The influence of subscapularis tendon reattachment on range of motion in reversed shoulder arthroplasty: a clinical study

Boer, Friso A. de; Kampen, Paulien M. van; Huijsmans, Pol E.

doi:10.1007/s12306-016-0401-8

Cited by 45 publications

(81 citation statements)

References 19 publications

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“…Only 2 studies in the literature 7,8 have examined whether the patients who underwent subscapularis repair at their index repair had an intact tendon during follow-up examination, and both of these studies used a reverse shoulder implant that has an onlay metaphysis and 145 to 155 neck shaft angle. A study by de Boer et al 7 examined integrity of repair with ultrasound in 25 patients who underwent repair after a tenotomy with tendon-tendon and tendon-bone suture fixation and found that 10 of the 25 (40%) were intact, with no difference in clinical outcome 8 examined 48 shoulders that underwent RTSA with subscapularis repair with transosseous sutures after a lesser tuberosity osteotomy and tenotomy. Ultrasound evaluation of these patients demonstrated that 23% of the subscapularis tendons were not healed at evaluation, 13% were intact, 33% were attenuated, and 31% were severely attenuated.…”

Section: Discussionmentioning

confidence: 99%

“…When the decision to repair the subscapularis is made, very little is known regarding optimal repair technique and outcomes after repair based on repair integrity, as only 2 studies to date in the literature have examined subscapularis repair integrity postoperatively. 7,8 Stem-based repair of the subscapularis has shown promising biomechanical sonographic and clinical results in anatomic total shoulder arthroplasty. 15,16 A similar technique has been developed for reverse shoulder arthroplasty.…”

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confidence: 99%

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Subscapularis Repair During Reverse Total Shoulder Arthroplasty Using a Stem-Based Double-Row Repair: Sonographic and Clinical Outcomes

Erickson

Shishani

Bishop

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Treatment of the subscapularis in reverse total shoulder arthroplasty (RTSA) is a controversial topic, with conflicting evidence regarding outcomes after repair. Purpose/Hypothesis: The purpose of this study was to report clinical and sonographic outcomes of a through-implant double-row suture technique for subscapularis repair in RTSA and to compare clinical outcomes and range of motion (ROM) between patients with an intact subscapularis tendon repair versus those whose tendon repair was not intact. The authors hypothesized that the novel repair technique would find more than 80% of tendons intact on ultrasound, with significant improvement in clinical outcome scores and ROM. The authors also hypothesized that patients with an intact subscapularis tendon repair would have better clinical outcomes compared with those with a nonintact tendon repair. Study Design: Case series; Level of evidence, 4. Methods: The study included all patients who underwent RTSA by 1 of 2 surgeons between August 2016 and March 2017 with the through-implant double-row suture technique for subscapularis repair. Subscapularis tendon integrity was assessed postoperatively via ultrasound at minimum 1-year follow-up. American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and pain visual analog scale (VAS) scores were recorded at the final follow-up visit in addition to ROM measures. Results: A total of 48 patients (31 males, 17 females; mean age, 68.9 ± 7.4 years; mean follow-up, 13.8 ± 2.1 months) were included. On ultrasound, the subscapularis was intact in 83.3% of patients. Regarding preoperative versus postoperative outcome scores, the ASES score (mean ± SD) significantly improved from 38.3 ± 14.7 to 81.9 ± 13.6, the SANE score significantly improved from 29.8 ± 24.2 to 75.5 ± 21.0, and the VAS pain score significantly improved from 5.9 ± 2.1 to 1.2 ± 1.6 ( P < .001 for all). Forward flexion and external rotation significantly improved. No significant difference existed in clinical outcome scores or ROM between patients with intact versus torn subscapularis tendons based on ultrasound. Conclusion: Subscapularis repair using a stem-based double-row repair technique during RTSA demonstrated an overall healing rate of 83.3%, as evidenced by ultrasound examination at short-term follow-up. Integrity of subscapularis repair did not affect clinical outcome or ROM.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Subscapularis Repair During Reverse Total Shoulder Arthroplasty Using a Stem-Based Double-Row Repair: Sonographic and Clinical Outcomes

Erickson

Shishani

Bishop

et al. 2020

Orthopaedic Journal of Sports Medicine

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“… 25 Or the study by de Boer et al which evaluated the influence of the subscapularis tendon on the ROM in rTSA, which included 65 patients. 14 …”

Section: Methods and Analysismentioning

confidence: 99%

“…Also, de Boer et al showed no significant differences in a range of motion (ROM) between subscapularis tendon repair or resection. 14 Without the need to reattach the subscapularis tendon, combined with the stability provided by the modern design of rTSA, patients can start mobilisation directly postoperative. In the study by Denard et al , patients undergoing anatomic total shoulder arthroplasty showed an increased ROM in the first 3 months in patients who were not immobilisated postoperatively compared with usual care.…”

Section: Introductionmentioning

confidence: 99%

Fast track rehabilitation after reversed total shoulder arthroplasty: a protocol for an international multicentre prospective cohort study

Essen¹,

Kornuijt

Vries³

et al. 2020

BMJ Open

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IntroductionThe use of reversed total shoulder arthroplasty (rTSA) has increased because of an increasing number of indications for this procedure and by ageing of the population. Usual postoperative care consists of immobilisation of the shoulder for a period of 2–6 weeks to allow healing of the subscapularis tendon and protection of the joint. However, new literature proved that reattachment of the subscapularis tendon is unnecessary. Therefore we hypothesised that immobilisation of the shoulder is not necessary and patients can start safely with mobilisation on the first postoperative day. We expect this fast track protocol to be safe and result in better short-term and long-term functional outcomes.Methods and analysisIn our prospective cohort, we will include at least 75 patients aged 50 years and older indicated for rTSA, with acute fracture treatment as an exclusion criterion. Patients will be selected and operated in three hospitals: two in the Netherlands and one in Curacao.Patients will visit the outpatient clinic preoperative, at 6 weeks, 3 months and 1 year postoperative. The data that will be collected includes baseline characteristics, reason for surgery, complications and adverse events, patient reported outcomes (Oxford Shoulder Score, EuroQol-5D and Numeric Rating Scale for pain) and range of motion of the shoulder.All patients will be instructed to use a sling only for 1 day and to follow a progressive physiotherapy schedule for 12 weeks. The primary outcome is the occurrence of complications and adverse events.Ethics and disseminationThe Medical Ethics Committee from the VUmc and Curacao reviewed this study protocol and granted exemption from ethical approval (METC VUmc 2019.111, METC Curacao 2019-02). Study results will be presented at (inter)national conferences and published in peer-reviewed journals.Trial registration numberNetherlands Trial Register (NL7656).

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“…To our knowledge, those 2 investigations 13 , 24 remain the only studies that have specifically examined the role of subscapularis repair on dislocation. One recent study 31 demonstrated no difference in functional or patient-reported outcomes after treatment with a medialized design with or without subscapularis repair, yet little work has been done to evaluate the effect of subscapularis repair on outcomes after reverse shoulder arthroplasty with a lateralized prosthesis, to our knowledge. Therefore, the present study was designed to further clarify the rates of complications, including dislocation, after lateralized reverse shoulder arthroplasty and to compare the functional outcomes after reverse shoulder arthroplasty performed with a lateralized design with or without subscapularis repair.…”

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confidence: 99%

Subscapularis Repair Is Unnecessary After Lateralized Reverse Shoulder Arthroplasty

Roberson

Shanley

Griscom

et al. 2018

JBJS OA

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Background:Controversy exists as to whether the subscapularis should be repaired after reverse shoulder arthroplasty. The purpose of the present study was to evaluate the utility of repairing the subscapularis after reverse shoulder arthroplasty with regard to complications, objective findings, and patient-reported outcome measures.Methods:We retrospectively reviewed the records for 99 patients who had undergone a lateralized reverse shoulder arthroplasty with (n = 58) or without (n = 41) subscapularis repair. Outcomes were compared with the Single Assessment Numeric Evaluation (SANE), Penn shoulder score (PSS), Veterans RAND (VR)-12, and American Shoulder and Elbow Surgeons (ASES) score at a minimum of 2 years of follow-up. Demographics, range of motion, and complications were also compared. A 1-way analysis of variance was performed to determine differences in performance and outcome scores, and a chi-square analysis was performed to compare the frequency of complications between groups.Results:There were no significant differences between the repair and no-repair groups in terms of SANE, PSS, ASES, or VR-12 scores. There also were no significant differences between the 2 groups in terms of postoperative ranges of forward elevation (128° versus 123°; p = 0.44) and external rotation (33° versus 29°; p = 0.29), the dislocation rate (5% versus 2%; p = 0.49), or the overall complication rate (9% versus 5%; p = 0.47).Conclusions:The results of the present study suggest that repair of the subscapularis tendon after lateralized reverse shoulder arthroplasty may not be necessary.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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The influence of subscapularis tendon reattachment on range of motion in reversed shoulder arthroplasty: a clinical study

Abstract: In reverse shoulder arthroplasty, no significant differences on range of motion, functional outcome scores or strength were found between subscapularis repair or no repair, whether the tendon healed at follow-up or not.

Cited by 45 publications

References 19 publications

Subscapularis Repair During Reverse Total Shoulder Arthroplasty Using a Stem-Based Double-Row Repair: Sonographic and Clinical Outcomes

Subscapularis Repair During Reverse Total Shoulder Arthroplasty Using a Stem-Based Double-Row Repair: Sonographic and Clinical Outcomes

Fast track rehabilitation after reversed total shoulder arthroplasty: a protocol for an international multicentre prospective cohort study

Subscapularis Repair Is Unnecessary After Lateralized Reverse Shoulder Arthroplasty

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