Isolated subscapularis repair for massive rotator cuff tear

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Shoulder Reconstruction

Background:

• Irreparable rotator cuff tears present a significant surgical challenge.
• Partial rotator cuff repair, particularly of the posterior cuff, has shown potential benefits.

Purpose of the Study:

• To evaluate the efficacy and safety of arthroscopic subscapularis-only repair with greater tuberoplasty for massive rotator cuff tears with irreparable supraspinatus and infraspinatus tendons.
• To assess functional outcomes and complications in patients undergoing this specific surgical technique.

Main Methods:

• Retrospective study of 41 patients with massive 3-tendon cuff tears and irreparable supraspinatus/infraspinatus tendons.
• Patients underwent arthroscopic subscapularis-only repair and greater tuberoplasty after failed conservative management.
• Outcomes assessed using American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores, range of motion, and functional tests.

Main Results:

• Mean ASES and SANE scores were 76% and 63%, respectively, at a mean follow-up of 35 months.
• Significant improvements in passive range of motion (156° forward flexion, 39° external rotation) and active arm elevation (74%) were observed.
• The procedure had a low complication rate (7.3%), with workers' compensation claims predicting lower outcomes.

Conclusions:

• Arthroscopic subscapularis-only repair and greater tuberoplasty may be a safe and effective treatment for massive rotator cuff tears with irreparable components.
• The technique can lead to significant functional improvement and pain reduction in select patients.
• Workers' compensation status is a factor to consider when predicting surgical outcomes.