The role of repair of Lafosse I subscapularis lesions in anterosuperior rotator cuff reconstruction / 中华骨科杂志

ABSTRACT

Objective:To observe the effect of Lafosse I subscapularis lesion repair on the reconstruction of anterosuperior rotator cufftear.Methods:A retrospective analysis was performed on patients who underwent surgical treatment of the supraspinatus torn combined with Lafosse I subscapularis lesion from January 2016 to October 2017. It was divided into two groups according to the subscapularis lesion was repaired or not. There were 16 cases in non-repaired group, 7 males and 9 females, aged from 48 to 75 years (average, 59.3 years). In this group, supraspinatus repair and subscapularis debridement with no repair were done. There were 13 cases in repaired group, 5 males and 8 females, aged from 45 to 72 years (average, 57.2 years). In this group, both supraspinatus and subscapularis were repaired. MRI was performed at last follow-up. The pain analogue scale (VAS), American Shoulder & Elbow Surgeons (ASES) score, Constant-Murley score and range of motion (ROM) were recorded at the last follow-up. Patients' satisfaction was recorded.Results:Twenty-nine patients had been followed up. Patients in non-repaired group were followed up 15.9±3.9 months (range 10-22 months), and patients in repaired group were followed up 16.9±3.4 months (range 10-21 months). At the last follow-up, VAS, ASES score, and Constant-Murley score of non-repaired group were 1.1±1.1, 88.4±4.0 and 85.9±3.2 respectively. VAS, ASES score, and Constant-Murley score of repaired group were 0.9±1.1, 89.6±2.9 and 87.5±2.6 respectively. VAS ( t=0.342, P=0.735), ASES score ( t=-0.941, P=0.355) and Constant-Murley score ( t=-1.392, P=0.175) showed no significant difference between non-repaired group and repaired group. At the last follow-up, forward flexion of affected shoulder in non-repaired group was 150.3°±17.3°, external rotation was 41.6°±16.0°, and internal rotation was L 2 level; Forward flexion in repaired group was 148.1°±16.3°, external rotation was 43.9°±9.2°, and internal rotation was L 1 level, which were improved significantly compared with those pre-operation. Forward flexion, external rotation, and internal rotation showed no statistically significant difference between non-repaired group and repaired group. 3 patients were found to have rotator cuff re-tear by MR examination. The re-tear rate was 10.34% (3/29). There were 2 cases in non-repaired group and 1 case in repaired group. At the last follow-up, the ASES score of re-tear patients was 85.3±3.1, which was better than preoperative 41.0±5.2 ( t=12.74, P<0.001). Forward flexion 131.67°±5.8° was better than preoperative 81.7°±11.5° ( t=6.708, P<0.001). One re-tear patient (in non-repaired group) received reoperation and got pain relief. The satisfaction of non-repaired group and repaired group were 93.7% and 92.3%, respectively. Conclusion:For type I subscapularis lesion combined with supraspinatus injury, wheter type I subscapularis lesion was repaired or notdidn't affect the repair effect of the anterosuperior rotator cuff tear in short-term follow-up.