Skip to main content
Top
Published in: MUSCULOSKELETAL SURGERY 2/2017

01-12-2017 | Original Article

Orthopedic resident’s learning curve for arthroscopic subscapularis tendon repair: short-term clinical and radiographic outcomes

Authors: E. Visonà, S. Vio, G. Franceschi, A. Maron, K. Corona, S. Cerciello, G. Merolla, A. Berizzi, R. Aldegheri

Published in: MUSCULOSKELETAL SURGERY | Special Issue 2/2017

Login to get access

Abstract

Background

Arthroscopic subscapularis (SSC) repair is a technically demanding procedure with a long learning curve. As effective completion of resident’s practical experience remains controversial, a prospective clinical study was performed to assess the functional and anatomical outcomes of subscapularis (SSC) arthroscopic repair by orthopedic residents. The pathological anatomy of the tears, the surgical approach and the difficulties encountered at the beginning of the learning curve were reported.

Materials and methods

Between June 2009 and June 2010, 30 patients with rotator cuff tear were preoperatively evaluated with clinical exam, Constant and UCLA scores. Surgery was performed under arthroscopy by a team of three orthopedic surgeons in training. A SSC tear, if present, was recorded and treated. The same clinical exam and functional scores were repeated at minimum 6 months of follow-up. Subscapularis strength recovery and tendon healing were investigated with arthromagnetic resonance imaging.

Results

A SSC tear was observed in 11 cases out of 30 and treated arthroscopically. The clinical scores improved in all patients: the average Constant score increased from 34 ± 14 to 77 ± 11 and the UCLA score from 11 ± 5 to 29 ± 3. The SSC tests were negative in all patients with the exception of one. Tendon healing was observed in 10 out of 11 cases.

Conclusions

Arthroscopic SSC repair performed by educated residents is possible and leads to good clinical and anatomical results. Surgery duration progressively improved as the learning curve advanced.

Level of evidence

Level 2.
Literature
2.
3.
go back to reference Bennett WF (2001) Subscapularis, medial, and lateral head coracohumeral ligament insertion anatomy. Arthroscopic appearance and incidence of “hidden” rotator interval lesions. Arthroscopy 17(2):173–180CrossRefPubMed Bennett WF (2001) Subscapularis, medial, and lateral head coracohumeral ligament insertion anatomy. Arthroscopic appearance and incidence of “hidden” rotator interval lesions. Arthroscopy 17(2):173–180CrossRefPubMed
4.
go back to reference Visona E, Paladini P, Merolla G, Cerciello S, Porcellini G (2015) Strength recovery after arthroscopic anterosuperior cuff repair: analysis of a consecutive series. Musculoskelet Surg 99(Suppl 1):S37–S42. doi:10.1007/s12306-015-0369-9 CrossRefPubMed Visona E, Paladini P, Merolla G, Cerciello S, Porcellini G (2015) Strength recovery after arthroscopic anterosuperior cuff repair: analysis of a consecutive series. Musculoskelet Surg 99(Suppl 1):S37–S42. doi:10.​1007/​s12306-015-0369-9 CrossRefPubMed
5.
go back to reference 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):744–750CrossRefPubMed 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):744–750CrossRefPubMed
6.
go back to reference Edwards TB, Walch G, Sirveaux F, Mole D, Nove-Josserand L, Boulahia A, Neyton L, Szabo I, Lindgren B (2005) Repair of tears of the subscapularis. J Bone Joint Surg Am 87(4):725–730. doi:10.2106/JBJS.D.02051 PubMed Edwards TB, Walch G, Sirveaux F, Mole D, Nove-Josserand L, Boulahia A, Neyton L, Szabo I, Lindgren B (2005) Repair of tears of the subscapularis. J Bone Joint Surg Am 87(4):725–730. doi:10.​2106/​JBJS.​D.​02051 PubMed
7.
go back to reference Neviaser RJ, Neviaser TJ (1995) Recurrent instability of the shoulder after age 40. J Shoulder Elb Surg 4(6):416–418CrossRef Neviaser RJ, Neviaser TJ (1995) Recurrent instability of the shoulder after age 40. J Shoulder Elb Surg 4(6):416–418CrossRef
8.
go back to reference Gerber C, Terrier F, Ganz R (1985) The role of the coracoid process in the chronic impingement syndrome. J Bone Joint Surg Br 67(5):703–708PubMed Gerber C, Terrier F, Ganz R (1985) The role of the coracoid process in the chronic impingement syndrome. J Bone Joint Surg Br 67(5):703–708PubMed
11.
go back to reference 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):21–33. doi:10.1053/jars.2003.50023 CrossRefPubMed 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):21–33. doi:10.​1053/​jars.​2003.​50023 CrossRefPubMed
12.
go back to reference Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R (2007) Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am 89(6):1184–1193. doi:10.2106/JBJS.F.00007 CrossRefPubMed Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R (2007) Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am 89(6):1184–1193. doi:10.​2106/​JBJS.​F.​00007 CrossRefPubMed
14.
go back to reference Gerber C, Hersche O, Farron A (1996) Isolated rupture of the subscapularis tendon. J Bone Joint Surg Am 78(7):1015–1023CrossRefPubMed Gerber C, Hersche O, Farron A (1996) Isolated rupture of the subscapularis tendon. J Bone Joint Surg Am 78(7):1015–1023CrossRefPubMed
15.
go back to reference Shin JJ, Saccomanno MF, Cole BJ, Romeo AA, Nicholson GP, Verma NN (2016) Pectoralis major transfer for treatment of irreparable subscapularis tear: a systematic review. Knee Surg sport Traumatol Arthrosc 6:1951–1960. doi:10.1007/s00167-014-3229-5 CrossRef Shin JJ, Saccomanno MF, Cole BJ, Romeo AA, Nicholson GP, Verma NN (2016) Pectoralis major transfer for treatment of irreparable subscapularis tear: a systematic review. Knee Surg sport Traumatol Arthrosc 6:1951–1960. doi:10.​1007/​s00167-014-3229-5 CrossRef
17.
go back to reference Toussaint B, Barth J, Charousset C, Godeneche A, Joudet T, Lefebvre Y, Nove-Josserand L, Petroff E, Solignac N, Hardy P, Scymanski C, Maynou C, Thelu CE, Boileau P, Graveleau N, Audebert S, French Arthroscopy S (2012) New endoscopic classification for subscapularis lesions. Orthop Traumatol surgery Res OTSR 98(8 Suppl):S186–S192. doi:10.1016/j.otsr.2012.10.003 CrossRefPubMed Toussaint B, Barth J, Charousset C, Godeneche A, Joudet T, Lefebvre Y, Nove-Josserand L, Petroff E, Solignac N, Hardy P, Scymanski C, Maynou C, Thelu CE, Boileau P, Graveleau N, Audebert S, French Arthroscopy S (2012) New endoscopic classification for subscapularis lesions. Orthop Traumatol surgery Res OTSR 98(8 Suppl):S186–S192. doi:10.​1016/​j.​otsr.​2012.​10.​003 CrossRefPubMed
18.
go back to reference Visona E, Cerciello S, Godeneche A, Neyton L, Fessy MH, Nove-Josserand L (2015) The “comma sign”: an anatomical investigation (dissection of the rotator interval in 14 cadaveric shoulders). Surg Radiol Anat SRA 37(7):793–798. doi:10.1007/s00276-015-1420-0 CrossRefPubMed Visona E, Cerciello S, Godeneche A, Neyton L, Fessy MH, Nove-Josserand L (2015) The “comma sign”: an anatomical investigation (dissection of the rotator interval in 14 cadaveric shoulders). Surg Radiol Anat SRA 37(7):793–798. doi:10.​1007/​s00276-015-1420-0 CrossRefPubMed
21.
go back to reference 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 Elb Surg 8(6):599–605CrossRef 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 Elb Surg 8(6):599–605CrossRef
23.
go back to reference Thomazeau H, Rolland Y, Lucas C, Duval JM, Langlais F (1996) Atrophy of the supraspinatus belly. Assessment by MRI in 55 patients with rotator cuff pathology. Acta Orthop Scand 67(3):264–268CrossRefPubMed Thomazeau H, Rolland Y, Lucas C, Duval JM, Langlais F (1996) Atrophy of the supraspinatus belly. Assessment by MRI in 55 patients with rotator cuff pathology. Acta Orthop Scand 67(3):264–268CrossRefPubMed
25.
go back to reference Habermeyer P, Magosch P, Pritsch M, Scheibel MT, Lichtenberg S (2004) Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. J Shoulder Elb Surg 13(1):5–12. doi:10.1016/S1058274603002568 CrossRef Habermeyer P, Magosch P, Pritsch M, Scheibel MT, Lichtenberg S (2004) Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. J Shoulder Elb Surg 13(1):5–12. doi:10.​1016/​S105827460300256​8 CrossRef
26.
go back to reference Matthews LS, Zarins B, Michael RH, Helfet DL (1985) Anterior portal selection for shoulder arthroscopy. Arthroscopy 1(1):33–39CrossRefPubMed Matthews LS, Zarins B, Michael RH, Helfet DL (1985) Anterior portal selection for shoulder arthroscopy. Arthroscopy 1(1):33–39CrossRefPubMed
29.
go back to reference Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164 Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164
30.
go back to reference Amstutz HC, Sew Hoy AL, Clarke IC (1981) UCLA anatomic total shoulder arthroplasty. Clin Orthop Relat Res 155:7–20 Amstutz HC, Sew Hoy AL, Clarke IC (1981) UCLA anatomic total shoulder arthroplasty. Clin Orthop Relat Res 155:7–20
31.
go back to reference Padua R, Padua L, Ceccarelli E, Romanini E, Zanoli G, Amadio PC, Campi A (2003) Italian version of the disability of the arm, shoulder and hand (DASH) questionnaire. Cross-cultural adaptation and validation. J Hand Surg 28(2):179–186CrossRef Padua R, Padua L, Ceccarelli E, Romanini E, Zanoli G, Amadio PC, Campi A (2003) Italian version of the disability of the arm, shoulder and hand (DASH) questionnaire. Cross-cultural adaptation and validation. J Hand Surg 28(2):179–186CrossRef
34.
35.
go back to reference Toussaint B, Audebert S, Barth J, Charousset C, Godeneche A, Joudet T, Lefebvre Y, Nove-Josserand L, Petroff E, Solignac N, Hardy P, Scymanski C, Maynou C, Thelu CE, Boileau P, Pitermann M, Graveleau N, French Arthroscopy S (2012) Arthroscopic repair of subscapularis tears: preliminary data from a prospective multicentre study. Orthop Traumatol Surg Res OTSR 98(8 Suppl):S193–S200. doi:10.1016/j.otsr.2012.10.004 CrossRefPubMed Toussaint B, Audebert S, Barth J, Charousset C, Godeneche A, Joudet T, Lefebvre Y, Nove-Josserand L, Petroff E, Solignac N, Hardy P, Scymanski C, Maynou C, Thelu CE, Boileau P, Pitermann M, Graveleau N, French Arthroscopy S (2012) Arthroscopic repair of subscapularis tears: preliminary data from a prospective multicentre study. Orthop Traumatol Surg Res OTSR 98(8 Suppl):S193–S200. doi:10.​1016/​j.​otsr.​2012.​10.​004 CrossRefPubMed
38.
go back to reference Lin L, Yan H, Xiao J, He Z, Luo H, Cheng X, Ao Y, Cui G (2016) The diagnostic value of magnetic resonance imaging for different types of subscapularis lesions. Knee Surg Sport Traumatol Arthrosc 7:2252–2258. doi:10.1007/s00167-014-3335-4 CrossRef Lin L, Yan H, Xiao J, He Z, Luo H, Cheng X, Ao Y, Cui G (2016) The diagnostic value of magnetic resonance imaging for different types of subscapularis lesions. Knee Surg Sport Traumatol Arthrosc 7:2252–2258. doi:10.​1007/​s00167-014-3335-4 CrossRef
39.
go back to reference Malavolta EA, Assuncao JH, Guglielmetti CL, de Souza FF, Gracitelli ME, Bordalo-Rodrigues M, Ferreira Neto AA (2016) Accuracy of preoperative MRI in the diagnosis of subscapularis tears. Arch Orthop Trauma Surg 136(10):1425–1430. doi:10.1007/s00402-016-2507-8 CrossRefPubMed Malavolta EA, Assuncao JH, Guglielmetti CL, de Souza FF, Gracitelli ME, Bordalo-Rodrigues M, Ferreira Neto AA (2016) Accuracy of preoperative MRI in the diagnosis of subscapularis tears. Arch Orthop Trauma Surg 136(10):1425–1430. doi:10.​1007/​s00402-016-2507-8 CrossRefPubMed
40.
go back to reference Ryu HY, Song SY, Yoo JC, Yun JY, Yoon YC (2016) Accuracy of sagittal oblique view in preoperative indirect magnetic resonance arthrography for diagnosis of tears involving the upper third of the subscapularis tendon. J Shoulder Elb Surg 25(12):1944–1953. doi:10.1016/j.jse.2016.02.038 CrossRef Ryu HY, Song SY, Yoo JC, Yun JY, Yoon YC (2016) Accuracy of sagittal oblique view in preoperative indirect magnetic resonance arthrography for diagnosis of tears involving the upper third of the subscapularis tendon. J Shoulder Elb Surg 25(12):1944–1953. doi:10.​1016/​j.​jse.​2016.​02.​038 CrossRef
41.
go back to reference Kim SJ, Jung M, Lee JH, Kim C, Chun YM (2014) Arthroscopic repair of anterosuperior rotator cuff tears: in-continuity technique vs. disruption of subscapularis-supraspinatus tear margin: comparison of clinical outcomes and structural integrity between the two techniques. J Bone Joint Surg Am 96(24):2056–2061. doi:10.2106/JBJS.N.00293 CrossRefPubMed Kim SJ, Jung M, Lee JH, Kim C, Chun YM (2014) Arthroscopic repair of anterosuperior rotator cuff tears: in-continuity technique vs. disruption of subscapularis-supraspinatus tear margin: comparison of clinical outcomes and structural integrity between the two techniques. J Bone Joint Surg Am 96(24):2056–2061. doi:10.​2106/​JBJS.​N.​00293 CrossRefPubMed
Metadata
Title
Orthopedic resident’s learning curve for arthroscopic subscapularis tendon repair: short-term clinical and radiographic outcomes
Authors
E. Visonà
S. Vio
G. Franceschi
A. Maron
K. Corona
S. Cerciello
G. Merolla
A. Berizzi
R. Aldegheri
Publication date
01-12-2017
Publisher
Springer Milan
Published in
MUSCULOSKELETAL SURGERY / Issue Special Issue 2/2017
Print ISSN: 2035-5106
Electronic ISSN: 2035-5114
DOI
https://doi.org/10.1007/s12306-017-0485-9

Other articles of this Special Issue 2/2017

MUSCULOSKELETAL SURGERY 2/2017 Go to the issue