[논문]Clinical and Structural Outcomes of Arthroscopic Intraarticular Knotless Fixation for Upper Subscapularis Tendon Tears: A Preliminary Report

Cho, Nam Su; Shim, Hee Seok; Nam, Ju Hyun; Rhee, Yong Girl

doi:10.5397/cise.2016.19.3.130

Clinical and Structural Outcomes of Arthroscopic Intraarticular Knotless Fixation for Upper Subscapularis Tendon Tears: A Preliminary Report 원문보기

Clinics in shoulder and elbow, v.19 no.3, 2016년, pp.130 - 136

Cho, Nam Su (Shoulder & Elbow Clinic, Department of Orthopedic Surgery, College of Medicine, Kyung Hee University) , Shim, Hee Seok (Shoulder & Elbow Clinic, Department of Orthopedic Surgery, College of Medicine, Kyung Hee University) , Nam, Ju Hyun (Shoulder & Elbow Clinic, Department of Orthopedic Surgery, College of Medicine, Kyung Hee University) , Rhee, Yong Girl (Shoulder & Elbow Clinic, Department of Orthopedic Surgery, College of Medicine, Kyung Hee University)

Abstract ▼ AI-Helper

Background: A novel technique for the repair of tears of the upper subscapularis tendon-intraarticular knotless fixation-has been introduced recently. The purpose of this study was to evaluate the clinical and structural outcomes of arthroscopic intraarticular knotless fixation for the treatment of upper subscapularis tendon tears. Methods: We retrospectively analyzed the clinical and radiological outcomes of 27 patients who underwent arthroscopic intraarticular knotless fixation for upper subscapularis tendon tears. Finally, a total of 10 patients who could participate in at least a 6 month follow-up of magnetic resonance imaging evaluation and in a least 1-year follow-up on an outpatient basis were enrolled in our study. The mean age at the time of operation was 60.7 years, and the mean duration of follow-up was 14.7 months. Two patients had concomitant tears of the supraspinatus tendon and 8 patients had concomitant tears of the supraspinatus and the infraspinatus tendons. Results: The clinical and radiological outcomes improved after the patients had undertaken arthroscopic intraarticular knotless fixation. The mean visual analogue scale score for pain during motion improved from 6.7 preoperatively to 1.4 at the final follow-up (p<0.001). The mean Constant score improved from 59.3 preoperatively to 79.6 at the final follow-up, and the mean the University of California at Los Angeles score, from 21.7 to 30.2, respectively (p<0.001 and p<0.001). The upper subscapularis tendon tear was healed in every patient except one (90%), for the patient had suffered from a postoperative trauma that resulted in a retear. Conclusions: We found that arthroscopic intraarticular knotless fixation gives good clinical and structural outcomes for the repair of upper subscapularis tendon tears. Arthroscopic intraarticular knotless fixation provided such a reliable and efficient restoration of the subscapularis tendon footprint that we anticipate it will become a widely-used procedure for upper subscapularis tendon tears.

주제어

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문제 정의

The purpose of this study was to evaluate the short-term clinical and functional outcomes of knotless repairs for upper subscapularis tendon tears. We hypothesized that the outcomes of arthroscopic intraarticular knotless fixation for an upper subscapularis tears, specifically clinical outcome and retear rate that are reported in the literature, will be equivalent to those of arthroscopic knot tying repair.

가설 설정

The purpose of the present study was to fill this gap in our knowledge by evaluating the clinical and structural outcomes of arthroscopic intraarticular knotless fixation for upper subscapularis tendon tears. We hypothesized that this mode of treatment for upper subscapularis tendon tears would be effective, in terms of clinical outcome and retear rate, at a level comparable to that of arthroscopic knot tying reported in the literature.

제안 방법

At the last follow-up we asked patients to take a subjective satisfaction survey and using that assessed the patient’s selfsurveyed satisfaction score.
Our study has few limitations. First, although our data were collected through a prospective approach, our findings are based on a retrospective analysis of data. Second, because only patients who partook in at least a 6 month follow-up of MRI examination and in more than a year follow-up on an outpatient basis were included in our study, there is potential for selection bias in our method of patient recruitment.
We carried out the belly press test and the lift-off test. From the preand postoperative values derived from these examinations, we made a comparative analysis between the preoperative and the last follow-up results. The Constant score,¹⁵⁾ the Shoulder Rating Scale of the University of California at Los Angeles (UCLA),¹⁶⁾ and the patient satisfaction score were used for the clinical assessment of the patients.
The following exclusion criteria was applied: patients with a larger than type IIb tear or a more retracted subscapularis tear, acromioclavicular arthritis that required distal clavicle resection, advanced glenohumeral arthritis, rotator cuff tears that involved workers’ compensation claim, and undergoing revision procedures.
All preoperative evaluations were performed a day before operation, and postoperative evaluations were performed regularly on an outpatient basis. The patients were evaluated for several physical examinations. We assessed the subjective pain score using the visual analogue scale (VAS).
The purpose of the present study was to fill this gap in our knowledge by evaluating the clinical and structural outcomes of arthroscopic intraarticular knotless fixation for upper subscapularis tendon tears. We hypothesized that this mode of treatment for upper subscapularis tendon tears would be effective, in terms of clinical outcome and retear rate, at a level comparable to that of arthroscopic knot tying reported in the literature.
To assess the impact of intraarticular knotless fixation on clinical factors, we assessed the change in clinical variables before and after the operation using the Constant score and the UCLA score. At the last follow-up we asked patients to take a subjective satisfaction survey and using that assessed the patient’s selfsurveyed satisfaction score.
001, respectively). To evaluate the impact of intraarticular knotless fixation on subscapularis function, we measured the subscapularis strength of the patients preoperatively and postoperatively using the belly-press test and the lift-off test. We found that the proportion of patients with a positive outcome for the belly-press test, which is indicative of poor subscapularis strength, decreased from 60% preoperatively to 0% at the last follow-up (p<0.
We measured the following shoulder range of motions (ROM): forward flexion, external rotation at the side, internal rotation to the back, and abduction. We carried out the belly press test and the lift-off test. From the preand postoperative values derived from these examinations, we made a comparative analysis between the preoperative and the last follow-up results.

대상 데이터

2. Arthroscopic images from a 62-yearold male patient. (A) A partial articular-sided tear of the upper subscapularis tendon can be seen.
5-T unit (Signa; GE Medical Systems, Chicago, IL, USA) by use of routine pulse sequences. The radiographic images were reviewed by an experienced senior radiologist who was informed that the patients had undergone a cuff repair but was blinded to the size and to the location of the tear. Continuity and re-rupture of the tendon were assessed on MRI scans in accordance to established MRI criteria.
After these criteria were fulfilled, the patients eligible for our study numbered 10 out of a possible 27. The study population comprised of 4 men and 6 women. The mean age of the patients at the time of operation was 60.

데이터처리

We assessed the statistical significance of the differences in the preoperative and the postoperative results using the Wilcoxon signed rank test. The comparative analysis of the preoperative and postoperative proportions of patients with positive signs for the physical test that evaluates subscapularis strength was made with the Pearson chi-square test. Statistical significance was set to an α level of 0.
We assessed the statistical significance of the differences in the preoperative and the postoperative results using the Wilcoxon signed rank test. The comparative analysis of the preoperative and postoperative proportions of patients with positive signs for the physical test that evaluates subscapularis strength was made with the Pearson chi-square test.

이론/모형

The patients were evaluated for several physical examinations. We assessed the subjective pain score using the visual analogue scale (VAS). We measured the following shoulder range of motions (ROM): forward flexion, external rotation at the side, internal rotation to the back, and abduction.

성능/효과

In conclusion, we found that favorable clinical and structural outcomes can be anticipated with arthroscopic intraarticular knotless fixation of upper subscapularis tendon tears. Since this treatment returned a consistently reliable and effective restoration of the subscapularis tendon footprint, we believe that arthroscopic intraarticular knotless fixation may in the future become an acceptable procedure for tears of the upper subscapularis tendon.

참고문헌 (21)

Arai R, Sugaya H, Mochizuki T, Nimura A, Moriishi J, Akita K. Subscapularis tendon tear: an anatomic and clinical investigation. Arthroscopy. 2008;24(9):997-1004.

상세보기
Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R. Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am. 2007;89(6):1184-93.

상세보기
Ticker JB. Subscapularis and biceps tendon pathology encountered during arthroscopic posterosuperior rotator cuff repair. Paper presented at: Arthroscopy Association of North America 26th Annual Meeting; 2007 Apr 26-29; San Francisco (CA).
Walch G, Nove-Josserand L, Boileau P, Levigne C. Subluxations and dislocations of the tendon of the long head of the biceps. J Shoulder Elbow Surg. 1998;7(2):100-8.

상세보기
Barth JR, Burkhart SS, De Beer JF. The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear. Arthroscopy. 2006;22(10):1076-84.

상세보기
Yoo JC, Rhee YG, Shin SJ, et al. Subscapularis tendon tear classification based on 3-dimensional anatomic footprint: a cadaveric and prospective clinical observational study. Arthroscopy. 2015;31(1):19-28.

상세보기
Burkhart SS, Tehrany AM. Arthroscopic subscapularis tendon repair: Technique and preliminary results. Arthroscopy. 2002;18(5):454-63.

상세보기
Bennett WF. Arthroscopic repair of isolated subscapularis tears: A prospective cohort with 2-to 4-year follow-up. Arthroscopy. 2003;19(2):131-43.

상세보기
Adams CR, Schoolfield JD, Burkhart SS. The results of arthroscopic subscapularis tendon repairs. Arthroscopy. 2008; 24(12):1381-9.

상세보기
Burkhart SS, Brady PC. Arthroscopic subscapularis repair: surgical tips and pearls A to Z. Arthroscopy. 2006;22(9):1014-27.

상세보기
Denard PJ, Burkhart SS. A new method for knotless fixation of an upper subscapularis tear. Arthroscopy. 2011;27(6):861-6.

상세보기
Gilmer BB, Crall TS, Guttmann D. Knotless arthroscopic repair of subscapularis tendon tears using looped suture. Arthrosc Tech. 2015;4(3):e267-71.

상세보기
Bartl C, Salzmann GM, Seppel G, et al. Subscapularis function and structural integrity after arthroscopic repair of isolated subscapularis tears. Am J Sports Med. 2011;39(6):1255-62.

상세보기
Sakurai G, Ozaki J, Tomita Y, Kondo T, Tamai S. Incomplete tears of the subscapularis tendon associated with tears of the supraspinatus tendon: cadaveric and clinical studies. J Shoulder Elbow Surg. 1998;7(5):510-5.

상세보기
Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;(214): 160-4.
Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. Endresult study of factors influencing reconstruction. J Bone Joint Surg Am. 1986;68(8):1136-44.

상세보기
Gusmer PB, Potter HG, Donovan WD, O'Brien SJ. MR imaging of the shoulder after rotator cuff repair. AJR Am J Roentgenol. 1997;168(2):559-63.

상세보기
Ticker JB, Burkhart SS. Why repair the subscapularis? A logical rationale. Arthroscopy. 2011;27(8):1123-8.

상세보기
Kelly BT, Williams RJ, Cordasco FA, et al. Differential patterns of muscle activation in patients with symptomatic and asymptomatic rotator cuff tears. J Shoulder Elbow Surg. 2005;14(2): 165-71.

상세보기
Kuechle DK, Newman SR, Itoi E, Morrey BF, An KN. Shoulder muscle moment arms during horizontal flexion and elevation. J Shoulder Elbow Surg. 1997;6(5):429-39.

상세보기
Keating JF, Waterworth P, Shaw-Dunn J, Crossan J. The relative strengths of the rotator cuff muscles. A cadaver study. J Bone Joint Surg Br. 1993;75(1):137-40.

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