Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-02-2016 | Shoulder

Long-term effects on subscapularis integrity and function following arthroscopic shoulder stabilization with a low anteroinferior (5:30 o’clock) portal

Authors: Stefan Buchmann, Peter U. Brucker, Knut Beitzel, Judith Bock, Matthias Eiber, Klaus Wörtler, Andreas B. Imhoff

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 2/2016

Abstract

Purpose

The use of a low anteroinferior (5:30 o’clock) portal for arthroscopic shoulder stabilization allows an anatomical refixation of the capsulolabral complex. This anteroinferior portal, however, penetrates the inferior subscapularis (SSC), which is criticized. Therefore, the aim of the study was to evaluate the functional and structural properties of the SSC in patients with anteroinferior shoulder stabilization. The hypothesis was that it does not harm the SSC by demonstrating full muscular function and imaging-based normal structure at a long-term follow-up.

Methods

Twenty patients were examined (14 males and six females; mean age 37.0 years) retrospectively after a mean follow-up of 9.6 years. At final follow-up, clinical examination and clinical scores (ASES, Constant–Murley, WOSI, and Rowe score) were documented. Additionally, SSC strength was evaluated with a custom-made electronic force measurement plate. All patients underwent bilateral magnetic resonance imaging to assess structural integrity and fatty infiltration (grading according to Fuchs et al.) of the SSC. Furthermore, vertical and transversal (superior and inferior) diameters of the muscle and the muscle area in a parasagittal plane were measured.

Results

Clinical scores revealed good-to-excellent long-term results (ASES 92 points, Constant–Murley 82 points, WOSI 85 %, and Rowe 84 points). Force measurement in comparison with the contralateral side showed no significant (p > 0.05) differences for the ‘belly-press’ test (ipsilateral 102 N vs. contralateral 101 N) and the ‘lift-off’ test (73 vs. 69 N). There were also no significant differences between the mean diameters and the areas of the SSC muscle belly (vertical diameter ipsilateral 92 mm vs. contralateral 94 mm; superior transversal 28 vs. 29 mm; inferior transversal 34 vs. 34 mm; area 2336 vs. 2526 mm²).

Conclusion

Arthroscopic labral repair with a low anteroinferior portal demonstrates no signs of structural and functional impairment of the SSC after 9.6 year follow-up. For clinical relevance, the lower part of the SSC can be penetrated for an optimal anchor placement in shoulder instabilities or Bankart fractures without concerns of a negative long-term effect on the SSC.

Level of evidence

Case series, Level IV.

Barth JR, Burkhart SS, De Beer JF (2006) The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear. Arthroscopy 22(10):1076–1084CrossRefPubMed

Bartl C, Salzmann GM, Seppel G, Eichhorn S, Holzapfel K, Wortler K, Imhoff AB (2011) Subscapularis function and structural integrity after arthroscopic repair of isolated subscapularis tears. Am J Sports Med 39(6):1255–1262CrossRefPubMed

Bartl C, Schumann K, Paul J, Vogt S, Imhoff AB (2011) Arthroscopic capsulolabral revision repair for recurrent anterior shoulder instability. Am J Sports Med 39(3):511–518CrossRefPubMed

Boileau P, Villalba M, Hery JY, Balg F, Ahrens P, Neyton L (2006) Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am 88(8):1755–1763CrossRefPubMed

Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164PubMed

De Simoni C, Burkart A, Imhoff AB (2000) A new inferior (5.30 o’clock) portal for arthroscopic repair of Bankart lesions. Arthroskopie 13(5):217–219CrossRef

Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 8(6):599–605CrossRefPubMed

Gartsman GM, Roddey TS, Hammerman SM (2000) Arthroscopic treatment of anterior-inferior glenohumeral instability. Two to five-year follow-up. J Bone Joint Surg Am 82-A(7):991–1003PubMed

Greis PE, Dean M, Hawkins RJ (1996) Subscapularis tendon disruption after Bankart reconstruction for anterior instability. J Shoulder Elbow Surg 5(3):219–222CrossRefPubMed

10.

Hertel R, Ballmer FT, Lombert SM, Gerber C (1996) Lag signs in the diagnosis of rotator cuff rupture. J Shoulder Elbow Surg 5(4):307–313CrossRefPubMed

11.

Imhoff AB, Ansah P, Tischer T, Reiter C, Bartl C, Hench M, Spang JT, Vogt S (2010) Arthroscopic repair of anterior-inferior glenohumeral instability using a portal at the 5:30-o’clock position: analysis of the effects of age, fixation method, and concomitant shoulder injury on surgical outcomes. Am J Sports Med 38(9):1795–1803CrossRefPubMed

12.

Juul-Kristensen B, Bojsen-Moller F, Finsen L, Eriksson J, Johansson G, Stahlberg F, Ekdahl C (2000) Muscle sizes and moment arms of rotator cuff muscles determined by magnetic resonance imaging. Cells Tissues Organs 167(2–3):214–222CrossRefPubMed

13.

Kirkley A, Griffin S, McLintock H, Ng L (1998) The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability. The Western Ontario Shoulder Instability Index (WOSI). Am J Sports Med 26(6):764–772PubMed

14.

Lenters TR, Franta AK, Wolf FM, Leopold SS, Matsen FA 3rd (2007) Arthroscopic compared with open repairs for recurrent anterior shoulder instability. A systematic review and meta-analysis of the literature. J Bone Joint Surg Am 89(2):244–254CrossRefPubMed

15.

Mauro CS, Voos JE, Hammoud S, Altchek DW (2011) Failed anterior shoulder stabilization. J Shoulder Elbow Surg 20(8):1340–1350CrossRefPubMed

16.

Maynou C, Cassagnaud X, Mestdagh H (2005) Function of subscapularis after surgical treatment for recurrent instability of the shoulder using a bone-block procedure. J Bone Joint Surg Br 87(8):1096–1101CrossRefPubMed

17.

Meyer M, Graveleau N, Hardy P, Landreau P (2007) Anatomic risks of shoulder arthroscopy portals: anatomic cadaveric study of 12 portals. Arthroscopy 23(5):529–536CrossRefPubMed

18.

Picard F, Saragaglia D, Montbarbon E, Tourne Y, Thony F, Charbel A (1998) Anatomo-clinical consequences of the vertical sectioning of the subscapular muscle in Latarjet intervention. Rev Chir Orthop Reparatrice Appar Mot 84(3):217–223PubMed

19.

Rhee YG, Ha JH, Cho NS (2006) Anterior shoulder stabilization in collision athletes: arthroscopic versus open Bankart repair. Am J Sports Med 34(6):979–985CrossRefPubMed

20.

Rhee YG, Lim CT, Cho NS (2007) Muscle strength after anterior shoulder stabilization: arthroscopic versus open Bankart repair. Am J Sports Med 35(11):1859–1864CrossRefPubMed

21.

Richards RR, An KN, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG, Iannotti JP, Mow VC, Sidles JA, Zuckerman JD (1994) A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg 3(6):347–352CrossRefPubMed

22.

Rowe CR, Patel D, Southmayd WW (1978) The Bankart procedure: a long-term end-result study. J Bone Joint Surg Am 60(1):1–16PubMed

23.

Scheibel M, Magosch P, Pritsch M, Lichtenberg S, Habermeyer P (2005) The belly-off sign: a new clinical diagnostic sign for subscapularis lesions. Arthroscopy 21(10):1229–1235CrossRefPubMed

24.

Scheibel M, Nikulka C, Dick A, Schroeder RJ, Popp AG, Haas NP (2007) Structural integrity and clinical function of the subscapularis musculotendinous unit after arthroscopic and open shoulder stabilization. Am J Sports Med 35(7):1153–1161CrossRefPubMed

25.

Schröder RJ, Scheibel M, Tsynman A, Magosch P, Habermeyer P (2006) Magnetic resonance analysis of the subscapularis muscle after open anterior shoulder stabilization. Rofo 178(7):706–712CrossRefPubMed

26.

Tauber M, Resch H, Forstner R, Raffl M, Schauer J (2004) Reasons for failure after surgical repair of anterior shoulder instability. J Shoulder Elbow Surg 13(3):279–285CrossRefPubMed

27.

Tischer T, Vogt S, Imhoff AB (2007) Arthroscopic stabilization of the shoulder with suture anchors with special reference to the deep anterior-inferior portal (5.30 o’clock). Oper Orthop Traumatol 19(2):133–154CrossRefPubMed

28.

Voos JE, Livermore RW, Feeley BT, Altchek DW, Williams RJ, Warren RF, Cordasco FA, Allen AA (2010) Prospective evaluation of arthroscopic Bankart repairs for anterior instability. Am J Sports Med 38(2):302–307CrossRefPubMed

29.

Yoon JP, Chung SW, Kim SH, Oh JH (2013) Diagnostic value of four clinical tests for the evaluation of subscapularis integrity. J Shoulder Elbow Surg 22(9):1186–1192CrossRefPubMed

Title: Long-term effects on subscapularis integrity and function following arthroscopic shoulder stabilization with a low anteroinferior (5:30 o’clock) portal
Authors: Stefan Buchmann
Peter U. Brucker
Knut Beitzel
Judith Bock
Matthias Eiber
Klaus Wörtler
Andreas B. Imhoff
Publication date: 01-02-2016
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 2/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-015-3545-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Long-term effects on subscapularis integrity and function following arthroscopic shoulder stabilization with a low anteroinferior (5:30 o’clock) portal

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Please log in to get access to this content

Other articles of this Issue 2/2016

Effects of surgical management on multidirectional instability of the shoulder: a meta-analysis

Midterm outcomes of arthroscopic remplissage for the management of recurrent anterior shoulder instability

Comparison of arthroscopic and open Latarjet with a learning curve analysis

Randomized controlled trial of arthroscopic electrothermal capsulorrhaphy with Bankart repair and isolated arthroscopic Bankart repair

Return to sports after arthroscopic capsulolabral repair using knotless suture anchors for anterior shoulder instability in soccer players: minimum 5-year follow-up study

Predictors of functional outcomes and recurrent shoulder instability after arthroscopic anterior stabilization