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.
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.
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.
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.
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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
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
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
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
Denard PJ, Koo SS, Murena L, Burkhart SS (2012) Pseudoparalysis: the importance of rotator cable integrity. Orthopedics 35:e1353–1357
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
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
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
Huri G, Kaymakoglu M, Garbis N (2019) Rotator cable and rotator interval: anatomy, biomechanics and clinical importance. EFORT Open Rev 4:56–62
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Schnaser E, Toussaint B, Gillespie R, Lefebvre Y, Gobezie R (2013) Arthroscopic treatment of anterosuperior rotator cuff tears. Orthopedics 36:e1394–1400
Warner JJ, Higgins L, Parsons IMT, Dowdy P (2001) Diagnosis and treatment of anterosuperior rotator cuff tears. J Shoulder Elbow Surg 10:37–46
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
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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
- Rotator cuff tear
- Rotator cable
- Anterior cable