This article reports results of 23 shoulders with combined tears of the supraspinatus and upper subscapularis repaired with open surgery. The supraspinatus was repaired to a trough, the biceps was usually tenodesed, and the subscapularis was repaired to the lesser tuberosity. At a minimum of 36 months, two of the supraspinatus repairs had failed. Successful repair did not prevent the progression of fatty infiltration. Post operative Constant scores were not related to the degree of fatty infiltration.
These are important lesions to distinguish from isolated supraspinatus tears for two reasons: (1) repair of the subscapularis seems important to prevent propagation of the tear and (2) biceps instability is always a concern because of the likely disruption of the the transverse humeral ligament. Two of our former colleagues prepared a masterful treatise on the anatomy of this area: Tendons, ligaments, and capsule of the rotator cuff. Gross and microscopic anatomy. Read it!
Once again we see a that, in spite of the technique of repair, failure of cuff repairs is not uncommon. See our previous posts on this topic.
Finally, since we're talking recently about the value equation (benefit/cost), it is time that we question the value of MRI's and ultrasound examinations to assess fatty infiltration/fatty atrophy. We are having difficulty understanding how these findings inform clinical decision-making in the management of cuff pathology. Is this assessment valuable?
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