Outcomes After Rotator Cuff Repair With Transverse Scapular Ligament Release in Patients With Severe Fatty Degeneration of the Infraspinatus

Abstract

Background:

In some large to massive rotator cuff tears (RCTs), fatty degeneration (FD) is more severe in the infraspinatus than the supraspinatus muscle, and in such cases, suprascapular neuropathy is highly suspected. Nerve release at the suprascapular notch might alleviate this problem.

Purpose:

To evaluate the effects of the transverse scapular ligament (TSL) release in patients with large to massive RCTs with more severe FD of the infraspinatus than the supraspinatus.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Between September 2017 and January 2022, arthroscopic TSL release with rotator cuff repair was performed in patients with large to massive RCTs and more severe FD of the infraspinatus muscle than the supraspinatus muscle (TSL group). Cuff integrity, FD, and atrophy of cuff muscles were evaluated using preoperative and 1-year postoperative magnetic resonance imaging. In addition, results were compared with those of patients who did not undergo TSL release during arthroscopic large to massive rotator cuff repair (NTSL group).

Results:

A total of 103 patients—20 in the TSL group and 83 in the NTSL group—were included. Group preoperative characteristics, including tear size and supraspinatus FD, were not significantly different, but infraspinatus FD (TSL vs NTSL; grade, 0-4, 0/0/5/10/5 vs 1/33/42/4/3) and atrophy (grade, 1-3. 3/9/8 vs 56/20/7) differed significantly (P < .001). Healing failure occurred in 13 of 20 (65%) patients in the TSL group and 30 of 83 (36%) patients in the NTSL group, which was a statistically significant difference (P = .019). Postoperatively, infraspinatus FD and atrophy were more severe in the TSL group than in the NTSL group (P < .001), and supraspinatus FD was more severe in the TSL group (P = .029). Seven patients in the TSL group achieved healing, but FD and atrophy of the supraspinatus and the infraspinatus showed no improvement in this group (all, P > .05).

Conclusion:

In patients with more FD in the infraspinatus than the supraspinatus muscle, TSL release appeared to have no benefit for cuff healing or FD reversal in cuff muscles. The possibility of suprascapular nerve entrapment remains in patients with more FD in the infraspinatus than the supraspinatus, and this potential nerve problem is not properly addressed by TSL release alone.

Keywords

atrophy fatty degeneration rotator cuff repair suprascapular nerve transverse scapular ligament

Get full access to this article

View all access options for this article.

References

Albritton

Graham

Richards

II Basamania

. An anatomic study of the effects on the suprascapular nerve due to retraction of the supraspinatus muscle after a rotator cuff tear. J Shoulder Elbow Surg. 2003;12(5):497-500.

Boykin

Friedman

Zimmer

, et al. Suprascapular neuropathy in a shoulder referral practice. J Shoulder Elbow Surg. 2011;20(6):983-988.

Collin

Treseder

Ladermann

, et al. Neuropathy of the suprascapular nerve and massive rotator cuff tears: a prospective electromyographic study. J Shoulder Elbow Surg. 2014;23(1):28-34.

Costouros

Porramatikul

Lie

Warner

. Reversal of suprascapular neuropathy following arthroscopic repair of massive supraspinatus and infraspinatus rotator cuff tears. Arthroscopy. 2007;23(11):1152-1161.

Cummins

Messer

Nuber

. Suprascapular nerve entrapment. J Bone Joint Surg Am. 2000;82(3):415-424.

Fuchs

Weishaupt

Zanetti

Hodler

Gerber

. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg. 1999;8(6):599-605.

Gerber

Meyer

Wieser

, et al. Suprascapular nerve decompression in addition to rotator cuff repair: a prospective, randomized observational trial. J Shoulder Elbow Surg. 2020;29(8):1633-1641.

Jensen

Taylor

Sanchez-Sotelo

. Factors influencing the reparability and healing rates of rotator cuff tears. Curr Rev Musculoskel Med. 2020;13(5):572-583.

Jerosch

Muller

Castro

. The incidence of rotator cuff rupture. An anatomic study. Acta Orthop Belg. 1991;57(2):124-129.

10.

Kim

Jang

Choi

Lee

H-R

Kim

. Evaluation of repair tension in arthroscopic rotator cuff repair: does it really matter to the integrity of the rotator cuff? Am J Sports Med. 2016;44(11):2807-2812.

11.

Kim

Y-S

Lee

H-J

Park

, et al. Arthroscopic in situ superior capsular reconstruction using the long head of the biceps tendon. Arthrosc Techn. 2018;7(2):e97-e103.

12.

Kong

Kim

, et al. Suprascapular neuropathy in massive rotator cuff tears with severe fatty degeneration in the infraspinatus muscle. Bone Joint J. 2016;98(11):1505-1509.

13.

Lafosse

Piper

Lanz

. Arthroscopic suprascapular nerve release: indications and technique. J Shoulder Elbow Surg. 2011;20(2):S9-S13.

14.

Lee

Kim

Lee

Yoon

Noh

K-C

. Clinical and anatomical outcomes of arthroscopic repair of large rotator cuff tears with allograft patch augmentation: a prospective, single-blinded, randomized controlled trial with a long-term follow-up. Clin Orthop Surg. 2022;14(2):263-271.

15.

Lim

Hong

Yoo

, et al. Visual MRI grading system to evaluate atrophy of the supraspinatus muscle. Korean J Radiol. 2014;15(4):501-507.

16.

Mallon

Wilson

Basamania

. The association of suprascapular neuropathy with massive rotator cuff tears: a preliminary report. J Shoulder Elbow Surg. 2006;15(4):395-398.

17.

Mochizuki

Sugaya

Uomizu

, et al. Humeral insertion of the supraspinatus and infraspinatus: new anatomical findings regarding the footprint of the rotator cuff. J Bone Joint Surg Am. 2008;90(5):962-969.

18.

Niemann

Juzeszyn

Kahanov

Eberman

. Suprascapular neuropathy in collegiate baseball player. Asian J Sports Med. 2013;4(1):76-81.

19.

Kim

Kang

Gong

. Effect of age on functional and structural outcome after rotator cuff repair. Am J Sports Med. 2010;38(4):672-678.

20.

Patte

. Classification of rotator cuff lesions. Clin Orthop Relat Res. 1990;254:81-86.

21.

Shi

Boykin

Lin

Warner

. Association of suprascapular neuropathy with rotator cuff tendon tears and fatty degeneration. J Shoulder Elbow Surg. 2014;23(3):339-346.

22.

Snyder

. Arthroscopic classification of rotator cuff lesions and surgical decision making. In: Synder

, Ed. Shoulder Arthroscopy. Philadelphia, PA: Lippincott Williams, and Wilkins; 2003:201-207.

23.

Vad

Southern

Warren

Altchek

Dines

. Prevalence of peripheral neurologic injuries in rotator cuff tears with atrophy. J Shoulder Elbow Surg. 2003;12(4):333-336.

24.

Warner

Krushell

Masquelet

Gerber

. Anatomy and relationships of the suprascapular nerve: anatomical constraints to mobilization of the supraspinatus and infraspinatus muscles in the management of massive rotator-cuff tears. J Bone Joint Surg Am. 1992;74(1):36-45.

25.

Yamakado

. Quantification of the learning curve for arthroscopic suprascapular nerve decompression: an evaluation of 300 cases. Arthroscopy. 2015;31(2):191-196.

26.

Yang

Wang

Zhang

, et al. Comparison of clinical outcome of decompression of suprascapular nerve at spinoglenoid notch for patients with posterosuperior massive rotator cuff tears and suprascapular neuropathy. BMC Musculoskelet Disord. 2021;22(1):202.

27.

Yang

T-H

Lin

M-H

Kuo

L-T

, et al. Suprascapular nerve release does not provide additional benefits in arthroscopic rotator cuff repair surgery: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2023;31(5):1873-1882.

28.

Yoo

Y-S

Jang

S-W

Kim

, et al. Does the suprascapular nerve move within the suprascapular notch? Biomechanical perspective using the finite element method. Yonsei Med J. 2022;63(7):657.