Anterior rotator cable disruption does not affect outcomes in rotator cuff tear with subscapularis involvement

Abstract

Purpose

The purpose of this study was to compare clinical and radiological outcomes after arthroscopic repair of two different rotator cuff tear configurations: anterosuperior rotator cuff tear and rotator cuff tears with subscapularis involvement. It was hypothesized that, although both tear configurations would show significant improvement in clinical outcomes after arthroscopic repair, the rotator cuff tears with subscapularis involvement where the anterior rotator cable maintains its integrity would have better clinical outcomes and structural integrity.

Methods

This study included 226 patients who underwent arthroscopic repair of anterosuperior rotator cuff tears (n = 107, group A) and rotator cuff tears with subscapularis involvement (n = 119, group B). The visual analog scale (VAS) pain score, subjective shoulder value (SSV), American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) shoulder score, and active range of motion (ROM) were assessed. Modified belly press test was performed to assess the strength of the subscapularis muscle. Cuff integrity was evaluated using magnetic resonance arthrography or computed tomographic arthrography at 6 months after operation.

Results

At 3-year follow-up, the VAS score, SSVs, ASES scores, UCLA shoulder scores, active ROM, and modified belly press test showed significant improvement in both groups (p < 0.001). However, these improvements showed no statistical significance between the two groups. On follow-up radiologic evaluations, no significant difference in re-tear rates between group A (25 of 107, 23.4%) and group B (23 of 119, 19.3%) was observed.

Conclusions

The presence of anterior cable involvement of the anterosuperior rotator cuff tear did not affect postoperative clinical outcomes and re-tear rate compared to rotator cuff tears with subscapularis involvement where the anterior cable integrity was maintained, although the anterosuperior rotator cuff tear was associated with more significant preoperative supraspinatus fatty infiltration. Therefore, the present study determined that it would not be necessary to differentiate treatment protocols between these patterns.

Level of evidence

Level III

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    Araki D, Miller RM, Fujimaki Y, Hoshino Y, Musahl V, Debski RE (2015) Effect of tear location on propagation of isolated supraspinatus tendon tears during increasing levels of cyclic loading. J Bone Joint Surg Am 97:273–278

    Article  Google Scholar 

  2. 2.

    Burkhart SS, Esch JC, Jolson RS (1993) The rotator crescent and rotator cable: an anatomic description of the shoulder's “suspension bridge”. Arthroscopy 9:611–616

    CAS  Article  Google Scholar 

  3. 3.

    Cho NS, Moon SC, Hong SJ, Bae SH, Rhee YG (2017) Comparison of clinical and radiological results in the arthroscopic repair of full-thickness rotator cuff tears with and without the anterior attachment of the rotator cable. Am J Sports Med 45:2532–2539

    Article  Google Scholar 

  4. 4.

    Curtis AS, Burbank KM, Tierney JJ, Scheller AD, Curran AR (2006) The insertional footprint of the rotator cuff: an anatomic study. Arthroscopy 22:609.e601

    Article  Google Scholar 

  5. 5.

    Denard PJ, Koo SS, Murena L, Burkhart SS (2012) Pseudoparalysis: the importance of rotator cable integrity. Orthopedics 35:e1353–1357

    Article  Google Scholar 

  6. 6.

    Di Schino M, Augereau B, Nich C (2012) Does open repair of anterosuperior rotator cuff tear prevent muscular atrophy and fatty infiltration? Clin Orthop Relat Res 470:2776–2784

    Article  Google Scholar 

  7. 7.

    Gagnier JJ, Robbins C, Bedi A, Carpenter JE, Miller BS (2018) Establishing minimally important differences for the American Shoulder and elbow surgeons score and the Western Ontario Rotator Cuff Index in patients with full-thickness rotator cuff tears. J Shoulder Elbow Surg 27:e160–e166

    Article  Google Scholar 

  8. 8.

    Gerber C, Fuchs B, Hodler J (2000) The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am 82:505–515

    CAS  Article  Google Scholar 

  9. 9.

    Huri G, Kaymakoglu M, Garbis N (2019) Rotator cable and rotator interval: anatomy, biomechanics and clinical importance. EFORT Open Rev 4:56–62

    Article  Google Scholar 

  10. 10.

    Keener JD, Hsu JE, Steger-May K, Teefey SA, Chamberlain AM, Yamaguchi K (2015) Patterns of tear progression for asymptomatic degenerative rotator cuff tears. J Shoulder Elbow Surg 24:1845–1851

    Article  Google Scholar 

  11. 11.

    Kim HM, Dahiya N, Teefey SA, Keener JD, Galatz LM, Yamaguchi K (2010) Relationship of tear size and location to fatty degeneration of the rotator cuff. J Bone Joint Surg Am 92:829–839

    Article  Google Scholar 

  12. 12.

    Kim SJ, Choi YR, Jung M, Lee WY, Chun YM (2017) Isolated subscapularis repair in irreparable posterosuperior massive rotator cuff tears involving the subscapularis tendon. Am J Sports Med 45:1269–1275

    Article  Google Scholar 

  13. 13.

    Kim SJ, Choi YR, Jung M, Yoon YK, Chun YM (2018) Concomitant coracoplasty during arthroscopic subscapularis repair does not yield better clinical outcomes and structural integrity. Knee Surg Sports Traumatol Arthrosc 26:56–62

    Article  Google Scholar 

  14. 14.

    Kim SJ, Jung M, Lee JH, Kim C, Chun YM (2014) Arthroscopic repair of anterosuperior rotator cuff tears: in-continuity technique vs. disruption of subscapularis-supraspinatus tear margin: comparison of clinical outcomes and structural integrity between the two techniques. J Bone Joint Surg Am 96:2056–2061

    Article  Google Scholar 

  15. 15.

    Kim SJ, Kim SH, Lee SK, Seo JW, Chun YM (2013) Arthroscopic repair of massive contracted rotator cuff tears: aggressive release with anterior and posterior interval slides do not improve cuff healing and integrity. J Bone Joint Surg Am 95:1482–1488

    Article  Google Scholar 

  16. 16.

    Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R (2007) Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am 89:1184–1193

    Article  Google Scholar 

  17. 17.

    Mesiha MM, Derwin KA, Sibole SC, Erdemir A, McCarron JA (2013) The biomechanical relevance of anterior rotator cuff cable tears in a cadaveric shoulder model. J Bone Joint Surg Am 95:1817–1824

    Article  Google Scholar 

  18. 18.

    Miller RM, Fujimaki Y, Araki D, Musahl V, Debski RE (2014) Strain distribution due to propagation of tears in the anterior supraspinatus tendon. J Orthop Res 32:1283–1289

    Article  Google Scholar 

  19. 19.

    Miller RM, Thunes J, Musahl V, Maiti S, Debski RE (2018) Effects of tear size and location on predictions of supraspinatus tear propagation. J Biomech 68:51–57

    Article  Google Scholar 

  20. 20.

    Mochizuki T, Sugaya H, Uomizu M, Maeda K, Matsuki K, Sekiya I et al (2009) Humeral insertion of the supraspinatus and infraspinatus. New anatomical findings regarding the footprint of the rotator cuff. Surgical technique. J Bone Joint Surg Am 91:1–7

    Article  Google Scholar 

  21. 21.

    Namdari S, Donegan RP, Dahiya N, Galatz LM, Yamaguchi K, Keener JD (2014) Characteristics of small to medium-sized rotator cuff tears with and without disruption of the anterior supraspinatus tendon. J Shoulder Elbow Surg 23:20–27

    Article  Google Scholar 

  22. 22.

    Nguyen ML, Quigley RJ, Galle SE, McGarry MH, Jun BJ, Gupta R et al (2012) Margin convergence anchorage to bone for reconstruction of the anterior attachment of the rotator cable. Arthroscopy 28:1237–1245

    Article  Google Scholar 

  23. 23.

    Oh JH, Kim SH, Kwak SH, Oh CH, Gong HS (2011) Results of concomitant rotator cuff and SLAP repair are not affected by unhealed SLAP lesion. J Shoulder Elbow Surg 20:138–145

    Article  Google Scholar 

  24. 24.

    Pinkowsky GJ, ElAttrache NS, Peterson AB, Akeda M, McGarry MH, Lee TQ (2017) Partial-thickness tears involving the rotator cable lead to abnormal glenohumeral kinematics. J Shoulder Elbow Surg 26:1152–1158

    Article  Google Scholar 

  25. 25.

    Rahu M, Kolts I, Poldoja E, Kask K (2017) Rotator cuff tendon connections with the rotator cable. Knee Surg Sports Traumatol Arthrosc 25:2047–2050

    Article  Google Scholar 

  26. 26.

    Schnaser E, Toussaint B, Gillespie R, Lefebvre Y, Gobezie R (2013) Arthroscopic treatment of anterosuperior rotator cuff tears. Orthopedics 36:e1394–1400

    Article  Google Scholar 

  27. 27.

    Warner JJ, Higgins L, Parsons IMT, Dowdy P (2001) Diagnosis and treatment of anterosuperior rotator cuff tears. J Shoulder Elbow Surg 10:37–46

    CAS  Article  Google Scholar 

  28. 28.

    Yoon JS, Kim SJ, Choi YR, Kim SH, Chun YM (2019) Arthroscopic repair of the isolated subscapularis full-thickness tear: single- versus double-row suture-bridge technique. Am J Sports Med 47:1427–1433

    Article  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Yong-Min Chun.

Ethics declarations

Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Ethical approval

All the procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yoon, TH., Kim, SJ., Choi, YR. et al. Anterior rotator cable disruption does not affect outcomes in rotator cuff tear with subscapularis involvement. Knee Surg Sports Traumatol Arthrosc 29, 154–161 (2021). https://doi.org/10.1007/s00167-020-05891-z

Download citation

Keywords

  • Rotator cuff tear
  • Rotator cable
  • Anterior cable
  • Subscapularis
  • Re-tear