2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Evaluating the Correlation Between Repair Tension and Healing Status in Subscapularis Tears After Arthroscopic Rotator Cuff Repair

Joe-Zhi Yen, MD TAIWAN
Kai-Lan Hsu, MD, Tainan TAIWAN
Wei-Ren Su, MD, MSc, Tainan TAIWAN

Department of Orthopaedic Surgery, National Cheng Kung University Hospital College of Medicine, National Cheng Kung University, Tainan City, Taiwan, TAIWAN

FDA Status Cleared

Summary

This study highlights the clinical significance of repair tension and patient age in predicting poor subscapularis healing after arthroscopic repair, providing key thresholds to guide surgical decision-making and improve long-term functional outcomes.

Abstract

Background

Studies have yet to explore the correlation between subscapularis (SSC) repair tension and both radiological and functional outcomes. In this study, we (1) examined the correlation between repair tension and radiological outcomes and (2) identified the cutoff values of these factors for predicting radiological and clinical outcomes after arthroscopic SSC repair.

Study Design: Cohort study; Level of evidence, 3.

Methods

Patients who underwent SSC repair and completed 2 years of follow-up from September 2020 to March 2022 were included in this retrospective study. Intraoperative evaluations included the repaired tendon, retraction length, and Lafosse’s classification of the SSC. Preoperative magnetic resonance imaging (MRI) was used to evaluate tendon retraction, muscle atrophy, and fatty infiltration. MRI was performed postoperatively at 6 months to evaluate SSC healing. American Shoulder and Elbow Surgeons (ASES) score, Constant–Murley scores, and internal rotation strength were evaluated preoperatively and at 6, 12, and 24 months postoperatively. Multivariate logistic regression revealed independent variables associated with poor healing, with receiver operating characteristic curves identifying the cutoff values for these variables.

Results

A total of 67 patients were included in the study. The mean SSC repair tension was 3.72 ± 1.48 kg, and the average SSC retraction length was 17.02 ± 5.58 mm. SSC repair tension strongly correlated with retraction length (r = 0.814). Poor healing was observed in 25.4% (17 out of 67) of the patients, with significant differences in age (p = 0.004), repair tension (p = 0.002), retraction length (p = 0.033), and Lafosse’s classification (p = 0.035) observed between the adequate healing and poor healing groups. Multivariable logistic regression revealed significantly increased odds ratios (ORs) for poor SSC healing in patients over 65 years of age and those with repair tension exceeding 4 kg. Patients with repair tension exceeding 4 kg have low internal rotation strength 24 months postoperatively (p = 0.047).

Conclusion

SSC healing status is correlated with age, repair tension, and retraction length. Patients over 65 years of age and those with repair tension exceeding 4 kg are at a significantly high risk of poor SSC healing. Patients with repair tension exceeding 4 kg have low internal rotation strength 24 months postoperatively, although no significant deterioration in shoulder function is observed.

Keywords:
Subscapularis repair, arthroscopic rotator cuff repair, internal rotation, repair tension