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Open Antegrade Muscle Advancement Reduces Retear Rates Compared to Arthroscopic Repair With Intra-articular Release
Woo-Sung Do1, Yong-Min Chun1, Sung-Jae Kim1
1Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Summary
Open subscapularis tendon repair with muscle advancement showed lower retear rates and better functional outcomes compared to arthroscopic repair in patients with significant fatty infiltration. Patient-reported outcomes were similar between the two surgical methods.
Area of Science:
- Orthopedic surgery
- Shoulder reconstruction
- Tendon repair
Background:
- Subscapularis tendon tears with Goutallier grade III or IV fatty infiltration present a surgical challenge.
- Arthroscopic repair without muscle advancement and open repair with muscle advancement are two treatment options.
Purpose of the Study:
- To compare the outcomes of arthroscopic repair without muscle advancement versus open repair with muscle advancement for subscapularis tendon tears with Goutallier grade III or IV fatty infiltration.
Main Methods:
- Retrospective comparative study of 170 patients (March 2009-October 2022) with subscapularis tears and Goutallier grade III/IV fatty infiltration.
- Comparison of clinical scores, range of motion, internal rotation strength, and retear rates between arthroscopic and open repair groups.
- Subgroup analysis for isolated subscapularis tears.
Main Results:
- Open repair showed significantly better modified belly-press test scores and internal rotation range of motion at 2 years post-surgery (P=.011, P=.021).
- Retear rates were significantly lower in the open repair group (51.7%) compared to the arthroscopic group (76.8%) (P<.001).
- Subgroup analysis for isolated tears mirrored these findings, with lower retear rates in open repair (37.5% vs 75.8%, P=.009).
Conclusions:
- Open repair with antegrade muscle advancement may be superior to arthroscopic repair without advancement for subscapularis tears with advanced fatty infiltration.
- Open repair potentially leads to lower retear rates and improved functional outcomes.
- Patient-reported outcomes did not significantly differ between the two surgical approaches.
