Does preoperative subscapularis fatty muscle infiltration really matter in anterosuperior rotator cuff tears repair outcomes? A prospective multicentric study

IntroductionAnterosuperior (AS) rotator cuff tear describes a combined tear of the subscapularis and the supraspinatus tendons. We hypothesized that results after AS tendon repairs might be influenced by the size of the subscapularis rupture and the preoperative subscapularis muscle fatty infiltration.MethodsA prospective multicentric study of 53 AS rotator cuff tears from five centers was performed (January 2008–January 2009). Subscapularis tendon retraction and fatty infiltration were assessed preoperatively. An ultrasonographic healing control was performed 1 year after surgery.ResultsPatients were on average 60 years (range, 43–75 years) and were operated on average 16 months (range, 2–72 months) after the beginning of their symptoms. The incidence of AS tears was found to be 18%. Average follow-up was 15 months (range, 12–24). The Constant-Murley (CM) score for the patients with AS ruptures improved significantly from 49 points (range, 35–51 points) preoperatively to 73 points postoperatively (range, 50–95 points)(P = 0.0205). CM score gains were 26 for Lafosse group 1 ruptures and 29 for Lafosse group 2 & 3 with pre- and postoperative P values at P < 0.0000001 and P < 0.000001, respectively. The last follow-up CM score according to the subscapularis fatty infiltration was 70 (range, 48–95) for groups 0–1, 70 (range, 56–87) for group 2, and 56 (range, 53–88) for groups 3–4 with pre- and postoperative P values at P < 0.001, P < 0.001, and P < 0.004, respectively. The global retear rate was 6%.DiscussionOur study showed that the CM score after repairs of AS rotator cuff tears was lower in advanced subscapularis fatty infiltration. However, gains in CM scores were similar whatever the initial subscapularis fatty infiltration. The rate of tendon healing was correlated with subscapularis fatty infiltration. Subscapularis tendon rupture size was not significantly correlated with outcomes.Level of evidenceLevel III.