Background:

Concomitant full-thickness tear of the subscapularis tendon is often neglected during primary posterosuperior rotator cuff repair, and its significance has not been investigated by any previous clinical study.

Purpose:

To investigate (1) the clinical and radiological outcomes of revision arthroscopic rotator cuff repair and (2) the number of neglected concomitant subscapularis full-thickness tears in the revision of posterosuperior rotator cuff retears and their structural integrity after repair.

Study Design:

Case series, Level of evidence, 4.

Methods:

This study retrospectively examined 58 patients who underwent arthroscopic rotator cuff revision for a retear of a previously repaired posterosuperior rotator cuff. Preoperative and postoperative functional scores and active range of motion (ROM) were assessed. The initial and most recent follow-up magnetic resonance imaging scans before revision and arthroscopic findings at the time of primary repair were reviewed to determine whether the concomitant subscapularis tear was newly developed or preexisting. Final confirmation of the tendon’s full-thickness tear was made during the revision procedure.

Results:

At final follow-up, mean functional shoulder scores and ROM improved significantly compared with the preoperative values (P < .001). Among the 58 revision cases, 25 (43.1%) had a neglected full-thickness tear of the subscapularis tendon. The fatty infiltration grade of the neglected subscapularis tear progressed from a mean of 1.1 before primary repair to a mean of 1.6 before revision, and the change indicated statistically significant deterioration (P < .001). Despite clinical improvement after revision surgery, the retear rate was considerable in the re-repaired cuff tendons (37.9%) as well as for the repaired concomitant subscapularis tears (24%).

Conclusion:

Among revision rotator cuff repairs, 43.1% had neglected subscapularis tears, and fatty infiltration of these initially neglected subscapularis tendons showed further progression at the time of revision. The retear rate after the repair of neglected subscapularis tears was higher than expected. Thus, detecting and treating subscapularis tear via meticulous preoperative evaluation and thorough inspection during primary arthroscopy are essential.

中文翻译：

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关节镜修复肩袖修复：以前被忽视的肩胛下肌撕裂的作用

背景：

肩胛下肌腱伴随的全层撕裂在初级后上肩袖修复过程中经常被忽视，其意义尚未被任何先前的临床研究调查。

目的：

调查（1）关节镜下肩袖修复修复的临床和放射学结果和（2）后上肩袖再撕裂修复中被忽视的伴随肩胛下肌全层撕裂的数量及其修复后的结构完整性。

学习规划：

案例系列，证据水平，4。

方法：

本研究回顾性检查了 58 名接受关节镜下肩袖翻修术的患者，以修复先前修复的后上肩袖再撕裂。评估术前和术后功能评分和活动范围（ROM）。回顾了翻修前的初始和最近的后续磁共振成像扫描以及初次修复时的关节镜检查结果，以确定伴随的肩胛下肌撕裂是新发生的还是预先存在的。在翻修过程中对肌腱的全层撕裂进行了最终确认。

结果：

在最后的随访中，平均肩关节功能评分和 ROM 与术前相比有显着改善（P < .001）。在 58 例翻修病例中，25 例（43.1%）肩胛下肌腱全层撕裂被忽视。被忽视的肩胛下肌撕裂的脂肪浸润等级从初次修复前的平均 1.1 进展到翻修前的平均 1.6，并且变化表明具有统计学意义的恶化（P < .001）。尽管翻修手术后临床有所改善，但再修复的袖带肌腱（37.9％）以及修复的伴随肩胛下肌撕裂（24％）的再撕裂率相当可观。

结论：

在翻修肩袖修复中，43.1% 忽略了肩胛下肌撕裂，这些最初被忽略的肩胛下肌腱的脂肪浸润在翻修时显示出进一步的进展。被忽视的肩胛下肌撕裂修复后的再撕裂率高于预期。因此，通过细致的术前评估和初次关节镜检查期间的彻底检查来检测和治疗肩胛下肌撕裂是必不可少的。