gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017)

24.10. - 27.10.2017, Berlin

Arthroscopic coracoplasty for subcoracoid impingement in 145 cases with a mean follow-up of 4 years

Meeting Abstract

  • presenting/speaker J. Christoph Katthagen - Klinik für Unfall-, Hand- und Wiederherstellungschirurige, Universitätsklinikum Münster, Münster, Germany
  • Travis Menge - Steadman Philippon Research Institue, Vail, United States
  • Marilee Horan - Steadman Philippon Research Institue, Vail, United States
  • Dimitri Tahal - Steadman Philippon Research Institue, Vail, United States
  • Gilbert Moatshe - Steadman Philippon Research Institue, Vail, United States
  • Peter Millett - The Steadman Clinic, Vail, United States

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocWI40-1364

doi: 10.3205/17dkou372, urn:nbn:de:0183-17dkou3725

Veröffentlicht: 23. Oktober 2017

© 2017 Katthagen et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: Nearly 30% of patients with rotator cuff pathology are affected by subcoracoid impingement syndrome (SCIS). SCIS presents as anterior shoulder pain and is often associated with lesions of the subscapularis (SSC) tendon, long head of the biceps (LHB) tendon, and biceps reflection pulley (BRP). There are two main theories to explain the onset of SCIS: (1) SCIS results from an anatomically narrowed coracohumeral interval (CHI), and (2) the presence of a full-thickness supraspinatus (ft-SSP) tear causes a narrowed CHI with subsequent development of SCIS. To date, it remains unclear if the outcomes of arthroscopic coracoplasty (CCP) are affected by the etiology of SCIS. The purpose of this study was to evaluate outcomes of arthroscopic CCP for SCIS in patients with and without associated ft-SSP tears.

Methods: This was an IRB-approved level III retrospective outcomes study with prospectively collected data. 149 patients with symptomatic SCIS who failed non-operative treatment were included. The CHI and the position of the coracoid tip in the sagittal plane were assessed on preoperative MRI. All patients had arthroscopically-confirmed SSC tears, LHB tears, and/or BRP lesions. All underwent arthroscopic subcoracoid decompression with CCP and biceps tenodesis. Outcomes of patients with and without arthroscopic repair of an associated ft-SSP tear were compared at final follow-up. Subjective evaluations included ASES, SF-12, QuickDASH, SANE, and VAS pain scores as well as the level of sport participation preoperatively and at minimum 2-years postoperatively. Satisfaction was collected postoperatively on a scale of 1 to 10, with 10 being very satisfied.

Results and Conclusion: The final cohort consisted of 145 patients (n=110 men, n=35 women) as 4 patients refused participation. 76 patients (52.4%) had an associated ft-SSP tear which was repaired arthroscopically with suture anchors. The CHI (8.5±3.4 vs 8.8±3.4mm) and the position of the coracoid tip (50.8±10.2 ° vs 49.5±6.1 ° ) were not significantly different between patients with and without ft-SSP tear (p>0.4). Outcomes data was available for 123/145(85%) patients at a mean of 4 years (range, 2-9). Mean age at surgery was 55 years. All outcome scores significantly improved postoperatively (p<0.05), with a median patient satisfaction of 10/10 (range 1-10). The mean age of patients with SCIS and associated ft-SSP tears (58.4 years) was significantly higher than in patients with SCIS without ft-SSP tears (51.9 years; p<0.001). Postoperative outcome scores following subcoracoid decompression with CCP for SCIS were significantly better in patients with arthroscopic repair of an associated ft-SSP tear when compared to patients without associated ft-SSP tear (p<0.05, Table 1).

Arthroscopic CCP for SCIS demonstrated significant improvements in function, decreased pain and high patient satisfaction. Patients with SCIS and associated ft-SSC tears had more favorable outcomes when compared to patients without an associated ft-SSP tear.