Subscapularis Repair in Reverse Total Shoulder Arthroplasty: Differences in Outcomes Based on Preoperative Quality of Subscapularis Tendon

Sung-Min Rhee; Joon Woo Lee; Jong Ung Lee; Cheol-Hwan Kim; Se Yeon Kim; Hyun Joo Ham; Radhakrishna Kantanavar; Yong-Girl Rhee

doi:10.1007/s43465-024-01139-x

Subscapularis Repair in Reverse Total Shoulder Arthroplasty: Differences in Outcomes Based on Preoperative Quality of Subscapularis Tendon

Indian J Orthop. 2024 Apr 17;58(6):747-754. doi: 10.1007/s43465-024-01139-x. eCollection 2024 Jun.

Authors

Sung-Min Rhee¹, Joon Woo Lee², Jong Ung Lee², Cheol-Hwan Kim², Se Yeon Kim², Hyun Joo Ham², Radhakrishna Kantanavar², Yong-Girl Rhee²

Affiliations

¹ Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital #23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 130-872 Republic of Korea.
² Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-dong, Deokyang-gu, Goyang-si, Gyeonggi-do 412-270 Republic of Korea.

PMID: 38812870
PMCID: PMC11130088 (available on 2025-04-17)
DOI: 10.1007/s43465-024-01139-x

Abstract

Purpose: This study examines the influence of preoperative fatty infiltration (FI) of the subscapularis tendon (SBS) on outcomes following reverse total shoulder arthroplasty (rTSA) with SBS repair.

Methods: A cohort of 161 rTSA patients with SBS repair, followed for a mean of 45.3 months, was divided into three groups based on FI: Group A (intact upper and lower portions, n = 85), Group B (intact lower portions, n = 44), and Group C (fatty infiltrated in both portions, n = 32). The mean age was 74.5 years (range: 65-95).

Results: Preoperative FI displayed significant disparity among the groups: Group A (1.18 ± 0.60), Group B (2.95 ± 0.56), and Group C (4.0 ± 0.00) (p < .001). Group A exhibited a more positive trend in activities of daily living, particularly in toileting ability (81% in Group A, 68% in Group B, and 72% in Group C), although without statistical significance (p = 0.220). Complication rates varied: Group A had seven acromial fractures (8%), three cases of instability (3%), and six instances of scapular notching (7%). Group B experienced four acromial fractures (9%) and four cases of scapular notching (9%), while Group C had only one case of scapular notching (3%) (p = 0.733).

Conclusion: In cases characterized by favorable preoperative SBS quality, there was an elevation in functional internal rotation (IR) post-surgery, accompanied by an increased incidence of postoperative complications. Hence, careful consideration is advised when determining the necessity for SBS repair.

Level of evidence: Level III, retrospective comparative study.

Keywords: Fatty infiltration; Reverse total shoulder arthroplasty; Rotator cuff; Subscapularis muscle.

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