Department of Shoulder and Elbow Surgery, ATOS-Clinic, Heidelberg, Germany.
Am J Sports Med. 2011 Mar;39(3):490-6. doi: 10.1177/0363546510388166. Epub 2010 Dec 28.
Diagnosis, operative treatment, and outcome assessment of isolated traumatic subscapularis tendon tears have not been widely studied.
To report the clinical outcome, value of clinical tests, predictive outcome factors, and return to sports in the management of isolated traumatic subscapularis tendon tears.
Case series; level of evidence, 4.
Thirty consecutive patients with a confirmed isolated subscapularis tear, except for associated biceps tendon injury or humeral avulsion of the glenohumeral ligaments (HAGL) lesions, found at arthroscopy were included in the study. The average age of the study population was 43.1 years. In all 30 patients, a traumatic event caused the onset of symptoms. The mean delay between trauma and surgery was 4 months. All patients underwent open tendon reconstruction with a suture anchor technique via a deltopectoral approach. Clinical assessment was done using the Constant score and specific subscapularis tests. Postoperative tendon integrity was assessed with ultrasound and magnetic resonance imaging. Sports activity, including competition level, sports discipline, and postoperative return to sports, was evaluated.
The average duration of follow-up was 46 months (range, 25-72 months). Seven patients had a full-thickness tear of the upper third of the tendon, 11 patients a full-thickness tear of the upper two-thirds of the tendon, and 12 patients had a complete subscapularis tendon tear. The Constant score increased from 51.3 preoperatively to 82.2 postoperatively (P < .01). Twenty-seven patients rated their postoperative result as excellent or good. Most positive preoperative lift-off and belly-press tests were reversed by surgery, with a rate of 6 (20%) persistent positive tests after surgery. Positive postoperative subscapularis tests were more likely related to a higher preoperative degree of fatty subscapularis muscle infiltration (P < .05). Ultrasound and magnetic resonance imaging revealed a structural intact repair at follow-up in 28 shoulders (93%). Seventy-five percent of athletes returned to their previous competition level.
Early repair of isolated traumatic subscapularis tendon tears and associated biceps tendon lesions or HAGL lesions achieves good functional outcomes with a low re-rupture rate and allows return to sports activity. Delay of surgery and higher degrees of preoperative fatty infiltration of the subscapularis muscle impair postoperative subscapularis function.
孤立性创伤性肩胛下肌腱撕裂的诊断、手术治疗和预后评估尚未得到广泛研究。
报告肩胛下肌腱撕裂的管理中临床结果、临床检查的价值、预测预后因素和重返运动情况。
病例系列；证据水平，4 级。
本研究纳入了 30 例连续确诊的孤立性肩胛下肌腱撕裂患者，这些患者除外合并肱二头肌肌腱损伤或盂肱上韧带（HAGL）撕裂的肩袖撕裂。研究人群的平均年龄为 43.1 岁。所有 30 例患者均因创伤性事件导致症状发作。创伤与手术之间的平均时间间隔为 4 个月。所有患者均通过经三角肌胸大肌入路的缝合锚钉技术行开放性肌腱重建。采用 Constant 评分和特定肩胛下肌检查进行临床评估。术后通过超声和磁共振成像评估肌腱完整性。评估运动活动，包括比赛水平、运动学科和术后重返运动情况。
平均随访时间为 46 个月（范围，25-72 个月）。7 例患者为肌腱上 1/3 全层撕裂，11 例患者为肌腱上 2/3 全层撕裂，12 例患者为肩胛下肌腱完全撕裂。Constant 评分由术前的 51.3 分提高到术后的 82.2 分（P <.01）。27 例患者将术后结果评为优或良。大多数术前阳性的“抬离试验”和“腹壁加压试验”在手术后得到逆转，术后仍有 6 例（20%）持续为阳性。术后肩胛下肌试验阳性更可能与术前肩胛下肌脂肪浸润程度较高相关（P <.05）。超声和磁共振成像在随访时显示 28 例（93%）肩结构完整修复。75%的运动员恢复到以前的比赛水平。
早期修复孤立性创伤性肩胛下肌腱撕裂和合并肱二头肌肌腱损伤或 HAGL 撕裂可获得良好的功能结果，且再断裂率低，允许重返运动。手术延迟和术前肩胛下肌脂肪浸润程度较高会损害术后肩胛下肌功能。
