Outcomes of Open and Arthroscopic Subscapularis Repairs (SS-18)

Abstract

Introduction Injury to the subscapularis tendon can be a cause of significant shoulder dysfunction. Diagnosis can be complex and therefore may be delayed. There is minimal literature on outcomes seen after subscapularis repair but some studies suggest shoulder function after rotator cuff repair is poorer in the setting of subscapularis repair. We present one-year minimum follow-up of a series of both arthroscopic and open subscapularis repairs. Methods We retrospectively reviewed 39 patients with one year follow-up after open or arthroscopic repair of a full-thickness subscapularis tear. Tear size (upper third, upper half, or entire subscapularis tendon) and pattern were recorded and any concomitant procedures documented. Preoperative and postoperative physical exams were completed including range of motion and the presence or absence of an abnormal stomach press. ASES and Constant scores were completed at 1 year by 24 of the total 39 patients. Results An open repair was performed in 17 patients and an arthroscopic repair in 22 patients. Average follow-up was 29 months (range 12-75 months). At most recent postoperative follow-up, the average active range of motion was forward elevation to 140 degrees, external rotation to 53 degrees, and internal rotation to T10. There was no significant difference in postoperative motion between open and arthroscopic repairs. Of those patients with an abnormal stomach press preoperatively, 48% continued to demonstrate an abnormal stomach press at latest follow-up. In those completing subjective outcome scores, the average ASES score was 76 and average Constant score was 73. There was no difference in range of motion, ASES, or Constant scores based on size of tear. Conclusion Outcomes of open and arthroscopic subscapularis repairs were equivalent. In addition, tear size was not predictive of outcome suggesting even complete subscapularis tears may do well after either open or arthroscopic repair. Though a complete repair was performed in all patients, nearly half of patients with an abnormal stomach press preoperatively were unable to perform a normal test postoperatively. Injury to the subscapularis tendon can be a cause of significant shoulder dysfunction. Diagnosis can be complex and therefore may be delayed. There is minimal literature on outcomes seen after subscapularis repair but some studies suggest shoulder function after rotator cuff repair is poorer in the setting of subscapularis repair. We present one-year minimum follow-up of a series of both arthroscopic and open subscapularis repairs. We retrospectively reviewed 39 patients with one year follow-up after open or arthroscopic repair of a full-thickness subscapularis tear. Tear size (upper third, upper half, or entire subscapularis tendon) and pattern were recorded and any concomitant procedures documented. Preoperative and postoperative physical exams were completed including range of motion and the presence or absence of an abnormal stomach press. ASES and Constant scores were completed at 1 year by 24 of the total 39 patients. An open repair was performed in 17 patients and an arthroscopic repair in 22 patients. Average follow-up was 29 months (range 12-75 months). At most recent postoperative follow-up, the average active range of motion was forward elevation to 140 degrees, external rotation to 53 degrees, and internal rotation to T10. There was no significant difference in postoperative motion between open and arthroscopic repairs. Of those patients with an abnormal stomach press preoperatively, 48% continued to demonstrate an abnormal stomach press at latest follow-up. In those completing subjective outcome scores, the average ASES score was 76 and average Constant score was 73. There was no difference in range of motion, ASES, or Constant scores based on size of tear. Outcomes of open and arthroscopic subscapularis repairs were equivalent. In addition, tear size was not predictive of outcome suggesting even complete subscapularis tears may do well after either open or arthroscopic repair. Though a complete repair was performed in all patients, nearly half of patients with an abnormal stomach press preoperatively were unable to perform a normal test postoperatively.