Open repair of isolated traumatic subscapularis tendon tears with a synthetic soft tissue reinforcement

Abstract

Missed or chronic subscapularis tendon ruptures may have muscle atrophy and tendon retraction resulting in a large defect with high risk of re-tear after a surgical repair. To improve the clinical results of this challenging surgery, the repaired tendon could be augmented with endogenous or exogenous materials. The purpose of this study was to evaluate the structural tendon integrity and clinical outcomes after an open subscapularis tendon repair with a synthetic soft tissue reinforcement. Ten patients were managed with an open repair of the subscapularis tendon with augmentation by means of SportMesh, a readily available synthetic degradable poly(urethaneurea) scaffold. Clinical findings were assessed for all patients preoperatively and postoperatively with use of the visual analog scale for pain and the DASH scoring system. All patients had an ultrasonographic study at the latest follow-up. The visual analog scale for pain (mean±standard deviation) improved significantly (P<0.01) from 7.9±1.1 preoperatively to 1.95±1.85 at the latest clinical follow-up evaluation. The mean DASH score at the latest clinical follow-up was 12.63%. Ultrasound imaging revealed a structural intact repair at follow-up in 9 shoulders (90%) with average 5.4mm in thickness (4.3mm in the contralateral healthy side). At a median follow-up of 23months, 80% (8 of 10) of patients had a good or excellent result after an open subscapularis tendon repair with a soft tissue reinforcement. As a synthetic material, SportMesh Soft Tissue Reinforcement eliminates the risk of collagen reactions, which may result from collagen or dermis patches. Although the follow-up is relatively short, our series shows a promising durable repair with a 10% re-tear rate at an average of 23 postoperative months. Level of evidence Case Series, Treatment Study, Level IV.