Bilateral coracohumeral distance discrepancy is associated with subscapularis tear in rotator cuff rupture patients.

Abstract

To describe the bilateral coracohumeral morphological discrepancy in rotator cuff rupture patients with and without subscapularis (SSC) involvement and to investigate its association with SSC tears. Two hundred and thirteen consecutive patients who were scheduled to have arthroscopic rotator cuff repair were prospectively enrolled in the current study. Patients with acute traumatic rotator cuff rupture, glenohumeral osteoarthritis, bilateral rotator cuff rupture, recurrent shoulder instability, systemic inflammatory disease, and previous shoulder surgery history were excluded. Coracohumeral distance (CHD), coracoid overlap (CO), lesser tuberosity index (LTI) and acromiohumeral interval (AHI) were measured bilaterally using CT scans. Based on arthroscopic findings, patients were included in either the SSC tear group (n = 72) or the control group (n = 141). In the SSC tear group, the affected shoulder possessed a significantly smaller CHD [95% confidence interval (CI) 6.1-7.2 vs. 7.2-8.0mm, p < 0.0001], larger LTI (95% CI 9.4-9.9 vs. 9.0-9.6mm, p < 0.0001), and smaller AHI (95% CI 5.0-5.5 vs. 7.1-7.5mm, p < 0.0001) than the contralateral normal shoulder. In the control group, there was no significant difference between bilateral CHD and CO, and the AHI bilateral discrepancy was less distinct. CO did not differ significantly in the bilateral comparison in either group. Among all evaluated parameters, bilateral CHD discrepancy was the best predictor of SSC tears, with an area under the curve (AUC) of 0.882. A cutoff value of 0.5mm had a sensitivity of 76.4% and specificity of 99.3% for SSC tears. The CHD values are significantly different between affected and contralateral shoulders in SSC tear patients. Bilateral CHD discrepancy is closely associated with subcoracoid impingement and SSC tears, and its presence warrants specific intraoperative SSC inspection. Level II.