Our Summary

This research study looked at whether a specific surgery, called an isolated subscapularis repair, could help relatively young patients (in their 50s and 60s) who had severe, non-repairable rotator cuff tears in their shoulders. In the past, these patients might have been recommended to have a more invasive surgery called a reverse arthroplasty.

The study included 24 patients who didn’t have shoulder arthritis. They all had the isolated subscapularis repair surgery and their pain levels, shoulder function, and range of motion were measured before and after the surgery. They also had a type of imaging test, called a magnetic resonance arthrogram (MRA), 6 months after the surgery to check the repair’s structural integrity.

Results showed that, on average, over about 2 to 4 years of follow-up, patients’ pain levels, shoulder function, and range of motion significantly improved after the surgery. However, there was no significant improvement in the ability to rotate the shoulder outwards. The MRA results showed that 27% of patients had a re-tear of the repaired area.

In conclusion, for relatively young patients with severe, non-repairable rotator cuff tears who don’t have arthritis, this less invasive surgery may be a beneficial alternative to more invasive options. It resulted in satisfactory short-term outcomes and the repaired area was generally structurally sound.

FAQs

  1. What is an isolated subscapularis repair and who is it recommended for?
  2. What were the results of the study on isolated subscapularis repair in patients with severe, non-repairable rotator cuff tears?
  3. What is a magnetic resonance arthrogram (MRA) and why was it used in this study?

Doctor’s Tip

It’s important to follow your physical therapy program diligently after rotator cuff repair surgery to help strengthen the muscles around the shoulder and improve range of motion. Additionally, avoid activities that could put strain on the shoulder, such as heavy lifting or overhead movements, to prevent re-injury. Be sure to communicate with your doctor if you experience any new or worsening pain after surgery.

Suitable For

It is important to note that this study specifically focused on relatively young patients with severe, non-repairable rotator cuff tears who do not have arthritis. The recommendation for rotator cuff repair surgery may vary depending on the individual patient’s age, overall health, severity of the tear, presence of arthritis, and other factors.

Typically, patients who are recommended for rotator cuff repair surgery are those who have significant pain, weakness, and limited range of motion in their shoulder due to a rotator cuff tear that has not responded to conservative treatments such as physical therapy or cortisone injections. Patients with partial-thickness tears, full-thickness tears, or massive tears may be candidates for rotator cuff repair surgery.

Ultimately, the decision to undergo rotator cuff repair surgery should be made in consultation with a healthcare provider who can evaluate the individual patient’s specific circumstances and recommend the most appropriate treatment option.

Timeline

Timeline:

  • Before surgery: Patients experience severe pain, limited range of motion, and decreased shoulder function due to a non-repairable rotator cuff tear. They may have been recommended a more invasive surgery, such as a reverse arthroplasty.
  • Surgery: Patients undergo an isolated subscapularis repair surgery to address the rotator cuff tear.
  • 6 months post-surgery: Patients undergo a magnetic resonance arthrogram (MRA) to assess the structural integrity of the repair.
  • 2 to 4 years post-surgery: Patients experience significant improvements in pain levels, shoulder function, and range of motion. However, there may not be significant improvement in the ability to rotate the shoulder outwards.
  • Follow-up: Some patients may experience a re-tear of the repaired area, but overall, the surgery results in satisfactory short-term outcomes and a structurally sound repair.

What to Ask Your Doctor

Some questions a patient should ask their doctor about rotator cuff repair include:

  1. What are the potential risks and complications associated with the isolated subscapularis repair surgery?
  2. How long is the recovery process after this surgery and what can I expect in terms of pain and rehabilitation?
  3. Will I need physical therapy after the surgery and if so, how long will it be needed?
  4. What are the expected outcomes in terms of pain relief, shoulder function, and range of motion after the surgery?
  5. How likely is it that the repaired area will re-tear and what steps can I take to prevent re-injury?
  6. Are there any alternative treatments or surgeries that I should consider for my severe, non-repairable rotator cuff tear?
  7. How experienced are you in performing the isolated subscapularis repair surgery and what is your success rate with this procedure?
  8. Do I meet the criteria for this surgery based on my age, level of shoulder arthritis, and other factors?
  9. How often will I need follow-up appointments to monitor the success of the surgery and my shoulder’s recovery?
  10. Are there any lifestyle changes or modifications that I should consider to support the healing process after the surgery?

Reference

Authors: Kim SJ, Choi YR, Jung M, Lee WY, Chun YM. Journal: Am J Sports Med. 2017 May;45(6):1269-1275. doi: 10.1177/0363546516688666. Epub 2017 Mar 20. PMID: 28318302