Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Am J Sports Med. 2023 Nov;51(13):3383-3392. doi: 10.1177/03635465231203702. Epub 2023 Oct 17.
Long-term studies on arthroscopic repair of large subscapularis (SSC) tears over the first facet with or without supraspinatus (SSP) tear are limited.
To assess the structural and clinical outcomes of arthroscopic repair of large SSC tears using magnetic resonance imaging (MRI) and identify the factors related to SSC retear and poor outcomes.
Case series; Level of evidence, 4.
This study involved 109 patients (84.0 ± 36.2 months of follow-up) who underwent arthroscopic repair of large SSC tears (Yoo and Rhee classification type III [n = 81] or IV [n = 28]) between 2011 and 2019. All patients underwent MRI at 6.1 ± 0.4 months after surgery, and 79 of 109 patients (72.5%) were followed up over 7 years. Clinical outcomes (active range of motion, functional scores, and belly press strength) and final poor clinical outcomes (reoperation, osteoarthritic change, and poor clinical outcome) were recorded. SSP tear size, rotator cuff atrophy and fatty infiltration (Goutallier classification), SSC tendon integrity (intact, intermediate, definite tear), and SSP tendon integrity (Sugaya classification) were evaluated by MRI.
The overall SSC retear rate was 8.3% (9/109) (type III, 2/81 [2.5%]; type IV, 7/28 [25.0%]; < .001). SSC Goutallier grade 4 showed a higher retear rate than grade 3 (7/33 [21.2%] vs 2/33 [6.1%]; = .149). A large SSP tear (in millimeters) (odds ratio [OR], 1.5; = .003), SSC Goutallier grade 4 (OR, 10.8; = .047), and SSP Goutallier grade 3 or 4 (OR, 0.02; = .013) were independent factors for SSC retear. Clinical outcomes, except for external rotation, were poorer in patients with SSC retear than in those without retear. Final poor clinical outcomes were observed in 27 of 79 patients (34.2%); female sex (OR, 7.7; = .007), SSC retear (OR, 8.2; = .025), and SSP retear (OR, 4.7; = .031) were independent factors.
Arthroscopic repair of large SSC tears has shown promising structural outcomes for type III tears but not type IV tears. SSC retear was affected by SSC atrophy, as well as SSP tear size and atrophy. Approximately one-third of the final poor clinical outcomes could be predicted, and SSC retear, SSP retear, and female sex were associated with long-term poor clinical outcomes, underscoring the importance of carefully selecting patients for arthroscopic repair of large SSC tears.
对于伴有或不伴有冈上肌（SSP）撕裂的第一关节面的大型肩胛下肌（SSC）撕裂的关节镜修复的长期研究有限。
使用磁共振成像（MRI）评估大型 SSC 撕裂的关节镜修复的结构和临床结果，并确定与 SSC 再撕裂和不良结果相关的因素。
病例系列；证据水平，4 级。
这项研究涉及 109 名患者（84.0±36.2 个月的随访），他们在 2011 年至 2019 年间接受了大型 SSC 撕裂（Yoo 和 Rhee 分类 III 型[n=81]或 IV 型[n=28]）的关节镜修复。所有患者在手术后 6.1±0.4 个月接受 MRI 检查，109 名患者中有 79 名（72.5%）随访超过 7 年。记录临床结果（主动活动范围、功能评分和腹部按压强度）和最终不良临床结果（再次手术、骨关节炎改变和不良临床结果）。通过 MRI 评估 SSP 撕裂大小、肩袖萎缩和脂肪浸润（Goutallier 分类）、SSC 肌腱完整性（完整、中间、明确撕裂）和 SSP 肌腱完整性（Sugaya 分类）。
总的 SSC 再撕裂率为 8.3%（9/109）（III 型，2/81[2.5%]；IV 型，7/28[25.0%]；<0.001）。SSC Goutallier 分级 4 的再撕裂率高于分级 3（7/33[21.2%]比 2/33[6.1%]；=0.149）。较大的 SSP 撕裂（毫米）（比值比[OR]，1.5；=0.003）、SSC Goutallier 分级 4（OR，10.8；=0.047）和 SSP Goutallier 分级 3 或 4（OR，0.02；=0.013）是 SSC 再撕裂的独立因素。与无再撕裂的患者相比，有 SSC 再撕裂的患者的临床结果（除了外旋）更差。79 名患者中有 27 名（34.2%）最终出现不良临床结果；女性（OR，7.7；=0.007）、SSC 再撕裂（OR，8.2；=0.025）和 SSP 再撕裂（OR，4.7；=0.031）是独立的因素。
对于 III 型撕裂，关节镜修复大型 SSC 撕裂显示出有希望的结构结果，但对于 IV 型撕裂则不然。SSC 再撕裂受 SSC 萎缩以及 SSP 撕裂大小和萎缩的影响。大约三分之一的最终不良临床结果可以预测，SSC 再撕裂、SSP 再撕裂和女性是与长期不良临床结果相关的因素，这强调了在选择接受大型 SSC 撕裂关节镜修复的患者时要谨慎。
