Background: Although the use of arthroscopic repair to treat rotator
cuff tears involving the subscapularis has increased, there are few studies on
treatment outcomes and repair integrity. We hypothesized that arthroscopic
repair of combined rotator cuff tears that include the subscapularis yields
successful functional and structural outcomes.
Methods: Our study population consisted of seventeen men and three
women (twenty shoulders) whose mean age was 61.7 years. The mean duration of
follow-up was 36.1 months, and all patients were followed for at least two
years. All had traumatic full-thickness tears of the subscapularis and
supraspinatus, and seven had a concomitant infraspinatus tear. The mean time
from the injury to the surgery was 2.7 months. An arthroscopic suture-anchor
technique was used for the repair. The shoulders were evaluated before and
after the procedure with use of the University of California at Los Angeles
(UCLA) score, the Japanese Orthopaedic Association (JOA) score, plain
radiographs, and magnetic resonance imaging scans.
Results: After arthroscopic repair, the mean UCLA and JOA scores
significantly improved from 14.9 and 55.7 points to 31.1 and 91.0 points,
respectively (p < 0.0001). According to the JOA rating scale, the outcome
was excellent for thirteen patients (65%), good for five (25%), fair for one
(5%), and poor for one (5%). Of the twenty patients, seven (35%) had recurrent
tears after the surgery; four of them had originally had a three-tendon tear
and the other three had had a two-tendon tear. Of these seven patients, one
had an excellent outcome; five, a good outcome; and one, a fair outcome. The
postoperative mean JOA score was significantly lower for the patients with a
failed repair than it was for those with an intact repair (p = 0.0034). The
patients with a failed repair also had a significantly higher mean age (68.4
years compared with 58.1 years for those with an intact repair; p = 0.014),
and the prevalence of recurrent tears was significantly higher in the patients
with severe tendon retraction compared with those with minimal or moderate
tendon retraction (p = 0.0191).
Conclusions: Arthroscopic repair with use of the suture anchor
technique is a safe and effective procedure for the treatment of combined
rotator cuff tears involving the subscapularis tendon; it can alleviate
shoulder pain and improve function and the range of motion. The postoperative
integrity of the repair correlates with the clinical results. Patient age and
the degree of tendon retraction can affect the integrity of the repair.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.