Clinical Outcomes of Patients Undergoing Isolated and Combined Subscapularis Repair

Subscapularis (SSC) tears can present as isolated or combined with additional rotator cuff tendon tears. The repair of SSC tear improves postoperative outcomes. However, the effect that SSC repair and healing have on functional outcomes after arthroscopic repair of isolated or combined SSC tears requires further investigation.

To (1) compare the clinical outcomes of arthroscopic rotator cuff repair (ARCR) of isolated SSC tears with those having SSC tears combined with supraspinatus and/or infraspinatus tears and (2) evaluate the effect of SSC healing on postoperative clinical outcomes.

Cohort study; Level of evidence 3.

A retrospective study was carried out in patients who underwent ARCR of isolated or combined SSC tears with a minimum 2-year follow-up. Three groups were compared: isolated SSC tear, anterosuperior rotator cuff tear with SSC tear (AS-RCT) and posterosuperior rotator cuff tear with SSC tear (PS-RCT). Patient-reported outcomes (PROs) and range of motion (ROM) were assessed pre- and postoperatively. SSC healing was evaluated via ultrasound at the final follow-up in a subset of patients.

The study included 588 patients with a minimum 2-year follow-up, of whom 279 underwent ultrasound assessments. PROs and ROM improved after ARCR in all groups (P < .01). The postoperative American Shoulder and Elbow Surgeons (ASES) score improvement was significantly higher for the AS-RCT group compared with the PS-RCT group (P = .01), with no statistically significant difference between isolated SSC and AS-RCT (P > .05), or between isolated SSC and PS-RCT groups (P > .05). There was no statistically significant difference when comparing the pre- to postoperative change in ROM between the groups (P > .05). The SSC healing rates for isolated SSC, AS-RCT, and PS-RCT groups were 88.1%, 91.6%, and 84.3%, respectively, (P >.24). There was no significant difference in ASES score or Subjective Shoulder Value (SSV) improvement between healed and unhealed groups in patients with isolated SSC tears (P > .05). ASES and SSV were significantly lower in unhealed SSC patients compared with those having a healed SSC in patients with AS-RCTs (ASES, P < .01; SSV, P < .01) and PS-RCTs (ASES, P > .01; SSV, P < .01).

Both isolated and combined SSC repairs showed improvement in PROs and ROM. SSC healing rates did not differ between isolated and combined SSC tears. While failure to heal did not affect the clinical outcome of isolated SSC tears, an unhealed SSC was associated with lower functional scores in combined tears. Regardless of tear type, a healed SSC was associated with increased shoulder strength.