Prospective Randomized Comparative Study of Outcome of Subscapularis Tear
Condition: Rotator Cuff Syndrome
Study type: Interventional

Summary: 
      The purpose of this study was to report actual percentage of subscapularis tear in
      concomitant with supraspinatus tendon tear (with or without infraspinatus tear) and
      investigate the amount of contribution of subscapularis repair as to the outcome of whole
      rotator cuff repair in terms of its clinical and radiologic aspects.
    

Detailed description: 
      Prospective randomized controlled study was designed to evaluate subscapularis repair in
      anterosuperior rotator cuff tear compared with debridement of the subscapularis tear. After
      identification of the subscapularis tear arthroscopically, final eligibility of participants
      for the study was established on the basis of intra-operative arthroscopic inspection of the
      subscapularis using 70 degrees arthroscope. Once eligibility was confirmed, patients were
      randomized to one of two arthroscopic methods; repair (group A) or debridement (group B) of
      the subscapularis tear. The treatment allocations were decided through an interphone by
      "Research Coordinator". Block randomization was performed and no stratification was
      performed. Random Sequence Generator (Random.org) was used for the randomization process by
      given number whose digit was residue of modulo 2 (0 - group A, 1 - group B). Sequence
      Boundaries was 1 (smallest value) to 300 (largest value) based on the number calculated from
      power analysis. After randomization, patients underwent arthroscopic repair or debridement of
      the subscapularis tear. Size of the rotator cuff tear was also determined by the arthroscopic
      finding (small-to-medium, medium-to-large, large-to-massive). When full-thickness tear was
      confined to supraspinatus, the tear was called small-to-medium size tear. Medium-to-Large
      size tear was defined as complete full-thickness supraspinatus tear combined with incomplete
      full-thickness infraspinatus tear. Large-to-massive tear consisted of complete full-thickness
      tear of supraspinatus and infraspinatus or complete full-thickness tear of supraspinatus and
      subscapularis or complete 3-tendon tears. Postoperatively, rehabilitation was identical for
      both groups and consisted of sling immobilization for six weeks. Pulley exercises were
      performed during this time period. After six weeks from the surgery, active-assisted exercise
      including stick exercise to achieve full range of motion was performed. After 9 weeks from
      the surgery, Theraband exercise was initiated to strengthen repaired rotator cuff muscles.
      All patients underwent ultrasound at 24 months follow-up to evaluate integrity of
      supraspinatus tendon. The evaluation of integrity of supraspinatus tendon was performed and
      compared between two groups to evaluate the contribution of the subscapularis tendon to
      rotator cuff integrity. Re-tear of the supraspinatus was carefully evaluated through
      ultrasound by musculoskeletal radiologists who were experienced in ultrasound-diagnosis of
      shoulder more than 10 years.
    

Intervention name(s): arthroscopic repair; arthroscopic debridement
Intervention type(s): Procedure; Procedure
Intervention description(s): If the subscapularis tendon was not sufficiently mobile, further anterior interval release between subscapularis and scapula was performed. LHB (long head of biceps tendon) was either treated with a biceps tenodesis or by tenotomy when there was tear or subluxation of it. The footprint area of the subscapularis tendon, which is trapezoidal in shape on the proximal part of the lesser tuberosity, was thoroughly cleaned of soft tissue and meticulous bone preparation was done prior to placement of anchor sutures.; Anterosuperior portal was made initially for debridement (capsulectomy and anterior bursectomy). A systematic release of the glenohumeral ligaments and the overlying subscapularis bursa was performed.The superior aspect of the tendon was freed from the surrounding structures (the coracohumeral and superior glenohumeral ligaments). The middle glenohumeral ligament was always released to identify the upper border of the subscapularis tendon.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: subscapularis tear; arthroscopic tendon repair; arthroscopic tendon debridement; ASES