Biologic Augmentation of the Subscapularis Tendon During Anatomic Shoulder Arthroplasty: A prospective case series utilizing dynamic ultrasound

Abstract

Five consecutively eligible patients with primary glenohumeral osteoarthritis underwent anatomic shoulder arthroplasty utilizing a collagen-based biointegrative implant (TAPESTRY®) to augment subscapularis tendon repairs. Evaluation of subscapularis healing was primarily assessed via dynamic ultrasound examinations at 6 months post-operatively. Subscapularis imaging was evaluated for tendon thickness, width, echotexture, and calcification. All five patients exhibited fully healed tendons at 6 months with no re-tears, representing a decrease in the 50% occurrence of subscapularis tears historically evidenced in ultrasound studies following shoulder arthroplasty. The subscapularis tendon in all patients was shown to be intact, four of which demonstrated macroscopically aligned collagen tendon architecture with anatomic size measurements, and one demonstrated mild tendinosis. Secondary clinical outcomes included validated shoulder outcome scores including the American Shoulder and Elbow Surgeons (ASES) assessment preoperatively and at 3 months and 6 months postoperatively. Improvements in ASES scores were greater than two-times (33 points at 3 months, and 35 points at 6 months) the published minimal clinically important difference (MCID) of 13.6 ± 2.3 for total shoulder arthroplasty (TSA). Additional data collected included graded belly press, lift-off, and range of motion assessments measured preoperatively and at 6 months postoperatively. Biologic augmentation of the subscapularis tendon with a collagen-based biointegrative implant in these 5 patients showed 100% healing rates assessed via dynamic ultrasound at 6 months post-operatively. All patients demonstrated tendon healing without postoperative complications or revisions. Further investigation is needed to validate the observations from this pilot study.