title: Recovery of subscapularis and shoulder function following arthroscopic treatment of isolated anterior and combined anterosuperior rotator cuff lesions.
abstract: BACKGROUND
  The purpose of the study was to evaluate the recovery of the subscapularis and shoulder function dependent on the type of lesion and type of surgical treatment, when compared to the non-affected contralateral shoulder. We hypothesized that regardless of type of lesion and performed surgical intervention, a significant muscle insufficiency as compared to the healthy contralateral side will remain.
  
  
  METHODS
  Sixty-eight patients (14 females and 54 males) with an anterior or anterosuperior cuff lesion at an average age of 55.7 ± 11.7 years (range 20-80 years) were prospectively evaluated up to 24 months. Intraoperatively, the lesions were classified according to current systems and treated by debridement or reconstruction. Pre- and postoperatively, the Constant Score (CS) as well as the belly-press angle (BPA) and back-to-hand distance (BHD) on the affected and on the contralateral shoulder was noted.
  
  
  RESULTS
  29.4% had an isolated subscapularis lesion whereas 69.1% had concomitant supraspinatus pathology. In 17 patients an arthroscopic debridement and in 51 patients an arthroscopic repair were performed. Postoperatively, all patients revealed a significant improvement of the CS, BPA and BHD (p < 0.05) independent of the type of lesion or the surgical intervention. However, reconstruction of the subscapularis tendon resulted in significant differences of CS, BPA and BHD (p < 0.05) compared to the contralateral shoulder.
  
  
  CONCLUSIONS
  Reconstruction of subscapularis lesions cannot provide full subscapularis function since a residual subscapularis insufficiency remains, other than in patients with small partial tears treated with debridement alone.
authors.affiliation: Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. christian.gerhardt@charite.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Gerhardt
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Center of Musculoskeletal Surgery, Ulm University, Ulm, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Bartl
authors.affiliation: Department of Trauma and Reconstructive Surgery, Friederikenstift Hospital, Hannover, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Voigt
authors.affiliation: Department of Trauma and Reconstructive Surgery, Friederikenstift Hospital, Hannover, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Lill
authors.affiliation: Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Scheibel
authors.affiliation: Departement of Trauma Surgery, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Frosch
authors.affiliation: Department of Trauma and Reconstructive Surgery, Friederikenstift Hospital, Hannover, Germany.
authors.forename: Jan Christoph
authors.initials: JC
authors.lastname: Katthagen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy / Q000379:methods*; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017006:Rotator Cuff / Q000503:physiopathology / Q000601:surgery; D000070636:Rotator Cuff Injuries; D012782:Shoulder / Q000503:physiopathology*; D013708:Tendon Injuries / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing
keywords: Anterior cuff lesion; Anterosuperior cuff tear; Shoulder; Subscapularis; Subscapularis function