RESUMO
BACKGROUND: Reverse shoulder arthroplasty is an established procedure for patients with rotator cuff tear arthropathy. However, the refixation of the subscapularis tendon remains a controversial and frequently discussed topic. This prospective randomized study was conducted to evaluate the clinical benefit of the subscapularis refixation after reverse shoulder arthroplasty. METHODS: Fifty patients (f: 36, m:14) were randomized and assigned to either the "repaired" (rep) or the "not repaired" (nrep) cohort. Intraoperatively, the subscapularis tendon was reattached in the rep-cohort with four tendon-to-tendon sutures, whereas no refixation was performed in the nrep-cohort. The Constant-Murley Score (CS) and the range of motion was evaluated preoperatively as well as 12 and 36 months postoperatively. The Subjective Shoulder Value (SSV) and the Lift-off test were performed 36 months postoperatively. The postoperative subscapularis integrity was assessed sonographically. RESULTS: Twelve months postoperatively the rep-cohort presented better results in the CS (rep: 71 vs. nrep: 66, p: 0.037). The normalized CS was 80% in the rep-cohort and 75% in the nrep-cohort (p: 0.114). At our last follow-up after 36 months we did not find significant differences between the rep-cohort and the nrep-cohort in the CS (rep: 76 vs. nrep: 75, p: 0.285) and normalized CS (rep: 91% vs. nrep: 91%, p: 0.388). Concerning internal rotation (in points) the rep-cohort achieved better results than the nrep-cohort (rep: 7.3 vs. nrep: 6.6, p: 0.040). Flexion (rep: 145° vs. nrep: 151°, p: 0.826), abduction (rep: 135° vs. nrep: 137° p: 0.816), external rotation (rep: 34° vs. nrep: 37°, p: 0.817) and the SSV (rep: 81% vs. nrep: 77%, p: 0.398) presented no significant differences between the cohorts. The ultrasound examination after 36 months displayed an intact tendon in 70%. CONCLUSION: While the subscapularis refixation effects the postoperative internal rotation positively, there were no differences in mid-term follow-up concerning the overall results after rTSA. Further, the external rotation is not affected by the refixation of the subscapularis tendon.
RESUMO
INTRODUCTION: Indications for reverse shoulder arthroplasties (rTSA) have increased since their development by Paul Grammont in 1985. Prosthesis design was enhanced over time, but the management of the tendon of the M. subscapularis (SSC-tendon) in primary rTSA is still a controversial subject with regard to perform a refixation or not. METHODS: 50 patients were randomized in a refixation group (A) and a non-refixation-group (B) of the SSC-tendon in a double-blinded fashion. SSC-function was assessed at baseline before surgery, such as 3 and 12 months after surgery. Constant-Murley-Shoulder Score (CS), American Shoulder and Elbow Surgeons Score (ASES), strength, range of motion (ROM), and pain on numeric rating scale (NRS) were measured in all examinations. An ultrasound examination of the shoulder was performed for evaluation of subscapularis tendon integrity at 3 and 12 month follow-up visits. Pain was evaluated on NRS via phone 5 days after surgery. Surgery was performed by a single experienced senior surgeon in all patients. RESULTS: Patients with a refixation of the SSC-tendon and primary rTSA had improved internal rotation [40° (20°-60°) vs. 32° (20°-45°); p = 0.03] at 12 months of follow-up. Additionally, the A-group had increased CS [74 (13-90) vs. 69.5 (40-79); p = 0.029] 1 year after surgery. Results were strengthened by subgroup analysis of successful refixation in ultrasound examination vs. no refixation. No differences were seen in ASES and NRS 1 year after rTSA. CONCLUSION: SSC-tendon repair in rTSA improves CS and internal rotation 12 months after surgery.
