinical outcomes may not be related to detachment of specific layers in the first facet.…”