Surgical reconstruction techniques for irreparable subscapularis tears provide functional improvement but variable failure rates: A systematic review

IF 3.3 Q1 ORTHOPEDICS
Marc Daniel Bouchard MD , Justin Gilbert MD , Omar Haque MD , Colin Kruse MD, MSc , Bianca Giovanna Vescio MB BCh BAO , Darshil Shah MBBS , Moin Khan MD, MSc, FRCSC , Bashar Alolabi MD, MSc, FRCSC
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引用次数: 0

Abstract

Introduction/Objectives

Irreparable subscapularis tears can cause severe functional impairment and present significant clinical challenges. Current treatment options include tendon transfers (TTs), anterior capsular reconstruction, and reverse shoulder arthroplasty. Each approach has distinct biomechanical advantages and limitations, but there remains no consensus regarding the optimal treatment. This systematic review aimed to evaluate and compare clinical outcomes, failure rates, and complication profiles of surgical reconstruction techniques for irreparable subscapularis tears.

Methods

This systematic review followed PRISMA guidelines. A comprehensive search was conducted in Embase, OVID Medline, and Emcare databases. Eligible studies included adults with irreparable subscapularis tears treated with surgical reconstruction (e.g., tendon transfers, graft augmentation, or anterior capsular reconstruction) and reporting clinical outcomes. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) score. A narrative synthesis was performed with descriptive statistics (frequencies, percentages, or weighted means with variability).

Results

Fourteen studies comprising 351 patients (355 shoulders) were included, with a mean age of 58.1 years (SD 9.5) and mean follow-up of 44.7 months (SD 54.4). Studied procedures included latissimus dorsi (LD) TT (6 studies, n ​= ​164), pectoralis major (PM) TT (5 studies, n ​= ​94), pectoralis minor (Pm) TT (1 study, n ​= ​74), and anterior capsular reconstruction (ACR; 2 studies, n ​= ​25). PM TT had the highest failure rate (13.0 ​%), followed by ACR (12.0 ​%), LD transfer (11.0 ​%), and Pm TT (1.4 ​%). Postoperative complications were most frequent after PM TT (12.8 ​%), while LD TT had a complication rate of 9.8 ​%. Patient-reported outcome measures improved across all groups, with the greatest Constant-Murley Score (CMS) improvement following LD TT (+33.0), the greatest Subjective Shoulder Value (SSV) improvement after PM TT (+38.6), and the largest Visual Analogue Scale (VAS) pain reduction following ACR (−5.0) and Pm transfer (−5.1).

Conclusions

Surgical reconstruction techniques for irreparable subscapularis tears provide improvements in pain and function, though failure and complication rates vary by procedure and appear worse with concomitant rotator cuff pathology. Further high-quality comparative studies are needed to refine patient selection and optimize surgical decision-making.

Level of evidence

IV.
不可修复的肩胛下肌撕裂手术重建技术提供功能改善但失败率可变:系统回顾。
简介/目的:不可修复的肩胛下肌撕裂可导致严重的功能损害,并提出了重大的临床挑战。目前的治疗方案包括肌腱转移(TTs)、前囊重建术和反向肩关节置换术。每种方法都有不同的生物力学优势和局限性,但关于最佳治疗仍未达成共识。本系统综述旨在评估和比较不可修复肩胛下肌撕裂手术重建技术的临床结果、失败率和并发症。方法:本系统综述遵循PRISMA指南。在Embase、OVID Medline和Emcare数据库中进行了全面的搜索。符合条件的研究包括接受手术重建(例如,肌腱转移、移植物增强或前囊重建)治疗的肩胛下肌撕裂的成人,并报告临床结果。方法学质量采用非随机研究方法学指数评分进行评估。采用描述性统计(频率、百分比或带变异性的加权平均值)进行叙述性综合。结果:14项研究共纳入351例患者(355例肩关节),平均年龄58.1岁(SD 9.5),平均随访时间44.7个月(SD 54.4)。研究的手术包括背阔肌(LD) TT(6项研究,n = 164)、胸大肌(PM) TT(5项研究,n = 94)、胸小肌(PM) TT(1项研究,n = 74)和前囊重建(ACR, 2项研究,n = 25)。PM TT失败率最高(13.0%),其次是ACR(12.0%)、LD转移(11.0%)和PM TT(1.4%)。PM TT术后并发症发生率最高(12.8%),LD TT术后并发症发生率为9.8%。患者报告的结果测量在所有组中都有所改善,LD TT后的恒定-莫利评分(CMS)改善最大(+33.0),PM TT后的主观肩值(SSV)改善最大(+38.6),ACR和PM转移后的视觉模拟量表(VAS)疼痛减轻最大(-5.0)。结论:不可修复肩胛下肌撕裂的手术重建技术可以改善疼痛和功能,尽管手术失败和并发症的发生率因手术而异,并且伴随肩袖病变会更严重。需要进一步的高质量比较研究来完善患者选择和优化手术决策。证据等级:四级。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.90
自引率
6.20%
发文量
61
审稿时长
108 days
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