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Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 1/2012

01-01-2012 | Orthopaedic Surgery

Combined tears of the subscapularis and supraspinatus tendon: clinical outcome, rotator cuff strength and structural integrity following open repair

Authors: Christoph Bartl, Monika Senftl, Stefan Eichhorn, Konstantin Holzapfel, Andreas Imhoff, Gian Salzmann

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 1/2012

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Abstract

Background

Anterosuperior rotator cuff tears involving the subscapularis and supraspinatus tendons are less common than other tears of the rotator cuff. The purpose of this study was to report the clinical outcome, rotator cuff strength and structural integrity of open repair of combined anterosuperior rotator cuff tears.

Patients and methods

Forty-eight patients at an average age of 58 years underwent open repair of a combined supraspinatus and subscapularis tendon tear. The follow-up evaluation included clinical scores, rotator cuff strength testing with a custom-made force measurement plate (FMP) and postoperative MRI to evaluate repair integrity and muscle cross-sectional area.

Results

After a mean follow-up of 49 months the average Constant score improved from 43 points preoperatively to 79 points postoperatively. The SST and the pain VAS were significantly improved by the procedure (each <0.05). The combined tear group with partial subscapularis tears (G1) did not achieve significantly better score results than the combined tear group with a full-thickness subscapularis tear (G2) (p > 0.05). Strength for all rotator cuff components was reduced significantly (p < 0.05) compared with the contralateral shoulder in both groups. MRI revealed a retear-rate of 4% for the subscapularis and a retear-rate of 19% for the supraspinatus. Postoperative muscle cross-sectional area of all rotator cuff muscles did not differ significantly between G1 and G2 (p > 0.05).

Conclusion

Open repair of combined anterosuperior rotator cuff tears achieved good postoperative results despite a residual rotator cuff strength deficit. Combined supraspinatus-/full-thickness subscapularis tears achieved equal clinical and radiographic results compared with supraspinatus-/partial-thickness subscapularis tears.
Literature
1.
Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG (2005) Arthroscopic repair of fullthickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am 87:1229–1240PubMedCrossRef
2.
Reilly P, Amis AA, Wallace AL, Emery RJ (2003) Supraspinatus tears: propagation and strain alteration. J Shoulder Elbow Surg 12:134–138PubMedCrossRef
3.
Nich C, Mutschler C, Vandenbussche E, Augereau B (2009) Long-term clinical and MRI results of open repair of the supraspinatus tendon. Clin Orthop Relat Res 467(10):2613–2622PubMedCrossRef
4.
Kreuz PC, Remiger A, Erggelet C, Hinterwimmer S, Niemayer P, Gächter A (2005) Isolated and combined rotator cuff tears involving the subscapularis tendon. Am J Sports Med 33:1831–1837PubMedCrossRef
5.
Flury MP, John M, Goldhan J, Schwyzer HK, Simmen BR (2006) Rupture of the subscapularis tendon (isolated or in combination with supraspinatus tear): when is a repair indicated? J Shoulder Elbow Surg 15:659–664PubMedCrossRef
6.
Sakurai G, Ozaki J, Tomita Y, Kondo T, Tamai S (1998) Incomplete tears of the subscapularis tendon associated with tears of the supraspinatus tendon: cadaveric and clinical studies. J Shoulder Elbow Surg 7(5):510–515PubMedCrossRef
7.
Bennett WF (2003) Arthroscopic repair of anterosuperior (supraspinatus/subscapularis) rotator cuff tears: a prospective cohort with 2- to 4-year follow-up. Classification of biceps subluxation/instability. Arthroscopy 19(1):21–33PubMedCrossRef
8.
Gerber C, Hersche O, Farron A (1996) Isolated rupture of the subscapularis tendon. J Bone Joint Surg Am 78(7):1015–1023PubMed
9.
Bartl C, Salzmann GM, Seppel G, Eichhorn S, Holzapfel K, Wörtler K, Imhoff AB (2011) Subscapularis function and structural integrity after arthroscopic repair of isolated subscapularis tears. Am J Sports Med 39(6):1255–1262PubMedCrossRef
10.
Nho SJ, Frank RM, Reiff SN, Verma NN, Romeo AA (2010) Arthroscopic repair of anterosuperior rotator cuff tears combined with open biceps tenodesis. J Bone Joint Surg Am 26(12):1667–1674
11.
Kim TK, Rauh PB, McFarland EG (2003) Partial tears of the subscapularis tendon found during arthroscopic procedures on the shoulder: a statistical analysis of sixty cases. Am J Sports Med 31(5):744–750PubMed
12.
Gerber C, Schebesta A (2000) Impingement of the deep surface of the subscapularis tendon and the reflection pulley on the anterosuperior glenoid rim: a preliminary report. J Shoulder Elbow Surg 9:483–490PubMedCrossRef
13.
Ide J, Tokiyoshi A, Hirose J, Mizuta H (2007) Arthroscopic repair of traumatic combined rotator cuff tears involving the subscapularis tendon. J Bone Joint Surg Am 89(11):2378–2388PubMedCrossRef
14.
Namdari S, Henn RF 3rd, Green A (2008) Traumatic anterosuperior rotator cuff tears: the outcome of open surgical repair. J Bone Joint Surg Am 90(9):1906–1913PubMedCrossRef
15.
Warner JJ, Higgins L, Parsons IMT, Dowdy P (2001) Diagnosis and treatment of anterosuperior rotator cuff tears. J Shoulder Elbow Surg 10(1):37–46PubMedCrossRef
16.
Fox JA, Noerdlinger MA, Romeo AA (2003) Arthroscopic subscapularis repair. Tech Shoulder Elbow Surg 4:154–168CrossRef
17.
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 8:599–605PubMedCrossRef
18.
Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures: pre- and postoperative evaluation by CT-scan. Clin Orthop 304:78–83PubMed
19.
Constant CR, Murley A (1987) A method of functional assessment of the shoulder. Clin Orthop 214:160–164PubMed
20.
Habermeyer P (2009) Schulterchirurgie. Urban-Schwarzenberg Verlag, Heidelberg
21.
Tennent TD, Beach WR, Meyers JF (2003) A review of the special tests associated with shoulder examination. Part I: the rotator cuff tests. Am J Sports Med 31(1):154–160PubMed
22.
Tennent TD, Beach WR, Meyers JF (2003) A review of the special tests associated with shoulder examination. Part II: laxity, instability, and superior labral anterior and posterior (SLAP) lesions. Am J Sports Med 31(2):301–307PubMed
23.
Hertel R, Ballmer FT, Lombert SM (1996) Lag signs in the diagnosis of rotator cuff rupture. J Shoulder Elbow Surg 5:307–313PubMedCrossRef
24.
Tokish JM, Decker MJ, Ellis HB, Torry MR, Hawkins RJ (2003) The belly-press test for the physical examination of the subscapularis muscle: electromyographic validation and comparison to the lift-off test. J Shoulder Elbow Surg 12:427–430PubMedCrossRef
25.
Samilson RL, Prieto V (1983) Dislocation arthropathy of the shoulder. J Bone Joint Surg Am 65:456–460PubMed
26.
Thomazeau H, Boukobza E, Morcet N, Chaperon J, Langlais F (1997) Prediction of rotator cuff repair results by magnetic resonance imaging. Clin Orthop 344:275–283PubMed
27.
Tung GA, Yoo DC, Levine SM, Brody JM, Green A (2001) Subscapularis tendon tear: primary and associated signs on MRI. Comput Assist Tomogr 25:417–424CrossRef
28.
Magee T, Gaenslen ES, Seitz R, Hinson GA, Wetzel LH (1997) MR Imaging of the shoulder after surgery. Am J Roentgenol 168:925–928
29.
Motamedi AR, Urrea LH, Hancock RE, Hawkins RJ, Ho C (2002) Accuracy of magnetic resonance imaging in determining the presence and size of reccurrent rotator cuff tears. J Shoulder Elbow Surg 11:6–10PubMedCrossRef
30.
Juul-Kristensen B, Bojsen-Möller 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 167:214–222PubMedCrossRef
31.
Scheibel MT, Tsynman A, Magosch P, Schroeder RJ, Habermeyer P (2006) Postoperative subscapularis muscle insufficiency after primary and revision open shoulder stabilization. Am J Sports Med 34(10):1586–1593PubMedCrossRef
32.
Rokito AS, Cuomo F, Gallagher MA, Zuckerman JD (1999) Long-term functional outcome of repair of large and massive chronic tears of the rotator cuff. J Bone Joint Surg Am 81:991–997PubMedCrossRef
33.
Mochizuki T, Sugaya H, Uomizu M, Maeda K, Matsuki K, Sekiya I, Muneta T, Akita K (2008) Humeral insertion of the supraspinatus and infraspinatus. New anatomical findings regarding the footprint of the rotator cuff. J Bone Joint Surg Am 90:962–969PubMedCrossRef
34.
Burkhart SS (1991) Arthroscopic treatment of massive rotator cuff tears. Clinical results and biomechanical rationale. Clin Orthop 267:45–56PubMed
35.
Hansen ML, Otis JC, Johnson JS, Cordasco FA, Craig EV, Warren RF (2008) Biomechanics of massive rotator cuff tears: implications for treatment. J Bone Joint Surg Am 90:316–325PubMedCrossRef
36.
Turkel SJ, Panio MW, Marshall JL, Girgis FJ (1981) Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint. J Bone Joint Surg Am 63:1208–1217PubMed
Metadata
Title
Combined tears of the subscapularis and supraspinatus tendon: clinical outcome, rotator cuff strength and structural integrity following open repair
Authors
Christoph Bartl
Monika Senftl
Stefan Eichhorn
Konstantin Holzapfel
Andreas Imhoff
Gian Salzmann
Publication date
01-01-2012
Publisher
Springer-Verlag
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 1/2012
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-011-1400-8

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