Does subscapularis tears combined with supraspinatus tears affect postoperative functional outcomes?

Yıl 2024, , 105 - 109, 15.01.2024

Orkun Gül , Yılmaz Ergişi , Mesut Tıkman , Halil Kekeç , Osman Çömez , Ozan Altun

https://doi.org/10.32322/jhsm.1363275

Öz

Aims: Roughly 50% of rotator cuff tears includes a tear in the subscapularis tendon. We conducted a comparative analysis of the functional outcomes following arthroscopic repair in patients with a tear in both the supraspinatus and subscapularis tendons, as well as those with a rupture solely in the supraspinatus tendon. Our hypothesis posits that the functional outcomes after surgery for rotator cuff tears, specifically those with tears including subscapularis tendon, are inferior compared to tears that only involve the supraspinatus tendon.
Methods: We classified patients who had arthroscopic repair for a rotator cuff tear in our clinic from January 2017 to April 2022 into two groups. The study comprised patients who received arthroscopic surgery for a diagnosed rotator cuff injury. The study excluded individuals who were younger than 18, individuals with large tears that could not be repaired, individuals with paralabral cysts, individuals with glenohumeral arthritis, individuals who had undergone labrum tear repair or slap lesion repair, individuals with concomitant neurovascular damage, and individuals who had a follow-up period of less than 6 months, patients who benefit from physiotherapy and medical treatment for 6 months. Following the application of exclusion criteria, a total of 39 patients were selected to participate in the study. The presence of a rotator cuff injury was verified through arthroscopy after being detected using clinical tests such as Jobe, drop arm test, Neer sign, lift-off and belly-press tests, and radiographic evidence such as magnetic resonance imaging. Patients who received subscapularis repair together with a supraspinatus tear were categorised as Group 1 (n=14), while those who just had supraspinatus surgery without any subscapularis tears were categorized as Group 2 (n=25). We recorded the demographic information. At the last postoperative outpatient clinic follow-up, both groups were compared in terms of mortality, laboratory parameters, radiological findings, visual analogue scale (VAS), Constant-Murley score1, American Shoulder and Elbow Surgeons score (ASES)2, and University of California Los Angeles (UCLA) scores.3 Postoperative satisfaction levels were categorised into four groups: very satisfied, satisfied, undecided, and dissatisfied.
Results: The groups did not show any significant differences in terms of age, gender distribution, and follow-up periods (p>0.05). There was no statistically significant disparity observed between the groups in relation to VAS, Constant-Murley score, ASES, and UCLA ratings assessed during the final postoperative outpatient clinic follow-up (p>0.05). There were no instances of re-rupture observed in any patient throughout the postoperative follow-up period. The postoperative satisfaction ratings show no significant difference between the two groups (p>0.05).
Conclusion: Our findings indicate that the outcomes of patients who received a surgical repair of rotator cuff tendons including subscapularis were at least as successful as those who underwent surgery for just supraspinatus tendon rupture. There is no basis to believe that arthroscopic repair will have a detrimental impact on the functional outcomes of individuals with rotator cuff tears which includes subscapularis tendon tears.

Anahtar Kelimeler

supraspinatus, subscapularis, shoulder arthroscopy, postoperative function, repair

Supraspinatus rüptürlerine eşlik eden subscapularis yırtıkları postoperatif fonksiyonel sonuçları etkiler mi?

Öz

Amaç: Rotator manşet yırtıklarının yaklaşık yarısında subscapularis tendon yırtığının eşlik ettiği bildirilmiştir. Subscapularis tendon yırtığının eşlik ettiği supraspinatus yırtığı olan hastalarda artroskopik tamir sonrası fonksiyonel sonuçları, izole supraspinatus tendon yırtığı olan hastaların artroskopik tamir sonrası fonksiyonel sonuçları ile karşılaştırarak “Rotator kablonun etkilendiği subscupalaris tendon yırtığı eşlik eden rotator manşet yırtıklarında ameliyat sonrası fonksiyonel sonuçlar izole supraspinatus tendon yırtıklarına göre daha kötüdür.” hipotezinin doğruluğunu araştırmayı amaçladık.
Materyal ve metod: Kliniğimizde Ocak 2017 ile Nisan 2022 tarihleri arasında rotator manşet yırtığı nedeniyle artroskopik tamir uygulanan hastalardan subscapularis tendon yırtığının eşlik ettiği supraspinatus yırtığı olguları Grup 1, subscapularis tendonun sağlam olduğu yalnızca supraspinatus tendon tamiri uygulanan hastalar Grup 2 olarak sınıflandırıldı. Her iki grup; mortalite, laboratuvar parametreleri, radyolojik bulgular, ameliyat sonrası son poliklinik kontrollerinde görsel analog skala (VAS), Constant-Murley skoru, American Shoulder and Elbow Surgeons skoru (ASES), University of California Los Angeles (UCLA) skorları açısından karşılaştırıldı. Ameliyat sonrası memnuniyet düzeyleri; çok memnun, memnun, kararsız ve memnun değil olmak üzere 4 kategoride sınıflandırıldı.
Bulgular: Gruplar arasında yaş, cinsiyet dağılımı ve takip süreleri açısından istatistiksel olarak anlamlı fark yoktu (p>0.05). Ameliyat sonrası son poliklinik kontrollerinde değerlendirilen VAS, Constant-Murley skoru, ASES ve UCLA skorları açısından gruplar arasında anlamlı fark yoktu (p>0.05). Ameliyat sonrası takip süresi boyunca hiçbir hastada rerüptür gözlenmedi. Ameliyat sonrası memnuniyet düzeyleri her iki grupta istatiksel olarak benzerdi (p>0.05).
Sonuç: Biz, subscapularis tendon tamiri yapılan hastalarda sonuçların en az izole supraspinatus tendon tamiri yapılan hastalar kadar başarılı olduğu sonucuna ulaştık. Subscapularis tendon yırtığı eşlik eden rotator manşet yırtığı olan hastalarda artroskopik tamirin fonksiyonel sonuçları kötü etkileyeceği düşüncesinin yersizdir.

Anahtar Kelimeler

supraspinatus, subscapularis, omuz artroskopisi, postoperatif fonksiyon, onarım

Kaynakça

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