SUBSCAPULARIS STRENGTH RECOVERY IN BRISTOW-LATARJET PROCEDURE

Authors: P Paladini; F Campi; G Merolla; A Pellegrini; G Porcellini

References: Presented at SECEC 2009

Purpose
Open shoulder stabilization procedures have been considered the gold standard for recurrent anterior shoulder instability, with success rates in the recently published literature. Loss of subscapularis function can be a significant complication after any surgery that involves its tenotomy. Anterior approaches using different subscapularis tendon takedown or incision techniques may impair subscapularis recovery and can negatively influence the final clinical outcome. The hypothesis was that the detachment of the subscapularis tendon in Bristow-Latarjet procedure leads to loss of function of the muscle respect to the splitting approach in fiber direction.

Material and Methods
Between 2000 and 2006 412 Bristow-Latarjet stabilization procedures were performed. In 287 patients an inverted Lshaped tenotomy approach were performed (Group A) while a longitudinal split of the subscapularis in 125 patients (Group B). At two years of follow up the patients were examined using different clinical tests and an isometric test to investigate subscapularis function.

Results
Clinical examinations showed that 28% of patients of Group A had an incompetent subscapularis showing a statistical difference (p< 0,001) with the mean peak force of the opposite side and with patients of the Group B. Patients of Group B experienced no statistical differences in the mean peak force of the subscapularis muscle with the opposite side.

Conclusion
Subscapularis shoulder function is one of the most critical factors in determining the patient's perception of surgical success of a Bristow-Latarjet procedure. The patients treated with a subscapularis splitting approach in fiber direction maintained a similar peak force respect the opposite side without tendon or muscle incompetency as reported in patients treated with L-shaped tenotomy.