Early outcomes of arthroscopic repair of obsolete traumatic subscapularis tears / 中华创伤杂志

ABSTRACT

Objective:To study the early effect of arthroscopy in the treatment of obsolete traumatic subscapularis tears.Methods:A retrospective case series study was used to analyze the clinical data of 28 patients with obsolete traumatic subscapularis tears admitted to Second People 's Hospital of Changzhou City from July 2017 to July 2020，including 16 males and 12 females，aged 47-72 years［（60.5±6.3）years］. According to Lafosse classification，the injury size was upper one third tear in 9 patients，upper half tear in 18 and complete tear in 1. According to Patte classification of the degree of retraction，4 patients were with no retraction，7 with retraction to the level of the lesser tuberosity，14 with retraction to the level of the humeral head，and 3 with retraction to the level of the glenoid. According to Goutallier classification，the level of fatty infiltration was at grade 0-1 in 17 patients，at grade 2 in 10 and at grade 3-4 in 1. All patients were repaired by arthroscopic surgery. The wound healing was observed at 2 weeks postoperatively. The visual analogue score（VAS），University of California at Los Angeles（UCLA）shoulder rating score，shoulder active forward elevation（AFE），active external rotation（AER），active internal rotation（AIR）were assessed before operation and at 3 months and 6 months postoperatively. Six months after operation，reexamination of the front and side view of the shoulder and MRI of the shoulder were performed to assess the recovery of the subscapular tendon. Results:All patients were followed up for 6-12 months［（8.7±1.3）months］. All wounds healed 2 weeks after operation，with no infection occurred. The VAS was（3.5±0.7）points and（2.6±0.5）points at 3 months and 6 months postoperatively，lower than（6.3±1.2）points before operation（ P<0.01）. The UCLA score was（20.4±2.5）points and（25.6±6.2）points at 3 months and 6 months postoperatively，higher than（9.5±1.7）points before operation（ P<0.01）. The preoperative range of motion of the affected shoulder in AFE，AER and AIR was（80.2±12.6）°，（52.5±7.6）°，（3.7±1.2）°，respectively. Three months after operation，the range of motion was（113.2±7.5）°，（60.1±6.3）°，（6.8±1.6）°，respectively. Six months after operation，the range of motion was（122.3±15.2）°，（65.6±10.5）°，（7.8±2.3）°，respectively. The range of motion of the affected shoulder at 3 months and 6 months postoperativley was better than that before operation（ P<0.01）. Six months after operation，MRI showed good recovery in 27 patients，while a small re-tear in 1 patient（Goutallier classification grade 3）. Conclusion:For patients with obsolete traumatic subscapularis tears，arthroscopic repair can significantly relieve the pain，and recover range of motion and function of the joint.