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Arthroscopic Repair of Traumatic Combined Rotator Cuff Tears Involving the Subscapularis Tendon
Junji Ide, MD1; Akinari Tokiyoshi, MD1; Jun Hirose, MD1; Hiroshi Mizuta, MD1
1 Department of Orthopaedic and Neuro-Musculoskeletal Surgery, Faculty of Medical and Pharmaceutical Sciences, Kumamoto University, 1-1-1, Honjo, Kumamoto 860-8556, Japan. E-mail address for J. Ide: ide@kumamoto-u.ac.jp
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
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Investigation performed at the Department of Orthopaedic and Neuro-Musculoskeletal Surgery, Faculty of Medical and Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Nov 01;89(11):2378-2388. doi: 10.2106/JBJS.G.00082
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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.

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    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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