The subscapularis healing index: A new scoring system for predicting subscapularis healing after arthroscopic repair

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dc.authoridKILIC, Ali Ihsan/0000-0001-7491-6044
dc.authoridDenard, Patrick/0000-0002-2641-5920
dc.contributor.authorKılıç, Ali İhsan
dc.contributor.authorZuk, Nicholas A.
dc.contributor.authorArdebol, Javier
dc.contributor.authorGalasso, Lisa A.
dc.contributor.authorNoble, Matthew B.
dc.contributor.authorMenendez, Mariano E.
dc.contributor.authorDenard, Patrick J.
dc.date.accessioned2025-03-20T09:50:45Z
dc.date.available2025-03-20T09:50:45Z
dc.date.issued2024
dc.departmentİzmir Bakırçay Üniversitesi
dc.description.abstractBackground: 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.
dc.description.sponsorshipArthrex; Steelhead Surgical; Medwest Associates
dc.description.sponsorshipL.A.G. has received support for education from Pinnacle and Arthrex and hospitality payments from Stryker. M.B.N. has received support for education from Rock Medical Orthopedics. M.E.M. has received consulting fees from Arthrex; support for education from Arthrex, Steelhead Surgical, and Medwest Associates; and hospitality payments from Stryker, Encore Medical, and Smith & Nephew. P.J.D. has received consulting fees and royalties from Arthrex, consulting fees from Pacira Pharmaceuticals, and support for education from Steelhead Surgical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
dc.identifier.doi10.1177/03635465241254029
dc.identifier.endpage2081
dc.identifier.issn0363-5465
dc.identifier.issn1552-3365
dc.identifier.issue8
dc.identifier.pmid38880490
dc.identifier.scopus2-s2.0-85196264818
dc.identifier.scopusqualityQ1
dc.identifier.startpage2071
dc.identifier.urihttps://doi.org/10.1177/03635465241254029
dc.identifier.urihttps://hdl.handle.net/20.500.14034/2298
dc.identifier.volume52
dc.identifier.wosWOS:001249275100001
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherSage Publications Inc
dc.relation.ispartofAmerican Journal of Sports Medicine
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/closedAccess
dc.snmzKA_WOS_20250319
dc.subjectsubscapularis tear
dc.subjectrotator cuff tear
dc.subjectprognostic factors
dc.subjectscoring system
dc.subjectsex
dc.subjecttear size
dc.subjectfatty infiltration
dc.subjectarthroscopic repair
dc.subjecthealing
dc.subjectretear
dc.subjectoutcomes
dc.titleThe subscapularis healing index: A new scoring system for predicting subscapularis healing after arthroscopic repair
dc.typeArticle

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