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Scientific Articles   |    
Clinical and Structural Results of Arthroscopic Repair of Isolated Subscapularis Tear
Laurent Nové-Josserand, MD1; Marie-Béatrice Hardy, MD1; Roger Leandro Nunes Ogassawara, MD1; Yannick Carrillon, MD1; Arnaud Godenèche, MD1
1 Centre Orthopédique Santy, 24 Avenue Paul Santy, F-69008 Lyon, France. E-mail address for L. Nové-Josserand: lnovejosserandpro@wanadoo.fr
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Investigation performed at the Centre Orthopédique Santy, Lyon, France



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Sep 05;94(17):e125 1-7. doi: 10.2106/JBJS.K.00008
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Abstract

Background: 

Even though the frequency of arthroscopic repair of isolated lesions of the subscapularis tendon has increased, few studies have presented clinical and anatomical outcomes of this treatment. We hypothesized that, after an arthroscopic repair, structural outcomes in the muscle have an influence on functional results.

Methods: 

A retrospective study was performed on twenty-two patients who had undergone arthroscopic repair of an isolated tear of the subscapularis tendon and had a mean follow-up of thirty-six months. Patients were evaluated preoperatively and postoperatively with use of the Constant-Murley score, a subjective shoulder value, the lift-off test, the belly-press test, and magnetic resonance imaging or computed tomography arthrography. The results were compared with those of a cohort of thirteen patients who underwent open repair of the subscapularis tendon tear.

Results: 

In the arthroscopic group, the Constant-Murley score improved from a mean of 66 points preoperatively to a mean of 85 points postoperatively (p < 0.05). The subscapularis tendon was healed in 86% of the patients. Three patients (14%) had a partial rupture limited to the superior tendon. Postoperatively, progression of fatty infiltration of the subscapularis muscle was observed in 55% of the patients. Ten patients (45%) had a severe but localized fatty infiltration area of the subscapularis muscle related to the larger tears. Subjective and functional outcomes were not influenced by tendon-healing or postoperative fatty infiltration (p > 0.05). Clinical testing was significantly improved, but incomplete corrections remained frequent. Although open repair resulted in higher subjective shoulder scores and better strength scores, most other clinical parameters, postoperative subscapularis testing results, and structural outcomes were comparable between the arthroscopic repair and the open repair group.

Conclusions: 

Arthroscopic repair of isolated subscapularis tears was associated with improved shoulder function and improved results on clinical testing. The tendon-healing rate was high but resulted in incomplete correction of the results of clinical testing. Progression of fatty infiltration in the subscapularis muscle was observed on magnetic resonance imaging but did not influence the clinical outcomes.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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