Kapilan Shri, Nabergoj Marko, Lädermann Alexandre, Collin Philippe
CHP Saint Grégoire, 6 Boulevard de la Boutière, 35760 Saint-Grégoire, France.
Institut Locomoteur de l'Ouest (ILO), 35760 Saint-Grégoire, France.
J Clin Med. 2025 Jan 10;14(2):416. doi: 10.3390/jcm14020416.
The importance of the subscapularis tendon in reverse shoulder arthroplasty (RSA) has been increasingly emphasized lately. Recent studies have indicated that a repaired subscapularis tendon has better functional outcomes. This study is aimed at comparing the healing rate of repaired subscapularis tendons between onlay and inlay Bony Increased Offset-Reversed Shoulder Arthroplasty (BIO-RSA). This retrospective comparative review covers all patients who underwent BIO-RSA at a single center, comprising 189 cases performed by on a single surgeon from January 2012 till December 2021. We included all patients who underwent subscapularis tenotomy repair and who had a tendon ultrasound (US) examination at six months postoperatively (as requested in this single surgeon's usual protocol). These patients were divided into two comparable groups, an onlay group and an inlay group. Healing status was determined using the Sugaya classification, with healed subscapularis tendons defined as having Sugaya type I-III integrity and the unhealed tendons as having Sugaya type IV and V integrity. In total, 2 patients were excluded because ultrasound was not performed (they missed their appointment); 187 patients were evaluated; 98 patients underwent an onlay BIO-RSA; and 89 patients underwent an inlay BIO-RSA. The healing rate of the repaired subscapularis tendon was 73% in the onlay group and 56% in the inlay one ( = 0.020). The onlay systems may enhance subscapularis tendon healing compared to the inlay one, possibly due to the preserved intramedullary vascularity and the near-normal tendon excursion that can be achieved by the onlay system. Choosing an onlay design can minimize bone cuts during RSA, while achieving good subscapularis tendon healing.
近年来，肩胛下肌腱在反式肩关节置换术（RSA）中的重要性日益受到重视。近期研究表明，修复后的肩胛下肌腱功能预后更佳。本研究旨在比较覆盖式与嵌入式骨增量反式肩关节置换术（BIO-RSA）中肩胛下肌腱的修复愈合率。本回顾性比较研究涵盖了在单一中心接受BIO-RSA手术的所有患者，共189例，均由同一外科医生于2012年1月至2021年12月期间完成。我们纳入了所有接受肩胛下肌肌腱切断修复且术后六个月进行了肌腱超声（US）检查的患者（按照该外科医生的常规方案要求）。这些患者被分为两个可比组，即覆盖组和嵌入组。使用Sugaya分类法确定愈合状态，愈合的肩胛下肌腱定义为具有Sugaya I-III型完整性，未愈合的肌腱定义为具有Sugaya IV和V型完整性。共有2例患者因未进行超声检查（错过预约）被排除；187例患者接受评估；98例患者接受了覆盖式BIO-RSA手术；89例患者接受了嵌入式BIO-RSA手术。覆盖组修复后的肩胛下肌腱愈合率为73%，嵌入组为56%（ = 0.020）。与嵌入系统相比，覆盖系统可能会提高肩胛下肌腱的愈合率，这可能是由于覆盖系统保留了髓内血管以及可实现接近正常的肌腱活动度。选择覆盖式设计可在RSA手术中减少骨切割，同时实现良好的肩胛下肌腱愈合。
