Higher Upper Subscapularis Goutallier Grade and Coracohumeral Distance Narrowing Are Predictive of Subscapularis Tears in Patients Undergoing Arthroscopic Rotator Cuff Repair

Abstract

PurposeThe primary objective of this study was to evaluate the relationship between subscapularis (SSC) Goutallier grade and coracohumeral distance (CHD) and SSC tears. The second aim was to evaluate the relationship between these radiographic variables and long head biceps tendon (LHBT) lesions. MethodsA retrospective analysis was conducted on prospectively maintained data on patients who underwent arthroscopic rotator cuff repair (ARCR) of SSC tears between 2011 and 2021 with at least 6 months of follow-up. Patients with identified subscapularis tears during arthroscopy were included. A control group was established by randomly selecting patients without SSC tears from the same study period. Goutallier grading and CHD were obtained from preoperative magnetic resonance imaging (MRI) scans. Receiver operating characteristic (ROC) analysis was conducted to define optimal cutoff values for these diagnostic measures. ResultsThe study included 735 patients with SSC tears and 249 patients in the control group. Comparing subscapularis tear and intact groups' Goutallier grades revealed significant differences in infraspinatus, upper and lower SSC, and overall SSC (p<0.001). No significant difference was detected in supraspinatus Goutallier grade (p=0.364). A SSC tear was observed in 58.3% (n=265) of patients with Goutallier grade 0 of the upper SSC, 77.1% (n=195) of patients with grade 1 changes, 98.7% (n=155) with grade 2 changes, and 100% of grade 3 or 4 changes. Goutallier grade of the upper SSC showed a significant correlation with tear size (rs=0.533; p<0.01). CHD measurements were lower in individuals with SSC tears compared to those without tears (6.6 ± 1.7 vs 9.6 ± 1.8; p<0.001). Upper SSC Goutallier grade >1 had an acceptable area under the curve (AUC) of 0.742. In CHD of 7.96 mm or less had an excellent predictive AUC of 0.879. ConclusionHigher Goutallier grade and CHD narrowing are potential associations predictive of SSC tears. Routine MRI assessment of muscle of the upper SSC and the CHD can contribute to the diagnostic accuracy of SSC tears and offer valuable information regarding the severity of such tears. Level of EvidenceLevel III, diagnostic study