Computer tomography assessment of the subscapularis after reverse shoulder arthroplasty and subscapularis repair: reduction in subscapularis size do not affect clinical outcomes |
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| Institution: | 1. Orthopaedic Unit and Kirk Kilgour Sports injury Center, S. Andrea Hospital, University of Rome “Sapienza”, Rome, Italy;2. Radiology Department, S. Andrea Hospital, University of Rome “Sapienza”, Rome, Italy;3. Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA;1. Department of Orthopedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA;2. Deparment of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA;1. Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA;2. Boston Sports and Shoulder Center, Waltham, MA, USA;3. Tufts University School of Medicine, Boston, MA, USA;4. Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA;1. Columbia University Medical Center, Department of Orthopedic Surgery, New York, NY, USA;2. Kaiser Permanante, Department of Orthopaedic Surgery, Vancouver, WA, USA;3. Montefiore Medical Center, Department of Orthopaedic Surgery, New York, NY, USA |
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| Abstract: | BackgroundExcellent Clinical and patient-reported outcome have been reported following Reverse Shoulder Arthroplasty (RTSA). However, outcomes in range of motion (ROM) remain variable. The role and importance of subscapularis repair during RTSA is a topic of intense debate and the long term-integrity of the subscapularis after repair remains poorly studied. Aims of this study were to radiologically evaluate pre- and postoperative condition of the subscapularis muscle in RTSA with concurrent subscapularis tendon repair using transosseous suture, and to investigate the correlation between clinical and radiological results.MethodsPatients who had undergone RTSA with subscapularis repair in our Institute between January 2010 and November 2016 were included. Constant, UCLA, Simple Shoulder Test and Visual Analog Scale (VAS) pain questionnaires were administered pre- and postoperatively. Internal rotation ability was recorded on a 6-point scale. Pre - and postoperatively shoulder CT scans were performed by a blinded examiner from which subscapularis muscle cross-sectional area (SMCSA) and supraspinatus fossa cross-sectional area (SFCSA) were measured in square millimeters. The SMCSA/SFCSA ratio was employed to standardize values for individual anatomical differences between patients.ResultsThe study included 32 patients (32 shoulders). Mean follow-up was 74.6 months ± 15.2 months (range 35–117 months). Statistically significant differences were found between pre- and postoperative VAS score, Constant Score, UCLA and Simple Shoulder Test scales (P < .0001). A postoperative SMCSA reduction of >35% was found in 38% of patients. Only 21% of patients maintained their preoperative SMCSA/SFCSA ratio. Overall, a statistically significant difference in pre and postoperative SMCSA/SFCSA ratios was found (P < .001). A correlation between radiological findings and clinical outcomes was not found.ConclusionPostoperative subscapularis size expressed as SMCSA and SMCSA/SFCSA ratio, was significantly reduced in the majority of patients treated with non-lateralized RTSA design and concurrent subscapularis tendon repair at final follow-up. A correlation between radiological findings and clinical outcomes was not found. RTSA with subscapularis tendon repair provides a high degree of patient satisfaction, as well as statistically significant improvements in clinical outcomes and internal rotation ROM. Being associated with several advantages, subscapularis repair may be routinely recommended.Level of evidenceLevel II; Prospective Cohort Design; Prognosis Study |
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