Dataset Information

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

ABSTRACT: 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.

SUBMITTER: Erickson BJ

PROVIDER: S-EPMC7065284 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Publications

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

Erickson Brandon J BJ Shishani Yousef Y Bishop Meghan E ME Patel Midhat M Jones Stacy S Romeo Anthony A AA Lederman Evan S ES Gobezie Reuben R

Orthopaedic journal of sports medicine 20200309 3

<h4>Background</h4>Treatment of the subscapularis in reverse total shoulder arthroplasty (RTSA) is a controversial topic, with conflicting evidence regarding outcomes after repair.<h4>Purpose/hypothesis</h4>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 ...[more]

PMID: 32215277

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Project description:Massive irreparable rotator cuff tears (RCTs) affect the clinical outcomes of reverse shoulder arthroplasty (RSA). However, the effects of subscapularis repair on the outcomes of RSA, based on the degree of posterior-superior RCTs, are unclear. This study aimed to examine the effect of subscapularis repair on three-dimensional joint contact forces (JCFs) based on the degree of posterior-superior RCT severity in RSA. Ten human in vivo experimental data were used as input to the musculoskeletal model. A six-degrees-of-freedom (DOF) anatomical shoulder model was developed and validated against three-dimensional JCFs. The 6-DOF musculoskeletal shoulder model of RSA was then developed by importing the reverse shoulder implant into the validated anatomical shoulder model. Based on the various types of posterior-superior RCT severity, inverse dynamic simulations of subscapularis-torn and subscapularis-repaired models of RSA were performed: from isolated supraspinatus tears to partial or massive tears of the infraspinatus and teres minor. The intact rotator cuff model of RSA was also simulated for comparison with the different types of models. Our results showed that the more posterior-superior RCTs progressed in RSA, the more superior JCFs were observed at 90°, 105°, and 120° abduction in the subscapularis-torn model. However, subscapularis repair decreased the superior JCF at those angles sufficiently. In addition, the teres minor muscle-tendon force increased as infraspinatus bundle tears progressed in both the subscapularis-torn and -repaired models, in order to compensate for the reduced force during abduction. However, the teres minor muscle-tendon force was not as high as that of the infraspinatus muscle-tendon, which could result in muscle force imbalance between repaired subscapularis and teres minor. Therefore, our results suggest that repairing the subscapularis and the repairable infraspinatus during RSA can improve glenohumeral joint stability in the superior-inferior direction by restoring muscle force balance between the anterior cuff (i.e., subscapularis) and posterior cuff (i.e., infraspinatus and teres minor). The findings of this study can help clinician decide whether to repair the rotator cuff during RSA to enhance joint stability.

Dataset Information

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

Publications

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

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