Ten-year clinical and anatomic follow-up after repair of anterosuperior rotator cuff tears: influence of the subscapularis

• Published in: Journal of shoulder and elbow surgery Vol. 26; no. 10; pp. 1826 - 1833
• Main Authors: Nové-Josserand, Laurent, MD, Collin, Philippe, MD, Godenèche, Arnaud, MD, Walch, Gilles, MD, Meyer, Nicolas, MD, PhD, Kempf, Jean-Francois, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2017; Elsevier
• Subjects: Adult; Aged; anterosuperior; Computer Science; fatty infiltration; Female; Follow-Up Studies; Humans; Image Processing; long-term follow-up; Magnetic Resonance Imaging; Male; Middle Aged; Orthopedics; Prognosis; repair; rotator cuff; Rotator Cuff - pathology; Rotator Cuff Injuries - diagnosis; Rotator Cuff Injuries - surgery; Shoulder; subscapularis; supraspinatus; Time Factors; Wound Healing; Treatment Study; repair; subscapularis; fatty infiltration; rotator cuff; Shoulder; long-term follow-up; supraspinatus; Retrospective Cohort Design; Level III; anterosuperior
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2017.03.037

Background Anterosuperior rotator cuff tears are more frequent than expected. We report the results of a 10-year follow-up study after repair. Our hypothesis was that the extent of the subscapularis tear influenced the prognosis. Materials and methods The study population consisted of all 138 patients who underwent surgery in 14 participating centers in 2003 for full-thickness tears of the rotator cuff with lesions in the subscapularis and supraspinatus tendons. The patients were divided into 2 groups, depending on whether the subscapularis lesion affected only the superior half of the tendon (group A) or extended into the lower half (group B). Ninety-two patients (56 ± 7 years; 71 in group A and 21 in group B) were available for follow-up after 10 years (127 ± 16 months) with magnetic resonance imaging to evaluate tendon healing and muscle condition. Results The mean Constant scores were 59 ± 16 before surgery and 77 ± 14 at follow-up ( P  = 1.7 × 10−12 ). The retear rates were 25% for the supraspinatus and 13.5% for the subscapularis tendon. The clinical results for group A patients were better than those for group B. Severe fatty infiltration was observed more frequently in the subscapularis than in the supraspinatus muscle (27% vs. 12% of cases). Supraspinatus healing influenced subscapularis healing and fatty infiltration. Conclusions Repair of anterosuperior rotator cuff tears is satisfactory at 10 years, particularly if the subscapularis tear is not extensive. An extensive subscapularis tear is a negative prognosis factor. Postoperatively, fatty infiltration of the subscapularis muscle was frequently observed despite tendon healing.