Anterosuperiore Rotatorenmanschettenrupturen: Rupturkonfigurationen und Ergebnisse nach arthroskopischer Therapie – eine prospektive Studie

Repair of Lafosse I subscapularis injury adds no additional value in anterosuperior rotator cuff injury

Background

The study aimed to explore the additional value of repair of Lafosse I subscapularis injury compared with debridement in anterosuperior rotator cuff injury.

Methods

The prospective study was conducted on a total of 41 patients with supraspinatus tendon tear combined with Lafosse I subscapularis injury. Eighteen patients were divided into the repair group and 23 patients were divided into the non-repair group. The two groups were compared for intraoperative parameters, pain score, range of motion of the shoulder joint, shoulder joint function and quality of life (QoL) at pre-operation, 3 and 6 months postoperatively and the final follow-up visit.

Results

The width of supraspinatus tendon tear did not exceed 3 cm and did not retract beyond the glenoid in among patients. There was no statistical difference of preoperative data between two groups, including age, course of disease, positive Jobe test, positive Bear-hug test, positive Lift-off test, Patte stage, longitudinal tear and pain severity (P > 0.05). Compared to preoperative levels, the severity of pain, ASES scores and EQ-5D-3L scores were significantly lower at 3 and 6 months postoperatively and the final position (P < 0.05). However, there was no statistical difference in pain severity, ASES scores and EQ-5D-3L scores between repair group and non-repair group (P > 0.05). Similarly, compared to preoperative levels, the range of motion of shoulder joint was significantly improved after operation, including internal rotation, external rotation, forward flexion and elevation (P < 0.05). However, there was no statistical difference in range of motion of shoulder joint between repair group and non-repair group (P > 0.05).

Conclusion

Operative treatment can effectively lessen severity of pain in the patients, improve shoulder joint function, increase the range of motion of the shoulder joint and enhance the QoL in treating anterosuperior rotator cuff injury. However, repair of subscapularis brings no benefit compared to debridement in treating supraspinatus tendon tear combined with Lafosse I subscapularis injury.

Repair of Lafosse I subscapularis lesions brings no benefit in anterosuperior rotator cuff reconstruction

PURPOSE

Optimal management of partial anterosuperior rotator cuff tears is unknown. Our aim was to compare clinical and subjective outcomes of supraspinatus (SSP) repair patients treated with or without repair of an associated superior subscapularis (SSC) partial tear.

METHODS

SSP repair patients with an associated partial (Lafosse I) tear of the superior SSC tendon were retrospectively examined. Baseline and operative data and the outcomes of shoulder range of motion (ROM), pain level, strength, Constant-Murley Score, complications at 6 months as well as patient-reported Oxford Shoulder Score, Subjective Shoulder Value, and satisfaction at 6- and 24-month post-surgery were compared between patients with and without a repaired SSC tear. Mixed models and propensity-score matching were used to adjust baseline group differences.

RESULTS

Of 75 eligible patients, 34 had an SSC repair and were younger with better baseline function. Non-repair surgeries were significantly shorter by 34 min (95% CI 23-45; p < 0.001). There were no group differences in the clinical and patient-rated outcome scores at both follow-ups (n.s.) as well as in pain, muscle strength in abduction, ROM, the 6-month complication risk (risk difference - 1.9%), and satisfaction with postoperative shoulder condition (n.s.).

CONCLUSION

We could not show a functional or subjective benefit of repairing cranial partial tears of the SSC tendon over debridement only in the setting of an SSP reconstruction with 24 months of follow-up. A longer operative duration is expected if a partial SSC tear repair is performed.

LEVEL OF EVIDENCE

III.

Shoulder Instability – Results of Different Methods of Treatment

The aim of this study is to present results after different procedures of surgical treatment of the unstable shoulder joint: arthroscopic stabilization; arthroscopic stabilization followed by the operative technique by Matev; the Latarjet procedure in cases with the presence of bone defects. From 2004 to 2017 291 patients aged between 15 and 35 years were operated at the University Hospital “Prof. B. Boychev”, Medical University − Sofia. 247 patients had anterior and 44 − combined shoulder instability. 173 of the patients were active athletes practicing different disciplines. The average age at the time of the first dislocation was 17 years. In 172 patients, the first dislocation occurred without significant trauma, 124 of them had anterior shoulder instability and 48 – combined shoulder instability. In 120 patients with anterior dislocations, there was history of a serious injury during the first accident. The number of dislocations varied between ten and fifteen in all patients. For the same period, 45 patients with significant bone defects requiring open surgery (Latarjet procedure) were operated. Among the patients with bone defects, the dislocations were between 8 and 30 before the first examination. There were 11 patients, who had undergone previous surgery in different hospitals and different number of relaxations after surgery were found. The data were evaluated radiographically and clinically. Functionally, the patients recovered according to a well-established protocol of physiotherapy and the external rotation regained the full range of motion. The patients were able to return to their sports activity. The successful results in all patients show that these combined operative techniques can be the method of choice in the treatment of a greater number of dislocations of the shoulder, especially in people who seek to quickly return to active sport activities.

Recovery of subscapularis and shoulder function following arthroscopic treatment of isolated anterior and combined anterosuperior rotator cuff lesions

BACKGROUND

The purpose of the study was to evaluate the recovery of the subscapularis and shoulder function dependent on the type of lesion and type of surgical treatment, when compared to the non-affected contralateral shoulder. We hypothesized that regardless of type of lesion and performed surgical intervention, a significant muscle insufficiency as compared to the healthy contralateral side will remain.

PATIENTS AND METHODS

Sixty-eight patients (14 females and 54 males) with an anterior or anterosuperior cuff lesion at an average age of 55.7 ± 11.7 years (range 20-80 years) were prospectively evaluated up to 24 months. Intraoperatively, the lesions were classified according to current systems and treated by debridement or reconstruction. Pre- and postoperatively, the Constant Score (CS) as well as the belly-press angle (BPA) and back-to-hand distance (BHD) on the affected and on the contralateral shoulder was noted.

RESULTS

29.4% had an isolated subscapularis lesion whereas 69.1% had concomitant supraspinatus pathology. In 17 patients an arthroscopic debridement and in 51 patients an arthroscopic repair were performed. Postoperatively, all patients revealed a significant improvement of the CS, BPA and BHD (p < 0.05) independent of the type of lesion or the surgical intervention. However, reconstruction of the subscapularis tendon resulted in significant differences of CS, BPA and BHD (p < 0.05) compared to the contralateral shoulder.

CONCLUSION

Reconstruction of subscapularis lesions cannot provide full subscapularis function since a residual subscapularis insufficiency remains, other than in patients with small partial tears treated with debridement alone.

Strength recovery after arthroscopic anterosuperior cuff repair: analysis of a consecutive series

PURPOSE

The purpose of this study was to look at the functional outcomes of arthroscopic repair of anterosuperior rotator cuff tears.

METHODS

Sixty-one patients who underwent arthroscopic repair of anterosuperior cuff tears were retrospectively reviewed. At a minimum 6 months of follow-up, shoulder functional outcome scores including the Constant score (CS), simple shoulder test (SST) and visual analogic scale (VAS) were collected. Strength recovery for supraspinatus and subscapularis was investigated.

RESULTS

All patients (mean age 59 ± 7) were available at a mean follow-up of 18 ± 7 months. The average CS improved from 30.8 ± 10.2 preoperatively to 76.5 ± 12.0 postoperatively, average SST from 2.6 ± 2.0 to 8.8 ± 2.9 and average VAS pain scale from 3.8 ± 1 to 0.5 ± 0.5 (p < 0.0001). Strength at belly-press and Jobe tests significantly improved (p < 0.0001). All patients with the exception of one were satisfied with the intervention.

CONCLUSIONS

Arthroscopic repair of anterosuperior rotator cuff tears provides a significant improvement in pain relief and shoulder function. Strength recovery is demonstrated in medium correlation with tendon healing.

Does preoperative subscapularis fatty muscle infiltration really matter in anterosuperior rotator cuff tears repair outcomes? A prospective multicentric study

INTRODUCTION

Anterosuperior (AS) rotator cuff tear describes a combined tear of the subscapularis and the supraspinatus tendons. We hypothesized that results after AS tendon repairs might be influenced by the size of the subscapularis rupture and the preoperative subscapularis muscle fatty infiltration.

METHODS

A prospective multicentric study of 53 AS rotator cuff tears from five centers was performed (January 2008-January 2009). Subscapularis tendon retraction and fatty infiltration were assessed preoperatively. An ultrasonographic healing control was performed 1 year after surgery.

RESULTS

Patients were on average 60 years (range, 43-75 years) and were operated on average 16 months (range, 2-72 months) after the beginning of their symptoms. The incidence of AS tears was found to be 18%. Average follow-up was 15 months (range, 12-24). The Constant-Murley (CM) score for the patients with AS ruptures improved significantly from 49 points (range, 35-51 points) preoperatively to 73 points postoperatively (range, 50-95 points)(P=0.0205). CM score gains were 26 for Lafosse group 1 ruptures and 29 for Lafosse group 2 & 3 with pre- and postoperative P values at P<0.0000001 and P<0.000001, respectively. The last follow-up CM score according to the subscapularis fatty infiltration was 70 (range, 48-95) for groups 0-1, 70 (range, 56-87) for group 2, and 56 (range, 53-88) for groups 3-4 with pre- and postoperative P values at P<0.001, P<0.001, and P<0.004, respectively. The global retear rate was 6%.

DISCUSSION

Our study showed that the CM score after repairs of AS rotator cuff tears was lower in advanced subscapularis fatty infiltration. However, gains in CM scores were similar whatever the initial subscapularis fatty infiltration. The rate of tendon healing was correlated with subscapularis fatty infiltration. Subscapularis tendon rupture size was not significantly correlated with outcomes.

LEVEL OF EVIDENCE

Level III.