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    Determining the Patient Acceptable Symptom State (PASS) for Shoulder Strength After Subscapularis Arthroscopic Repair and Evaluating the Preoperative Predictors for PASS Achievement
    (Sage Publications Inc, 2024) Gonzalez-Morgado, Diego; Ardebol, Javier; Kilic, Ali Ihsan; Noble, Matthew B.; Galasso, Lisa A.; Menendez, Mariano E.; Denard, Patrick J.
    Background: Restoring shoulder strength after arthroscopic rotator cuff repair (ARCR) is critical, but there is limited understanding as to what patients consider satisfactory postoperative strength.Purpose: To determine the Patient Acceptable Symptom State (PASS) values for the Constant score strength parameter and internal rotation (IR) strength in patients who underwent ARCR for rotator cuff tears involving the subscapularis (SSC) muscle and evaluate for associations between preoperative and intraoperative patient characteristics with PASS achievement.Study Design: Case-control study; Level of evidence, 3.Methods: A retrospective analysis was conducted on prospectively collected data for 278 patients with an SSC tear (isolated or combined) who underwent ARCR and had minimum 2-year follow-up data. Functional outcomes (patient-reported outcomes, range of motion, Constant strength, and IR strength) were assessed preoperatively and at the latest follow-up. The overall, male, and female PASS values for postoperative strength measures were evaluated using receiver operating characteristic analysis. Correlation and logistic regression analyses were used to evaluate the relationship between preoperative variables and PASS achievement for Constant and IR strengths.Results: The mean follow-up time was 72.8 months. The overall, male, and female PASS values were 9.9 lb (4.5 kg), 14.5 lb (6.6 kg), and 8.5 lb (3.9 kg), respectively, for Constant strength and 15.2 lb (6.9 kg), 20.7 lb (9.4 kg), and 12.1 lb (5.5 kg), respectively, for IR strength. Older age, high fatty infiltration of the SSC tendon (Goutallier grades 3 and 4), and failure of SSC healing correlated negatively with PASS attainment for the strength measures. High fatty infiltration of the supraspinatus and infraspinatus muscles correlated negatively with Constant strength. Decreased coracohumeral distance (CHD) and larger SSC tears correlated negatively with achieving PASS for IR strength. Workers' compensation, high supraspinatus and SSC fatty infiltration, and the use of knotted suture anchors were predictors of not achieving the overall Constant strength PASS, while lower SSC fatty infiltration and high CHD were predictors of achieving the overall IR strength PASS.Conclusion: This study established the PASS values for Constant and IR strengths for patients after ARCR involving the SSC tendon. Workers' compensation, high supraspinatus and SSC fatty infiltration, and the use of knotted suture anchors were predictors of not achieving the overall Constant strength PASS, while lower SSC fatty infiltration and high CHD were predictors of achieving the overall IR strength PASS.
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    Postoperative Outcomes Are Comparable Between Arthroscopic Subscapularis Repairs Performed With Either All-Suture Anchors or Hard-Body Anchors
    (Elsevier Inc., 2024) Gonzalez-Morgado, Diego; Ardebol, Javier; Kilic, Ali Ihsan; Noble, Matthew B.; Galasso, Lisa A.; Nugent, Matthew; Phillips, Cameron
    Purpose: To compare clinical outcomes and tendon healing rates of patients undergoing arthroscopic rotator cuff repairs involving the subscapularis (SSC) tendon (isolated or combined) with all-suture anchors (ASAs) versus hard-body anchors (HBAs) and to compare SSC healing rates between these 2 anchors. Methods: A retrospective comparative study was performed on patients who underwent arthroscopic rotator cuff repair of the SSC with either ASAs or HBAs and had a minimum 2-year follow-up. Range of motion and patient-reported outcomes were collected pre- and postoperatively, including a visual analog scale for pain, American Shoulder and Elbow Surgeons score, and Subjective Shoulder Value. Postoperative strength was measured, including Constant strength and belly press test. SSC healing was evaluated on ultrasounds at the final follow-up. Results: Eighty-four patients met the study criteria. Twenty-eight underwent SSC repair with ASAs and 56 with HBAs. The mean follow-up for the ASA group and HBA group was 44 ± 22.7 months and 48.4 ± 28.3, respectively (P = .743). Baseline characteristics were comparable between groups (P > .05). Overall, patient-reported outcomes and range of motion showed significant improvements from baseline to the final follow-up in all groups (P < .001). Postoperatively, patients in the ASA group had greater improvement in forward flexion compared to the HBA group: 31° (95% confidence interval, 20°-42°) versus 14° (95% confidence interval, 5°-8°), respectively (P = .002). Postoperative Constant strength was higher in the ASA group compared to the HBA group: 17.5 ± 7.5 versus 13.5 ± 5.6, respectively (P = .04). No statistically significant difference in SSC retear rates was observed between groups: none in the ASA group and 3 (10.7%) in the HBA group (P = .27). Conclusions: Arthroscopic SSC repair leads to significant functional improvement, with both ASAs and HBAs demonstrating similar low failure rates. Level of Evidence: Level III, retrospective cohort study. © 2024 The Authors
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    The Subscapularis Healing Index: A New Scoring System for Predicting Subscapularis Healing After Arthroscopic Repair
    (Sage Publications Inc, 2024) Kilic, Ali I.; Zuk, Nicholas A.; Ardebol, Javier; Galasso, Lisa A.; Noble, Matthew B.; Menendez, Mariano E.; Denard, Patrick J.
    Background: Previous research has emphasized the effect of prognostic factors on arthroscopic rotator cuff repair (ARCR) success, but a specific focus on subscapularis (SSC) tendon repair healing is lacking. Purpose: To identify prognostic factors for SSC healing after ARCR and develop the Subscapularis Healing Index (SSC-HI) by incorporating these factors. Study Design: Case-control study; Level of evidence, 3. Methods: This was a retrospective study using prospectively maintained data collected from patients with isolated or combined SSC tears who underwent ARCR between 2011 and 2021 at a single institution with a minimum 2-year follow-up. Functional outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), and visual analog scale (VAS) pain scale. SSC tendon healing was evaluated via ultrasound at the final follow-up. Multivariate logistic regression analysis was performed to determine the factors affecting SSC healing, and based on these factors, the SSC-HI, which ranges from 0 to 15 points, was developed using odds ratios (ORs). Results: Among 1018 ARCR patients, 931 met the inclusion criteria; 279 returned voluntarily for postoperative SSC ultrasound assessment. The overall healing failure rate was 10.8% (30/279). Risk factors for healing failure included female sex (P = .008; OR, 3.119), body mass index (BMI) >= 30 (P = .053; OR, 2.323), supraspinatus fatty infiltration >= 3 (P = .033; OR, 3.211), lower SSC fatty infiltration >= 2 (P = .037; OR, 3.608), and Lafosse classification >= 3 (P = .007; OR, 3.224). A 15-point scoring system comprised the following: 3 points for female sex, 2 points for BMI >= 30, 3 points for supraspinatus fatty infiltration >= 3, 4 points for lower SSC fatty infiltration >= 2, and 3 points for Lafosse classification >= 3. Patients with <= 4 points had a 4% healing failure rate, while those with >= 9 points had a 55% rate of healing failure. Patients with a healed SSC reported significantly higher ASES (healed SSC: Delta ASES, 44.7; unhealed SSC: Delta ASES, 29; P < .01) and SSV (healed SSC: Delta SSV, 52.9; unhealed SSC: Delta SSV, 27.5; P < .01) and lower VAS (healed SSC: Delta VAS, -4.2; unhealed SSC: Delta VAS, -3; P < .01) scores compared with those with an unhealed SSC. Conclusion: The SSC-HI scoring system integrates clinical and radiological factors to predict SSC healing after surgical repair. Successful SSC healing was found to be associated with enhanced functional outcomes, underscoring the clinical relevance of SSC healing prediction in the management of these tears.