Análisis de los resultados y los factores adversos de la reparación artroscópica de las lesiones del subescapular de origen degenerativo / Analysis of the results and adverse factors of arthroscopic repair of degenerative subscapular lesions

Objetivo: Realizar una revisión de roturas del subescapular (SBE) de origen degenerativo tras su reparación por artroscopia y evaluar si los resultados son equiparables en términos de dolor y función a los de pacientes más jóvenes con roturas traumáticas. Material y método: Se han revisado de forma retrospectiva los datos de 80 roturas de SBE de las 660 roturas de manguito rotador intervenidas por el mismo equipo de cirujanos desde junio de 2008 hasta junio de 2018. Se recogieron los datos clínicos de los pacientes intervenidos: edad, género, lateralidad, demora de intervención, patologías asociadas, localización del dolor, valor de la escala visual analógica (EVA) y del test de Constant-Murley (TCM); se han recogido también los datos quirúrgicos: tipo y tamaño de lesión, lesión asociada del bíceps y gesto quirúrgico asociado, estenosis coracoidea y gesto quirúrgico asociado y número y tipo de anclajes empleados. Se realizó estudio estadístico con prueba de regresión lineal múltiple, pruebas paramétricas (t de Student o ANOVA) y pruebas no paramétricas. Resultados: De 80 pacientes, 36 fueron mujeres (45%) y 44, hombres (55%); media de edad de 61años (rango 47 a 81); demora media de la cirugía de 3,5meses (rango 1 a 6); hombro derecho afecto en 46 casos (57,5%), el izquierdo en 34 (42,5%); 22 (27,5%) fueron lesiones aisladas, 58 (72,5%), asociadas a rotura del supraespinoso (SPE). La mejoría media fue de 5,0 puntos en términos de la EVA y de 39,9 puntos de media en el TCM. Índice de nueva rotura, 1,25%. Factores adversos: tamaño de la rotura, demora de intervención, mujeres. Los pacientes con rotura tipo I-B tienen mejor resultado total en el TCM que los tipos I-A y III. A mayor demora se observan peores resultados, tanto de la EVA como del TCM. Las mujeres presentan resultados peores y estadísticamente significativos tanto en la EVA (p=0,00) como en el TCM (p=0,01).(AU)

Objective: To carry out a review of degenerative subscapularis ruptures (SSC) after their arthroscopic repair and to evaluate whether the results are comparable in terms of pain and function to those of younger patients with traumatic ruptures. Methods: The data of 80 SSC tears of the 660 rotator cuff tears operated on by the same team of surgeons from June 2008 to June 2018 were retrospectively reviewed. The clinical data of the surgical indications were collected: age, gender, laterality, intervention delay, associated pathologies, location of pain, value of the Visual Analogue Scale (VAS) and the Constant-Murley test (CMT); surgical data were also collected: type and size of lesion, associated biceps injury and associated surgical procedure, coracoid stenosis and associated surgical procedure, number and type of anchors used. A statistical study was performed with multiple linear regression test, parametric tests (Student's t or ANOVA) and non-parametric tests. Results: Of 80 patients, 36 were women (45%) and 44, men (55%); mean age 61years (range 47 to 81); mean delay of surgery 3.5months (range 1 to 6); right shoulder affected in 46 cases (57.5%), left in 34 (42.5%); 22 (27.5%) were isolated lesions, 58 (72.5%) were associated with supraspinatus rupture (SE). The mean improvement was 5.0 points in terms of the VAS and 39.9 points on average in the CMT. New breakage rate, 1.25%. Adverse factors: size of the tear, delay in intervention, women. Patients with type I-B rupture have a better overall result in the CMT than types I-A and III. The longer the delay, the worse results are observed, both for the VAS and the CMT. Women present worse and statistically significant results both in the VAS (P=.00) and in the CMT (P=.01). Conclusions: Excellent and good results have been obtained in this group of patients, but there are adverse factors such as the size of the tear, the duration of the symptoms and the association of other pathologies, especially in women.(AU)

[Translated article] Analysis of the results and adverse factors of arthroscopic repair of degenerative subscapular lesions / Análisis de los resultados y los factores adversos de la reparación artroscópica de las lesiones del subescapular de origen degenerative

Objetivo: Realizar una revisión de roturas del subescapular (SBE) de origen degenerativo tras su reparación por artroscopia y evaluar si los resultados son equiparables en términos de dolor y función a los de pacientes más jóvenes con roturas traumáticas. Material y método: Se han revisado de forma retrospectiva los datos de 80 roturas de SBE de las 660 roturas de manguito rotador intervenidas por el mismo equipo de cirujanos desde junio de 2008 hasta junio de 2018. Se recogieron los datos clínicos de los pacientes intervenidos: edad, género, lateralidad, demora de intervención, patologías asociadas, localización del dolor, valor de la escala visual analógica (EVA) y del test de Constant-Murley (TCM); se han recogido también los datos quirúrgicos: tipo y tamaño de lesión, lesión asociada del bíceps y gesto quirúrgico asociado, estenosis coracoidea y gesto quirúrgico asociado y número y tipo de anclajes empleados. Se realizó estudio estadístico con prueba de regresión lineal múltiple, pruebas paramétricas (t de Student o ANOVA) y pruebas no paramétricas. Resultados: De 80 pacientes, 36 fueron mujeres (45%) y 44, hombres (55%); media de edad de 61años (rango 47 a 81); demora media de la cirugía de 3,5meses (rango 1 a 6); hombro derecho afecto en 46 casos (57,5%), el izquierdo en 34 (42,5%); 22 (27,5%) fueron lesiones aisladas, 58 (72,5%), asociadas a rotura del supraespinoso (SPE). La mejoría media fue de 5,0 puntos en términos de la EVA y de 39,9 puntos de media en el TCM. Índice de nueva rotura, 1,25%. Factores adversos: tamaño de la rotura, demora de intervención, mujeres. Los pacientes con rotura tipo I-B tienen mejor resultado total en el TCM que los tipos I-A y III. A mayor demora se observan peores resultados, tanto de la EVA como del TCM. Las mujeres presentan resultados peores y estadísticamente significativos tanto en la EVA (p=0,00) como en el TCM (p=0,01).(AU)

Objective: To carry out a review of degenerative subscapularis ruptures (SSC) after their arthroscopic repair and to evaluate whether the results are comparable in terms of pain and function to those of younger patients with traumatic ruptures. Methods: The data of 80 SSC tears of the 660 rotator cuff tears operated on by the same team of surgeons from June 2008 to June 2018 were retrospectively reviewed. The clinical data of the surgical indications were collected: age, gender, laterality, intervention delay, associated pathologies, location of pain, value of the Visual Analogue Scale (VAS) and the Constant-Murley test (CMT); surgical data were also collected: type and size of lesion, associated biceps injury and associated surgical procedure, coracoid stenosis and associated surgical procedure, number and type of anchors used. A statistical study was performed with multiple linear regression test, parametric tests (Student's t or ANOVA) and non-parametric tests. Results: Of 80 patients, 36 were women (45%) and 44, men (55%); mean age 61years (range 47 to 81); mean delay of surgery 3.5months (range 1 to 6); right shoulder affected in 46 cases (57.5%), left in 34 (42.5%); 22 (27.5%) were isolated lesions, 58 (72.5%) were associated with supraspinatus rupture (SE). The mean improvement was 5.0 points in terms of the VAS and 39.9 points on average in the CMT. New breakage rate, 1.25%. Adverse factors: size of the tear, delay in intervention, women. Patients with type I-B rupture have a better overall result in the CMT than types I-A and III. The longer the delay, the worse results are observed, both for the VAS and the CMT. Women present worse and statistically significant results both in the VAS (P=.00) and in the CMT (P=.01). Conclusions: Excellent and good results have been obtained in this group of patients, but there are adverse factors such as the size of the tear, the duration of the symptoms and the association of other pathologies, especially in women.(AU)

[Translated article] Analysis of the results and adverse factors of arthroscopic repair of degenerative subscapular lesions.

OBJECTIVE: To carry out a review of degenerative subscapularis ruptures (SSC) after their arthroscopic repair and to evaluate whether the results are comparable in terms of pain and function to those of younger patients with traumatic ruptures. METHODS: The data of 80 SSC tears of the 660 rotator cuff tears operated on by the same team of surgeons from June 2008 to June 2018 were retrospectively reviewed. The clinical data of the surgical indications were collected: age, gender, laterality, intervention delay, associated pathologies, location of pain, value of the Visual Analogue Scale (VAS) and the Constant-Murley test (CMT); surgical data were also collected: type and size of lesion, associated biceps injury and associated surgical procedure, coracoid stenosis and associated surgical procedure, number and type of anchors used. A statistical study was performed with multiple linear regression test, parametric tests (Student's t or ANOVA) and non-parametric tests. RESULTS: Of 80 patients, 36 were women (45%) and 44, men (55%); mean age 61 years (range 47-81); mean delay of surgery 3.5 months (range 1-6); right shoulder affected in 46 cases (57.5%), left in 34 (42.5%); 22 (27.5%) were isolated lesions, 58 (72.5%) were associated with supraspinatus rupture (SE). The mean improvement was 5.0 points in terms of the VAS and 39.9 points on average in the CMT. New breakage rate, 1.25%. Adverse factors: size of the tear, delay in intervention, women. Patients with type I-B rupture have a better overall result in the CMT than types I-A and III. The longer the delay, the worse results are observed, both for the VAS and the CMT. Women present worse and statistically significant results both in the VAS (p 0.00) and in the CMT (p 0.01). CONCLUSIONS: Excellent and good results have been obtained in this group of patients, but there are adverse factors such as the size of the tear, the duration of the symptoms and the association of other pathologies, especially in women.

Analysis of the results and adverse factors of arthroscopic repair of degenerative subscapular lesions. / Análisis de los resultados y los factores adversos de la reparación artroscópica de las lesiones del subescapular de origen degenerativo.

OBJECTIVE: To carry out a review of degenerative subscapularis ruptures (SSC) after their arthroscopic repair and to evaluate whether the results are comparable in terms of pain and function to those of younger patients with traumatic ruptures. METHODS: The data of 80 SSC tears of the 660 rotator cuff tears operated on by the same team of surgeons from June 2008 to June 2018 were retrospectively reviewed. The clinical data of the surgical indications were collected: age, gender, laterality, intervention delay, associated pathologies, location of pain, value of the Visual Analogue Scale (VAS) and the Constant-Murley test (CMT); surgical data were also collected: type and size of lesion, associated biceps injury and associated surgical procedure, coracoid stenosis and associated surgical procedure, number and type of anchors used. A statistical study was performed with multiple linear regression test, parametric tests (Student's t or ANOVA) and non-parametric tests. RESULTS: Of 80 patients, 36 were women (45%) and 44, men (55%); mean age 61years (range 47 to 81); mean delay of surgery 3.5months (range 1 to 6); right shoulder affected in 46 cases (57.5%), left in 34 (42.5%); 22 (27.5%) were isolated lesions, 58 (72.5%) were associated with supraspinatus rupture (SE). The mean improvement was 5.0 points in terms of the VAS and 39.9 points on average in the CMT. New breakage rate, 1.25%. Adverse factors: size of the tear, delay in intervention, women. Patients with type I-B rupture have a better overall result in the CMT than types I-A and III. The longer the delay, the worse results are observed, both for the VAS and the CMT. Women present worse and statistically significant results both in the VAS (P=.00) and in the CMT (P=.01). CONCLUSIONS: Excellent and good results have been obtained in this group of patients, but there are adverse factors such as the size of the tear, the duration of the symptoms and the association of other pathologies, especially in women.

Tenodesis intrarticular del bíceps y reparacion simultanea de lesiones de subescapular laffosse I y II con anclaje sin nudos. Nota técnica / Intraarticular biceps tenodesis and simultaneous subscapularis lafosse type I or II repair with knotless anchor. Technical Note

La tendinopatía de la porción larga del Bíceps es causa frecuente de dolor en el hombro. Usualmente esta patología se relaciona con tendinopatía y lesiones del manguito rotador comprometiendo con mayor frecuencia el tendón del subescapular. El diagnóstico de esta entidad es difícil tanto clínica como radiológicamente, y la precisión diagnóstica de las lesiones parciales del Bíceps en Resonancia Nuclear Magnética (RMN) es relativamente baja. El objetivo de la nota técnica es presentar una Tenodesis intra-articular de la porción larga del Bíceps utilizando un anclaje óseo sin nudos, el cual sirve a su vez para reinsertar lesiones de tendón subescapular Laffosse tipo I y II con suturas adicionales.

Long head biceps tendinopathy is a common cause of shoulder pain. Usually, this pathology is related to both, tendinopathy and rotator cuff injuries, most frequently involving the subscapularis tendon. The diagnosis of this entity is difficult clinically and radiologically, and the diagnostic sensitivity and specificity of partial biceps injuries in Magnetic Resonance imaging (MRI) is relatively low. The aim of the technical note is to present an intra-articular tenodesis of the long head of the biceps using a knotless bone anchor, which serves once to reinsert type I and II Laffosse subscapular tendon injuries with additional sutures.