Abstract
BackgroundThe postoperative integrity of the subscapularis tendon after primary anatomical shoulder arthroplasty has a significant effect on postoperative results. A transosseus Single Row Refixation technique (SRR) has shown up to 30% of partial tears in literature, a modified Double Row Refixation technique (DRR) has biomechanically shown a significantly reduced tear rate, but is yet to be proven in a clinical setting. Thus, we compared the SRR to the DRR technique using clinical outcome parameters and ultrasound examination.Materials and methods36 patients (40 shoulders; 20f, 16 m; øage: 66 years) were included in our retrospective cohort study. 20 shoulders were treated with the SRR technique (12f, 8 m; FU ø40.9 months) and 20 with the DRR technique (11f, 9 m; FU ø31.6 months). The SRR was performed with three to five transosseus mattress sutures. DRR consisted of two medial placed transosseus sutures and four laterally placed single tendon-to-tendon sutures. The postoperative subscapularis integrity was evaluated by ultrasound examination, the clinical outcome was assessed with the Constant–Murley Score (CS) and the American Shoulder and Elbow Surgeons Score (ASES).ResultsThe subscapularis tendon was intact in 14 patients (70%) after SRR, whereas 18 patients (90%) treated with the DRR demonstrated a sonographically intact postoperative subscapularis tendon. The CS was 61.4 points in the SRR cohort and 67.3 points in the DRR cohort (p = 0.314). No significant differences were found in both cohorts preoperative (øSRR: 21.3 points; øDRR: 16.2 points, p = 0.720) and postoperative absolute ASES Scores (øSRR: 70.2 points; øDRR: 73.0 points, p = 0.792). However, the DRR cohort showed a statistical tendency to a higher postoperative ASES increase than the SRR cohort (øSRR-ASES increase: 48.9 points; øDRR-ASES increase: 56.8 points, p = 0.067).ConclusionThe results of this study show that application of the DRR technique can significantly reduce the total rate of postoperative subscapularis tears what effects a clinical tendency towards higher ASES improvements and a better range of motion compared to the SRR technique.
Highlights
Shoulder arthroplasty has become a widely used and acknowledged procedure with good to excellent mid- to long-term results for patients with primary or secondary glenohumeral osteoarthritis [20, 22]
We conducted this study to compare our earlier results with the Single Row Refixation technique (SRR) technique to the Double Row Refixation technique (DRR) technique regarding the postoperative integrity of the subscapularis tendon and the subsequent clinical outcome
The hypothesis of this study was that the DRR technique would result in a higher rate of intact subscapularis tendons after anatomic shoulder arthroplasty and provide at least good clinical results
Summary
Shoulder arthroplasty has become a widely used and acknowledged procedure with good to excellent mid- to long-term results for patients with primary or secondary glenohumeral osteoarthritis [20, 22]. In an effort to improve structural integrity of the SRR, the Double Row Refixation (DRR) was biomechanically introduced by Ahmad et al [1] Their cadaveric study presents a significantly higher fixation strength of the DRR technique under cyclic loading compared to the simple transosseus SRR technique. We conducted this study to compare our earlier results with the SRR technique to the DRR technique regarding the postoperative integrity of the subscapularis tendon and the subsequent clinical outcome. Conclusion The results of this study show that application of the DRR technique can significantly reduce the total rate of postoperative subscapularis tears what effects a clinical tendency towards higher ASES improvements and a better range of motion compared to the SRR technique
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