title: Long-term subscapularis strength assessment after Bristow-Latarjet procedure: isometric study.
abstract: BACKGROUND
  The subscapularis is the strongest rotator cuff muscle. Bristow-Latarjet procedure may impair subscapularis function. The aim of the study is to describe the difference in isometric subscapularis (SSC) strength after L-shape tenotomy versus muscle split in patients who underwent to Bristow-Latarjet procedure.
  
  
  METHODS
  From 2000 to 2006, we enrolled 376 patients for Bristow-Latarjet procedures. We identified 2 groups according to the subscapularis approach. Group A included 264 subjects with subscapularis L shape tenotomy; group B included 112 subjects with subscapularis muscle split. The subscapularis function was assessed with lift-off and belly-press tests. Isometric strength of rotator cuff muscle was assessed at an average follow-up of 45 months in group A and 42 months in group B, recording the maximum isometric peak torque (PT) (N), maximum isometric couple (Nm), relative strength index (N/Kg), strength, couple and external/internal rotator ratio. Constant and Rowe were used as scores.
  
  
  RESULTS
  Subscapularis assessment in the overall population showed 33 cases (8.8%) with a positive Lift-off test and 30 cases (8%) with a positive belly-press test. Rowe and Constant scores increased in both groups (P < .01). The mean PT in group A was lower of 24,8 Nw than group B (P < .01); similarly, the max PT values of group A were lower of 26.1 Nw than group B (P < .01).
  
  
  CONCLUSIONS
  L-shaped tenotomy in Bristow-Latarjet procedure has a weakening effect on the subscapularis and for these reasons we strongly recommend the muscle split approach for an optimal subscapularis function recovery.
authors: Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, E-R, Italy. palpaolo@tin.it
authors: Paolo
authors: P
authors: Paladini
authors: Giovanni
authors: G
authors: Merolla
authors: Elisa
authors: E
authors: De Santis
authors: Fabrizio
authors: F
authors: Campi
authors: Giuseppe
authors: G
authors: Porcellini
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007537:Isometric Contraction / Q000502:physiology*; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D011184:Postoperative Period; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000503:physiopathology* / Q000601:surgery; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D058971:Tenotomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome