Does Pseudoparesis Affect the Outcomes of Isolated Subscapularis Tear Repair? A Mid-term Follow-up Study

Background: The role of subscapularis tears in pseudoparesis in massive rotator cuff tears has been thoroughly investigated in the literature. However, further research is required to assess the effect of pseudoparesis on clinical outcomes in isolated subscapularis tear repair. Purpose/Hypothesis: The purpose of the present study was to compare the outcomes of patients with and without preoperative pseudoparesis after repair of isolated subscapularis tears at midterm follow-up. It was hypothesized that patients who underwent arthroscopic repair of isolated subscapularis tears would have satisfactory results regardless of the presence of preoperative pseudoparesis. Study Design: Cohort study; Level of evidence, 3. Methods: The study included 75 patients who underwent arthroscopic repair of isolated subscapularis tears between July 2014 and December 2019 and were evaluated at the final follow-up. Patients were classified into 2 groups based on the degree of preoperative active forward elevation (AFE), using a cutoff of 90° to define pseudoparesis: the nonpseudoparesis group (AFE, >90°; n = 49) and the pseudoparesis group (AFE, ≤90°; n = 26). The range of motion (ROM), visual analog scale score, University of California–Los Angeles shoulder rating scale (UCLA) score, Constant-Murley score (CMS), and Subjective Shoulder Value (SSV) were compared preoperatively and at the final follow-up. Results: The median duration of follow-up was 56 months (range, 48-108 months). At the preoperative assessment, active and passive forward elevation, active and passive internal rotation, and the CMS, UCLA score, and SSV were significantly lower in the pseudoparesis group (P <.05). For both groups, significant improvements were observed postoperatively in AFE, passive forward elevation, active internal rotation, passive internal rotation, and all functional outcome scores. There was no significant difference between the groups for both functional scores and ROM values in the postoperative measurements (P >.05). Also, a higher prevalence of pseudoparesis was observed with involvement of the inferior subscapularis tendon or Lafosse type 3 and 4 tears. Conclusion: The main finding of the present study is that satisfactory outcomes could be achieved after arthroscopic repair of isolated subscapularis tears, regardless of preoperative pseudoparesis.