Clinical and Radiological Evaluation of Subscapular Suture Integrity in Reverse Shoulder Arthroplasty

Area of Science:

• Orthopedic Surgery
• Musculoskeletal Imaging
• Biomedical Engineering

Background:

• Reverse shoulder arthroplasty (RSA) is a common procedure for complex shoulder pathologies.
• The subscapular tendon (SST) is crucial for shoulder function and often involved in RSA.
• Suture integrity of the SST is hypothesized to impact postoperative outcomes.

Purpose of the Study:

• To correlate ultrasound-assessed subscapular tendon (SST) suture integrity with clinical functionality after reverse shoulder arthroplasty (RSA).
• To evaluate the presence and viability of the sutured SST post-RSA using ultrasound.
• To assess the relationship between SST viability and specific clinical tests and range of motion.

Main Methods:

• Retrospective study of 18 patients undergoing RSA with SST repositioning.
• Clinical evaluation included Gerber lift-off, IR lag sign, abdominal compression tests, and FF, ER, IR measurements at a median of 31 months postoperatively.
• Shoulder ultrasounds were performed to assess SST presence, viability, and fibrillar pattern.

Main Results:

• Subscapular tendon (SST) was visualized in 72.2% of patients; 38.4% of visualized tendons showed altered fibrillar patterns, suggesting nonviability.
• No significant association was found between SST viability and positive outcomes on Gerber lift-off, IR lag sign, or abdominal compression tests.
• No significant differences in forward flexion, external rotation, or internal rotation mobility were observed between patients with viable and nonviable SSTs.

Conclusions:

• A correlation between ultrasound-assessed SST repair integrity and clinical functionality after RSA could not be established.
• The study indicates a high failure rate for SST repairs, evidenced by the high incidence of nonviable or absent tendons.
• Further research is needed to optimize SST repair techniques and improve functional outcomes following RSA.