Department of Orthopaedics and Traumatology, Izmir Bakırcay University, Izmir, Turkey.
Department of Shoulder Surgery, Oregon Shoulder Institute, Medford, Oregon, USA.
Am J Sports Med. 2024 Jul;52(8):2071-2081. doi: 10.1177/03635465241254029. Epub 2024 Jun 16.
Previous research has emphasized the effect of prognostic factors on arthroscopic rotator cuff repair (ARCR) success, but a specific focus on subscapularis (SSC) tendon repair healing is lacking.
To identify prognostic factors for SSC healing after ARCR and develop the Subscapularis Healing Index (SSC-HI) by incorporating these factors.
Case-control study; Level of evidence, 3.
This was a retrospective study using prospectively maintained data collected from patients with isolated or combined SSC tears who underwent ARCR between 2011 and 2021 at a single institution with a minimum 2-year follow-up. Functional outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), and visual analog scale (VAS) pain scale. SSC tendon healing was evaluated via ultrasound at the final follow-up. Multivariate logistic regression analysis was performed to determine the factors affecting SSC healing, and based on these factors, the SSC-HI, which ranges from 0 to 15 points, was developed using odds ratios (ORs).
Among 1018 ARCR patients, 931 met the inclusion criteria; 279 returned voluntarily for postoperative SSC ultrasound assessment. The overall healing failure rate was 10.8% (30/279). Risk factors for healing failure included female sex ( = .008; OR, 3.119), body mass index (BMI) ≥30 ( = .053; OR, 2.323), supraspinatus fatty infiltration ≥3 ( = .033; OR, 3.211), lower SSC fatty infiltration ≥2 ( = .037; OR, 3.608), and Lafosse classification ≥3 ( = .007; OR, 3.224). A 15-point scoring system comprised the following: 3 points for female sex, 2 points for BMI ≥30, 3 points for supraspinatus fatty infiltration ≥3, 4 points for lower SSC fatty infiltration ≥2, and 3 points for Lafosse classification ≥3. Patients with ≤4 points had a 4% healing failure rate, while those with ≥9 points had a 55% rate of healing failure. Patients with a healed SSC reported significantly higher ASES (healed SSC: ΔASES, 44.7; unhealed SSC: ΔASES, 29; < .01) and SSV (healed SSC: ΔSSV, 52.9; unhealed SSC: ΔSSV, 27.5; < .01) and lower VAS (healed SSC: ΔVAS, -4.2; unhealed SSC: ΔVAS, -3; < .01) scores compared with those with an unhealed SSC.
The SSC-HI scoring system integrates clinical and radiological factors to predict SSC healing after surgical repair. Successful SSC healing was found to be associated with enhanced functional outcomes, underscoring the clinical relevance of SSC healing prediction in the management of these tears.
先前的研究强调了预后因素对关节镜下肩袖修复（ARCR）成功的影响，但缺乏对肩胛下肌（SSC）肌腱修复愈合的具体关注。
确定 ARCR 后 SSC 愈合的预后因素，并通过纳入这些因素来制定肩胛下肌愈合指数（SSC-HI）。
病例对照研究；证据水平，3 级。
这是一项回顾性研究，使用前瞻性维护的数据，这些数据来自于 2011 年至 2021 年在一家单机构接受 ARCR 的单独或合并 SSC 撕裂的患者，随访时间至少 2 年。使用美国肩肘外科医生（ASES）评分、主观肩部值（SSV）和视觉模拟量表（VAS）疼痛量表评估功能结果。在最后一次随访时通过超声评估 SSC 肌腱愈合情况。采用多变量逻辑回归分析确定影响 SSC 愈合的因素，并基于这些因素，使用比值比（OR）开发 SSC-HI，范围为 0 至 15 分。
在 1018 例 ARCR 患者中，931 例符合纳入标准；279 例自愿返回接受术后 SSC 超声评估。总的愈合失败率为 10.8%（30/279）。愈合失败的危险因素包括女性（ =.008；OR，3.119）、BMI≥30（ =.053；OR，2.323）、冈上肌脂肪浸润≥3（ =.033；OR，3.211）、下 SSC 脂肪浸润≥2（ =.037；OR，3.608）和 Lafosse 分类≥3（ =.007；OR，3.224）。15 分评分系统包括：3 分女性，2 分 BMI≥30，3 分冈上肌脂肪浸润≥3，4 分下 SSC 脂肪浸润≥2，3 分 Lafosse 分类≥3。得分≤4 分的患者愈合失败率为 4%，而得分≥9 分的患者愈合失败率为 55%。愈合的 SSC 患者报告的 ASES（愈合的 SSC：ΔASES，44.7；未愈合的 SSC：ΔASES，29； ＜.01）和 SSV（愈合的 SSC：ΔSSV，52.9；未愈合的 SSC：ΔSSV，27.5； ＜.01）评分以及 VAS（愈合的 SSC：ΔVAS，-4.2；未愈合的 SSC：ΔVAS，-3； ＜.01）评分明显高于未愈合的 SSC 患者。
SSC-HI 评分系统整合了临床和影像学因素，以预测手术修复后 SSC 的愈合。成功的 SSC 愈合与功能结果的改善有关，这突显了 SSC 愈合预测在这些撕裂管理中的临床相关性。
