{"paper_id":"03cbfcac-1f3a-4482-9036-a7fc7d05a7ab","body_text":"Effect of Subscapularis Integrity on Functional Recovery After Posterior Latissimus Dorsi Tendon Transfer for Posterior–Superior Irreparable Rotator Cuff Tears | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of Subscapularis Integrity on Functional Recovery After Posterior Latissimus Dorsi Tendon Transfer for Posterior–Superior Irreparable Rotator Cuff Tears Chang Hee Baek, Bo Taek Kim, Jung Gon Kim, Chaemoon Lim, Phuoc Hau Huynh, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9115678/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Purpose Posterior latissimus dorsi (LD) transfer is widely used to treat posterior–superior irreparable rotator cuff tears (PSIRCTs), but the impact of subscapularis integrity on postoperative outcomes remains debated. This study aimed to evaluate the effect of subscapularis integrity on clinical and radiologic outcomes following arthroscopic-assisted posterior LD transfer. Methods This retrospective study included patients who underwent arthroscopic-assisted posterior LD transfer for PSIRCTs and were classified into Subscapularis Intact and Subscapularis Tear groups. Surgical indications included PSIRCTs, intact or repairable subscapularis, and minimal glenohumeral arthritis. Clinical assessments comprised VAS, Constant score, ASES score, and active range of motion (ROM). Radiologic evaluations included acromiohumeral distance (AHD), Hamada grade, and integrity of the transferred tendon. Postoperative complications and the achievement of minimal clinically important differences (MCID) were also recorded. Results A total of 53 patients were included, classified into the Subscapularis Intact group (n = 34) and the Subscapularis Tear group (n = 19). At a mean follow-up of 62.9 ± 12.9 months, both groups demonstrated significant improvements in pain, patient-reported outcome measures (PROMs), and range of motion (ROM). Patients with an intact subscapularis achieved higher postoperative Constant scores (70.7 ± 8.9 vs. 62.3 ± 8.9, p = 0.002) and ASES scores (75.5 ± 8.8 vs. 66.7 ± 8.8, p = 0.001) than those with tears. Retear rates (17.6% vs. 26.3%, p = 0.465) and overall complications were similar between groups. Radiographically, the acromiohumeral distance decreased and the Hamada grade increased slightly in both groups, consistent with previously reported outcomes. Conclusion Posterior LD transfer provides significant improvements in pain, function, and range of motion for patients with PSIRCTs. Although both groups demonstrated meaningful improvements, patients with an intact subscapularis tended to achieve significantly higher Constant and ASES scores compared with those with subscapularis tears. Level of Evidence IV, Retrospective Case-series Posterior–superior irreparable rotator cuff tear Latissimus dorsi transfer Subscapularis Shoulder function Tendon transfer Introduction Posterior–superior irreparable rotator cuff tears (PSIRCTs) represent a challenging clinical problem, particularly in patients with a preserved glenohumeral joint.[1, 2] Various surgical techniques, including partial repair, patch augmentation, superior capsule reconstruction, tendon transfers, and reverse shoulder arthroplasty, have been used to treat these patients.[1-6] Although these procedures can provide pain relief and functional improvement, each has inherent limitations in fully replicating the biomechanical function of the native rotator cuff complex. Among the available tendon transfer procedures, posterior latissimus dorsi (LD) transfer has been widely adopted for the treatment of PSIRCTs involving severe supraspinatus and infraspinatus tears.[6, 7] This procedure effectively restores the posterior force couple, enhances external rotation, and contributes to improved shoulder elevation.[8] When the posterior–superior cuff is deficient, the anterior portion of the rotator cuff, particularly the subscapularis, plays a critical compensatory role in maintaining the anterior–posterior force couple and overall shoulder stability. Subscapularis insufficiency may disrupt this balance, leading to anterior translation and altered glenohumeral kinematics.[9-11] Previous biomechanical and clinical studies have demonstrated that subscapularis deficiency may negatively affect outcomes after procedures such as lower trapezius transfer and superior capsule reconstruction in PSIRCTs.[12-14] However, the effect of subscapularis integrity on clinical outcomes following posterior LD transfer remains understudied and is still a matter of debate.[15-20] Therefore, the purpose of this study is to evaluate the effect of subscapularis integrity on clinical and radiologic outcomes after arthroscopic-assisted posterior LD transfer for PSIRCTs. The study hypothesis was that patients with an intact subscapularis tendon would demonstrate superior functional outcomes compared with those with a torn subscapularis, based on preoperative imaging and confirmed by intraoperative findings. Study Design and Patient Selection This retrospective study included patients who underwent arthroscopic-assisted posterior LD transfer for PSIRCTs between April 2012 and June 2020 at a single institution. The surgical indications were as follows: (1) persistent shoulder pain and functional limitation despite conservative management; (2) severely retracted supraspinatus and infraspinatus tendons to glenoid level; (3) advanced fatty infiltration of the supraspinatus and infraspinatus muscles (Goutallier[21] grade 3 or 4); (4) intraoperative confirmation that the retracted supraspinatus and infraspinatus tendons could not be mobilized to their anatomic footprint; (5) intact or repairable subscapularis tendon (Lafosse[22] classification ≤ III); and (6) absence or minimal glenohumeral arthritis (Hamada[23] grade ≤ 2). Patients were excluded if they were lost to follow-up or lacked postoperative clinical or radiologic data. The current study compared clinical outcomes between patients with a preoperatively intact subscapularis and those with a preoperative subscapularis tear, as determined by preoperative magnetic resonance imaging (MRI) and confirmed intraoperatively prior to subscapularis treatment. Lafosse type I tears were treated with debridement, whereas Lafosse types II and III tears underwent repair at the index surgery. No irreparable subscapularis tears were included, as irreparable subscapularis deficiency was not an indication for posterior LD tendon transfer. Surgical Procedure All procedures were performed by a single senior surgeon using a standardized arthroscopic-assisted posterior LD transfer technique previously described in the literature.[24] Patients were positioned in the lateral decubitus position under general anesthesia. The procedure began with diagnostic arthroscopy to evaluate the glenohumeral joint and the long head of the biceps (LHB) tendon. A total of 19 patients (55.9%) and 4 patients (21.0%) had an intact LHB, while complete tears with distal retraction were found in 4 patients (11.7%) and 10 patients (52.6%) in the Subscapularis Intact Group and Subscapularis Tear Group, respectively. Partial LHB tears were treated with either tenotomy (Subscapularis Intact Group, N = 8; Subscapularis Tear Group, N = 4) or tenodesis (Subscapularis Intact Group, N = 3; Subscapularis Tear Group, N = 1), depending on the degree of tendon degeneration and intraoperative findings. For any subscapularis tears (N=19), Lafosse[22] type I tears (N=5) were treated with debridement, type II tears (N=10) with single-row repair, and type III tears (N=4) with double-row repair. The torn supraspinatus and infraspinatus tendons were then assessed, and if they could not be mobilized to their anatomic footprint despite adequate release, posterior LD transfer was performed. The LD tendon was harvested through a small posterior axillary incision made along its anterior border with the shoulder flexed, internally rotated, and abducted. The LD tendon was identified and isolated with careful protection of the radial nerve and the anterior humeral circumflex vessels. Blunt dissection was carried out from proximal to distal to release the muscle, ensuring sufficient excursion for transfer. The tendon was reinforced with No. 2 nonabsorbable sutures using a continuous running locking stitch technique to facilitate subsequent fixation. Arthroscopically, the greater tuberosity was prepared by thorough debridement and decortication of the supraspinatus and infraspinatus footprint to enhance tendon-to-bone healing. The harvested LD tendon was then passed under the deltoid through the interval between the external rotators and the posterior border of the deltoid. Two triple-loaded suture anchors were inserted at the medial aspect of the prepared footprint, and the sutures were passed through the LD tendon in a mattress configuration. Final fixation was achieved using a double-row suture-bridge construct with three to four knotless anchors, providing secure tendon apposition and optimal contact pressure at the footprint. Postoperative Rehabilitation Following surgery, the operated arm was immobilized in a 30° abduction brace with the shoulder maintained in neutral rotation for four weeks. During this period, patients performed gentle self-assisted passive range of motion (ROM) exercises to prevent stiffness while protecting the repair. Between postoperative weeks 4 and 12, rehabilitation advanced to active-assisted and active ROM exercises with gradual restoration of functional mobility. From three months onward, a structured strengthening program was implemented to enhance dynamic stability and shoulder function. Heavy lifting and labor-intensive activities were restricted for at least six months postoperatively. Clinical Assessment All clinical and radiologic evaluations were conducted preoperatively and at the final follow-up. Pain intensity was assessed using the visual analog scale (VAS), and shoulder function was evaluated with patient-reported outcome measures (PROMs), including the Constant score and the American Shoulder and Elbow Surgeons (ASES) score. Active ROM was measured for forward elevation, abduction, external rotation at the side, and internal rotation behind the back. Internal rotation was recorded according to the highest spinal level reached by the thumb (0 = greater trochanter, 2 = buttock, 4 = lumbosacral junction, 6 = L3, 8 = T12, and 10 = T8). Radiologic evaluations included measurement of the acromiohumeral distance (AHD) and Hamada grade to assess subacromial space and arthritic progression. AHD was measured preoperatively and at the final follow-up as the shortest distance between the inferior border of the acromion undersurface and the apex of the humeral head on standardized true anteroposterior radiographs. MRI was obtained for all patients preoperatively and at the final follow-up. Fatty infiltration of the rotator cuff muscles was graded using the Goutallier[21] classification, and subscapularis tendon integrity was classified according to the Lafosse[22] classification. At the final follow-up, integrity of the transferred latissimus dorsi tendon was evaluated using MRI, with retear defined as loss of tendon continuity on postoperative MRI. To determine the clinical relevance of postoperative improvement, the minimal clinically important difference (MCID) was calculated for the VAS, Constant score, and ASES scores. Postoperative complications, including retear, infection, and progression of osteoarthritis, were also recorded. Statistical Analysis All statistical analyses were performed using SPSS software (version 26; IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean ± standard deviation, and categorical variables as frequencies and percentages. The Shapiro–Wilk test was used to assess the normality of data distribution. Between-group comparisons (Subscapularis Intact vs. Subscapularis Tear groups) were conducted using the independent t-test for continuous variables and the chi-square or Fisher’s exact test for categorical variables. Paired t-tests were used to compare preoperative and postoperative outcomes within each group. The MCID was determined using the 0.5 standard deviation distribution method.[25] The primary significance level was set at α = 0.05. For secondary and multiple between-group comparisons, a Bonferroni correction was applied, and statistical significance was assessed using the corresponding adjusted p-value thresholds Results Seven patients were excluded, including two who had died and five who were lost to follow-up or had incomplete data. A total of 53 patients (Subscapularis Intact Group, N = 34; Subscapularis Tear Group, N = 19) were included with a mean follow-up duration of 62.9 ± 12.9 months (range, 48–100 months). Baseline characteristics, including age, sex, symptom duration, dominant arm involvement, and comorbidities such as diabetes and hypertension, were comparable between groups. Fatty infiltration of the supraspinatus and infraspinatus muscles did not differ significantly between groups. [Table I]. Overall, the cohort demonstrated significant postoperative improvements in pain, PROM, and ROM compared with preoperative values. Radiographically, the AHD decreased from 8.3 ± 2.4 mm to 6.3 ± 3.1 mm (p < 0.001), and the mean Hamada grade increased slightly from 1.2 ± 0.4 to 2.1 ± 1.1 (p < 0.001) by final follow-up. [Table II] When comparing outcomes based on subscapularis integrity, both groups showed improvement in all parameters, including pain, PROMs, and ROM. However, the Subscapularis Intact group achieved superior postoperative Constant score (70.7 ± 8.9 vs. 62.3 ± 8.9, p = 0.002) and ASES scores (75.5 ± 8.8 vs. 66.7 ± 8.8, p = 0.001). Although gains in ROM were comparable between groups, preoperative internal rotation was significantly lower in the Subscapularis Tear group (p < 0.001), a difference that was no longer observed postoperatively. [Table III] The proportion of patients achieving the MCID for VAS, Constant score, and ASES scores did not differ significantly between groups (all p > 0.05). [Table IV] At final MRI follow-up, retear rates were 17.6% in the Subscapularis Intact group and 26.3% in the Subscapularis Tear group (p = 0.465). Two patients in each group underwent conversion to lower trapezius tendon transfer due to symptomatic retear, while the remaining patients with retears were managed conservatively, as their symptoms were tolerable. Progression of arthritis (Hamada +1) showed no significant difference between the two groups (p = 0.459). However, progression to severe arthritis (Hamada grade ≥ 3) occurred in two patients from the Subscapularis Intact group, both of whom experienced retears and subsequently underwent conversion to reverse shoulder arthroplasty approximately three years postoperatively. [Table V]. Discussion This study evaluated the effect of subscapularis integrity on clinical outcomes after arthroscopic-assisted LD tendon transfer for PSIRCTs. Both groups—patients with intact subscapularis and those with subscapularis tears—showed significant postoperative improvement in pain, function, and ROM compared with preoperative status. However, patients with an intact subscapularis achieved significantly greater improvement in clinical outcome scores, including the Constant score and ASES scores, than those with subscapularis tears. Although retear and other complication rates did not show significant differences between groups, the overall findings indicate that subscapularis contributes to more favorable clinical recovery following posterior LD transfer. Posterior LD transfer has been widely recognized as an effective treatment option for PSIRCTs.[15, 16, 19, 26] Gerber et al.[16] reported on 57 shoulders with a mean follow-up of 147 months, demonstrating that LD transfer provided substantial and durable improvements in shoulder function and pain relief for PSIRCTs. Similarly, Kany et al.[19], in a cohort of 143 patients with a minimum follow-up of 10 years, found that LD transfer led to satisfactory clinical outcomes, although 18 of 147 shoulders (12%) required conversion to reverse shoulder arthroplasty. El-Azab et al.[15] also showed that pain relief and functional improvement were maintained for a mean of 9.3 years after LD transfer, with younger patients achieving better outcomes. The findings of the current study align with these previous reports. Posterior LD transfer resulted in significant improvements in pain, PROMs, and ROM. Radiographically, the AHD decreased from 8.3 ± 2.4 mm to 6.3 ± 3.1 mm (p < 0.001), and the mean Hamada grade increased slightly from 1.2 ± 0.4 to 2.1 ± 1.1 (p < 0.001) at final follow-up. These changes are comparable to those reported by Kany et al.[19], who observed a minimal decrease in subacromial space (0.3 ± 2.0 mm) at a minimum 10-year follow-up, and by Gerber et al.[16], who reported significant progression in Hamada stage (from 1.2 ± 0.5 to 2.0 ± 1.0) and a decrease in AHD (from 7.4 ± 1.9 mm to 4.9 ± 2.0 mm). El-Azab et al.[15] reported a mean Hamada grade increase from 1.7 (range, 0–2) preoperatively to 2.2 (range, 1–5) postoperatively (p < 0.0001, effect size = 0.2). Overall, the present study supports the existing notion that posterior LD transfer provides durable clinical improvements, with radiographic changes and complication rates consistent with previously published literature. The role of subscapularis integrity in the outcomes of posterior LD transfer remains an important topic, as the subscapularis acts as a critical anterior stabilizer and internal rotator, balancing the posteriorly directed forces of the supraspinatus and infraspinatus. When the subscapularis is intact, the transferred LD tendon can effectively restore the force couple between the anterior and posterior rotator cuff, facilitating smoother shoulder kinematics and improved external rotation strength.[24] Previous studies have reported mixed results regarding the effect of subscapularis status. El-Azab et al.[15] found no clinical difference in long-term outcomes between patients who underwent concomitant repair of partial subscapularis lesions and those with an intact subscapularis. Similarly, Cunningham et al.[26] compared LD transfer in patients with intact subscapularis (n = 22) versus those with tears (n = 26) and observed encouraging clinical scores and high patient satisfaction regardless of subscapularis integrity. However, Gerber et al.[16] showed inferior outcomes in the presence of subscapularis insufficiency, suggesting that LD transfer may be of limited benefit when subscapularis function is deficient. In the present study, patients with an intact subscapularis achieved significantly greater improvements in clinical outcomes, including Constant and ASES scores, compared with those with subscapularis tears. This finding emphasizes the importance of subscapularis integrity in optimizing the biomechanical and functional benefits of posterior LD transfer. Preoperative subscapularis pathology may be associated with altered anterior force balance and superior humeral head translation, which could potentially attenuate the biomechanical advantage of a posterior tendon transfer and contribute to less favorable restoration of glenohumeral mechanics. These observations are consistent with biomechanical principles and help clarify the role of subscapularis function in determining postoperative recovery after LD transfer. This study has several limitations. First, its retrospective design and relatively small sample size may limit the generalizability of the results. Second, the assessment of subscapularis integrity relied on preoperative MRI and intraoperative evaluation, which may have introduced subjectivity and observational bias. Third, although postoperative MRI was used to confirm tendon integrity, quantitative muscle strength testing and electromyographic analysis were not performed. Fourth, it should also be noted that preoperative internal rotation was significantly worse in the Subscapularis Tear group. Although this difference was no longer present at final follow-up, it may have acted as a potential confounding factor when interpreting postoperative clinical outcome scores in this retrospective analysis. Fifth, baseline differences in subscapularis fatty infiltration between groups may have independently influenced postoperative functional outcomes, as greater fatty infiltration is associated with reduced muscle function regardless of tendon integrity. Sixth, postoperative structural integrity and strength of the subscapularis were not specifically assessed; therefore, the relationship between subscapularis healing status, muscle strength, and functional outcomes could not be directly evaluated. Seventh, concomitant procedures performed at the index surgery, including biceps-related procedures and partial rotator cuff repair when indicated, may have acted as additional confounding factors. Finally, longer follow-up would be required to evaluate the durability of functional recovery and the potential progression of glenohumeral arthropathy over time. Despite these limitations, the present study provides meaningful clinical evidence that subscapularis integrity significantly influences clinical outcomes following posterior LD transfer for irreparable posterior-superior rotator cuff tears. Conclusion Posterior LD transfer provides significant improvements in pain, function, and range of motion for patients with PSIRCTs. Although both groups demonstrated meaningful improvements, patients with an intact subscapularis tended to achieve significantly higher Constant and ASES scores compared with those with subscapularis tears. Declarations Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. IRB / Informed Consent This study was approved by the Institutional Review Board. The requirement for informed consent was waived owing to the retrospective design of the study and the lack of additional harm to the patients. Author Contribution C.H.B - Conceptualization, Data curation, Investigation, Methodology, Supervision, Validation, Writing - review and editing B.T.K - Conceptualization, Data curation, Investigation, Methodology, Supervision, Validation, Visualization Writing - review and editing , Writing - original draft J.G.K - Conceptualization, Data curation, MethodologyC.L - Conceptualization, Data curation, MethodologyP.H.H - Conceptualization, Data curation, MethodologyP.T.P - Conceptualization, Data curation, MethodologyS.J.K- Data curation, Methodology, Visualization Acknowledgement None References Kucirek NK, Hung NJ, Wong SE (2021) Treatment Options for Massive Irreparable Rotator Cuff Tears. Curr Rev Musculoskelet Med 14 (5):304-315. doi:10.1007/s12178-021-09714-7 Sheth MM, Shah AA (2023) Massive and Irreparable Rotator Cuff Tears: A Review of Current Definitions and Concepts. 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Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res (304):78-83 Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R (2007) Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am 89 (6):1184-1193. doi:10.2106/jbjs.F.00007 Hamada K, Fukuda H, Mikasa M, Kobayashi Y (1990) Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res (254):92-96 Baek CH, Lee DH, Kim JG (2022) Latissimus dorsi transfer vs. lower trapezius transfer for posterosuperior irreparable rotator cuff tears. J Shoulder Elbow Surg 31 (9):1810-1822. doi:10.1016/j.jse.2022.02.020 Malavolta EA, Yamamoto GJ, Bussius DT, Assunção JH, Andrade-Silva FB, Gracitelli MEC, Ferreira Neto AA (2022) Establishing minimal clinically important difference for the UCLA and ASES scores after rotator cuff repair. 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Demographics Variables SSC Intact (n=34) SSC Tear (n=19) P-value Sex, Male / Female, n (%) 23 (67.6) / 11 (32.3) 15 (78.9) / 4 (21.0) 0.391 Age (year) 61.4 ± 6.5 (38-75) 61.6 ± 5.0 (52-69) 0.899 Follow-up (month) 60.9 ± 9.1 (48-93) 66.4 ± 17.3 (48-100) 0.133 Length of Symptoms (month) 11.2 ± 3.6 (6-20) 12.1 ± 3.6 (7-21) 0.403 Dominant arm involvement, n (%) 25 (73.5) 14 (73.7) 0.990 DM, n (%) 8 (23.5) 4 (21.0) 0.840 HTN, n (%) 8 (23.5) 3 (15.8) 0.515 Smoking, n (%) 3 (8.8) 4 (21.0) 0.215 SSC tear Lafosse classification, n (%) <.001* Type 1 - 5 (26.3) Type 2 - 10 (52.6) Type 3 - 4 (21.0) Preoperative SSC FI grade, n (%) <.001* Grade 0 or 1 25 (73.5) 5 (26.3) Grade 2 9 (26.5) 14 (73.7) Preoperative SSP FI grade, n (%) 0.174 Grade 3 21 (61.7) 8 (42.1) Grade 4 13 (38.2) 11 (57.9) Preoperative ISP FI grade, n (%) 0.154 Grade 3 11 (32.3) 10 (52.6) Grade 4 23 (67.6) 9 (47.3) Preoperative Teres minor FI grade, n (%) 0.275 Grade 0 or 1 24 (70.6) 16 (84.2) Grade 2 3 (8.8) 2 (10.5) Grade 3 6 (17.6) 0 (0) Grade 4 1 (2.9) 1 (5.2) SSC, Subscapularis; DM, Diabetes Mellitus; HTN, Hypertension; SSC, Subscapularis; SSP, Supraspinatus; ISP, Infraspinatus; FI, Fatty Infiltration; Unless otherwise noted, values are mean ± standard deviation (range); Table II. Clinical Outcome of Entire Cohort Variables Preoperative Postoperative P-value VAS score 5.0 ± 1.0 2.2 ± 1.5 <.001* Constant score 47.6 ± 6.5 67.7 ± 9.7 <.001* ASES score 51.9 ± 6.9 72.3 ± 9.7 <.001* Active ROM (degree) FE (°) 110 ± 17 135 ± 30 <.001* ABD (°) 89 ± 20 113 ± 31 <.001* ER at side (°) 21 ± 10 34 ± 9 <.001* IR at back † 4.6 ± 1.6 5.6 ± 1.4 <.001* AHD, mean ± SD 8.3 ± 2.4 6.3 ± 3.1 <.001* Hamada grade, mean ± SD 1.2 ± 0.4 2.1 ± 1.1 <.001* VAS, Visual Analog Scale; ASES, American Shoulder and Elbow Surgeons; ROM, range of motion; FE, forward elevation; ABD, abduction; ER, external rotation; IR, internal rotation; AHD, Acromion Humeral Distance. Unless otherwise noted, values are mean ± standard deviation; * The significant P value is below .05. † Internal rotation was measured as the level that could be reached by the thumb; 0, greater trochanter; 2, buttock; 4, lumbosacral junction; 6, L3; 8, T12; and 10, T8 Table III. Clinical Outcome Between the Two Groups Variables SSC Intact (n=34) SSC Tear (n=19) P-value VAS score Preoperative 4.9 ± 1.1 5.2 ± 1.0 0.295 Postoperative 2.1 ± 1.5 2.4 ± 1.5 0.564 P-value <.001* <.001* Constant score Preoperative 48.7 ± 6.5 45.6 ± 6.1 0.092 Postoperative 70.7 ± 8.9 62.3 ± 8.9 0.002* P-value <.001* <.001* ASES score Preoperative 53.2 ± 7.2 49.5 ± 5.8 0.066 Postoperative 75.5 ± 8.8 66.7 ± 8.8 0.001* P-value <.001* <.001* Active ROM (degree) FE (°) Preoperative 112 ± 19 105 ± 13 0.170 Postoperative 138 ± 29 129 ± 32 0.305 P-value <.001* 0.003 ABD (°) Preoperative 92 ± 20 83 ± 18 0.115 Postoperative 116 ± 29 108 ± 32 0.386 P-value <.001* 0.008 ER at side (°) Preoperative 22 ± 11 19 ± 7 0.309 Postoperative 34 ± 9 33 ± 11 0.582 P-value <.001* <.001* IR at back † Preoperative 5.3 ± 1.5 3.2 ± 0.8 <.001* Postoperative 5.8 ± 1.6 5.2 ± 1.0 0.203 P-value 0.180 <.001* AHD (mm) Preoperative 8.1 ± 2.5 8.8 ± 2.1 0.254 Postoperative 6.3 ± 3.1 6.4 ± 3.2 0.928 P-value 0.005 <.001* Hamada grade Preoperative 1.2 ± 0.5 1.1 ± 0.2 0.137 Postoperative 2.1 ± 1.1 2.1 ± 1.3 0.772 P-value <.001* 0.001* SSC, Subscapularis; VAS, Visual Analog Scale; ASES, American Shoulder and Elbow Surgeons; ROM, range of motion; FE, Forward Elevation; ABD, abduction; ER, External Rotation; IR, Internal Rotation; AHD, Acromion Humeral Distance; Unless otherwise noted, values are mean ± standard deviation; * The significance level was set at 0.002 for continuous data and 0.006 for categorical data using Bonferroni correction. † Internal rotation was measured as the level that could be reached by the thumb; 0, greater trochanter; 2, buttock; 4, lumbosacral junction; 6, L3; 8, T12; and 10, T8 Table IV. Minimal Clinically Important Difference Variables MCID Achieved, n (%) SSC Intact (n=34) SSC Tear (n=19) P-value Value Achieved (%) Value Achieved (%) VAS score 0.9 32 (94.1) 0.9 17 (89.5) 0.548 Constant score 6.2 30 (88.2) 5.7 16 (84.2) 0.685 ASES score 6.2 28 (82.3) 5.4 17 (89.5) 0.497 SSC, Subscapularis; MCID, Minimal Clinically Important Difference; VAS, Visual Analog Scale; ASES, American Shoulder and Elbow Surgeons; Table V. Complications Variables SSC Intact (n=34) SSC Tear (n=19) P-value Re-tear, n (%) 6 (17.6) 5 (26.3) 0.465 Infection, n (%) 2 (5.9) 1 (5.2) 0.927 Progression to Arthritis (Hamada +1) , n (%) 18 (52.9) 8 (42.1) 0.459 Progression to Severe Arthritis (Hamada ≥3), n (%) 2 (5.9) 0 (0) 0.290 SSC, Subscapularis Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 15 May, 2026 Reviewers invited by journal 29 Apr, 2026 Editor assigned by journal 30 Mar, 2026 Submission checks completed at journal 30 Mar, 2026 First submitted to journal 13 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-9115678\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":633187382,\"identity\":\"3ecc0867-0d38-4ec5-8ba9-b6028de51e05\",\"order_by\":0,\"name\":\"Chang Hee Baek\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYBACgwNAgrGBgUGCvQHEtSBFCw+IZSBBWItkA0yLRAKIT4QWfvbmw595d9jJSc58fnXDjwIJBv727gS8Wth4jqVJ855JNpaWzim72QN0mMSZsxvwa5HIMWPmbWNOnCedk3aDB6jFQCKXgBb5N8afedvq6+dJnkm7+YcoLRI8BtK8bYcTpCXYj90mzhaetDTJuWeOG87syWG7LWMgwUPYL+yHD394u6NaXuL48Wc33/yxkeNv78WvBQnwGIBJYpWDAPsDUlSPglEwCkbBCAIAZQBDI78ONwIAAAAASUVORK5CYII=\",\"orcid\":\"\",\"institution\":\"Yeosu Baek Hospital\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Chang\",\"middleName\":\"Hee\",\"lastName\":\"Baek\",\"suffix\":\"\"},{\"id\":633187384,\"identity\":\"04881771-eae3-45e9-a72b-8ef2fe3b4a21\",\"order_by\":1,\"name\":\"Bo Taek Kim\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Yeosu Baek Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Bo\",\"middleName\":\"Taek\",\"lastName\":\"Kim\",\"suffix\":\"\"},{\"id\":633187387,\"identity\":\"a7bac06c-f5d3-4440-b57d-9f112308f9cd\",\"order_by\":2,\"name\":\"Jung Gon Kim\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Yeosu Baek Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Jung\",\"middleName\":\"Gon\",\"lastName\":\"Kim\",\"suffix\":\"\"},{\"id\":633187389,\"identity\":\"177fe1c5-3b76-4159-b1d8-df23493638e4\",\"order_by\":3,\"name\":\"Chaemoon Lim\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Yeosu Baek Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Chaemoon\",\"middleName\":\"\",\"lastName\":\"Lim\",\"suffix\":\"\"},{\"id\":633187393,\"identity\":\"05712ca2-bc01-47ca-8626-8ed3c67ab8ee\",\"order_by\":4,\"name\":\"Phuoc Hau Huynh\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Cho Ray Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Phuoc\",\"middleName\":\"Hau\",\"lastName\":\"Huynh\",\"suffix\":\"\"},{\"id\":633187394,\"identity\":\"887c859b-3c08-4726-bd8a-c7ef3e23f970\",\"order_by\":5,\"name\":\"Phuoc Tho Pham\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Cho Ray Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Phuoc\",\"middleName\":\"Tho\",\"lastName\":\"Pham\",\"suffix\":\"\"},{\"id\":633187395,\"identity\":\"9c98ae46-cf0f-4d72-9b99-94f7b2e3b947\",\"order_by\":6,\"name\":\"Seung Jin Kim\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Yeosu Baek Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Seung\",\"middleName\":\"Jin\",\"lastName\":\"Kim\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-03-13 14:23:23\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-9115678/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-9115678/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":108976840,\"identity\":\"0068ca51-9baf-446b-b613-6e9794bfd219\",\"added_by\":\"auto\",\"created_at\":\"2026-05-11 11:29:07\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":371551,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9115678/v1/554c2437-584f-4cfb-852e-61657e1b08d0.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Effect of Subscapularis Integrity on Functional Recovery After Posterior Latissimus Dorsi Tendon Transfer for Posterior–Superior Irreparable Rotator Cuff Tears\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003ePosterior\\u0026ndash;superior irreparable rotator cuff tears (PSIRCTs) represent a challenging clinical problem, particularly in patients with a preserved glenohumeral joint.[1, 2] Various surgical techniques, including partial repair, patch augmentation, superior capsule reconstruction, tendon transfers, and reverse shoulder arthroplasty, have been used to treat these patients.[1-6] Although these procedures can provide pain relief and functional improvement, each has inherent limitations in fully replicating the biomechanical function of the native rotator cuff complex. Among the available tendon transfer procedures, posterior latissimus dorsi (LD) transfer has been widely adopted for the treatment of PSIRCTs involving severe supraspinatus and infraspinatus tears.[6, 7] This procedure effectively restores the posterior force couple, enhances external rotation, and contributes to improved shoulder elevation.[8]\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eWhen the posterior\\u0026ndash;superior cuff is deficient, the anterior portion of the rotator cuff, particularly the subscapularis, plays a critical compensatory role in maintaining the anterior\\u0026ndash;posterior force couple and overall shoulder stability. Subscapularis insufficiency may disrupt this balance, leading to anterior translation and altered glenohumeral kinematics.[9-11] Previous biomechanical and clinical studies have demonstrated that subscapularis deficiency may negatively affect outcomes after procedures such as lower trapezius transfer and superior capsule reconstruction in PSIRCTs.[12-14] However, the effect of subscapularis integrity on clinical outcomes following posterior LD transfer remains understudied and is still a matter of debate.[15-20] Therefore, the purpose of this study is to evaluate the effect of subscapularis integrity on clinical and radiologic outcomes after arthroscopic-assisted posterior LD transfer for PSIRCTs. The study hypothesis was that patients with an intact subscapularis tendon would demonstrate superior functional outcomes compared with those with a torn subscapularis, based on preoperative imaging and confirmed by intraoperative findings.\\u003c/p\\u003e\"},{\"header\":\"Study Design and Patient Selection\",\"content\":\"\\u003cp\\u003eThis retrospective study included patients who underwent arthroscopic-assisted posterior LD transfer for PSIRCTs between April 2012 and June 2020 at a single institution. The surgical indications were as follows: (1) persistent shoulder pain and functional limitation despite conservative management; (2) severely retracted supraspinatus and infraspinatus tendons to glenoid level; (3) advanced fatty infiltration of the supraspinatus and infraspinatus muscles (Goutallier[21] grade 3 or 4); (4) intraoperative confirmation that the retracted supraspinatus and infraspinatus tendons could not be mobilized to their anatomic footprint; (5) intact or repairable subscapularis tendon (Lafosse[22] classification \\u0026le; III); and (6) absence or minimal glenohumeral arthritis (Hamada[23] grade \\u0026le; 2). Patients were excluded if they were lost to follow-up or lacked postoperative clinical or radiologic data. The current study compared clinical outcomes between patients with a preoperatively intact subscapularis and those with a preoperative subscapularis tear, as determined by preoperative magnetic resonance imaging (MRI) and confirmed intraoperatively prior to subscapularis treatment. Lafosse type I tears were treated with debridement, whereas Lafosse types II and III tears underwent repair at the index surgery. No irreparable subscapularis tears were included, as irreparable subscapularis deficiency was not an indication for posterior LD tendon transfer.\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u003cstrong\\u003eSurgical Procedure\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll procedures were performed by a single senior surgeon using a standardized arthroscopic-assisted posterior LD transfer technique previously described in the literature.[24] Patients were positioned in the lateral decubitus position under general anesthesia. The procedure began with diagnostic arthroscopy to evaluate the glenohumeral joint and the long head of the biceps (LHB) tendon. A total of 19 patients (55.9%) and 4 patients (21.0%) had an intact LHB, while complete tears with distal retraction were found in 4 patients (11.7%) and 10 patients (52.6%) in the Subscapularis Intact Group and Subscapularis Tear Group, respectively. Partial LHB tears were treated with either tenotomy (Subscapularis Intact Group, N = 8; Subscapularis Tear Group, N = 4) or tenodesis (Subscapularis Intact Group, N = 3; Subscapularis Tear Group, N = 1), depending on the degree of tendon degeneration and intraoperative findings. For any subscapularis tears (N=19), Lafosse[22] type I tears (N=5) were treated with debridement, type II tears (N=10) with single-row repair, and type III tears (N=4) with double-row repair. The torn supraspinatus and infraspinatus tendons were then assessed, and if they could not be mobilized to their anatomic footprint despite adequate release, posterior LD transfer was performed.\\u003c/p\\u003e\\n\\u003cp\\u003eThe LD tendon was harvested through a small posterior axillary incision made along its anterior border with the shoulder flexed, internally rotated, and abducted. The LD tendon was identified and isolated with careful protection of the radial nerve and the anterior humeral circumflex vessels. Blunt dissection was carried out from proximal to distal to release the muscle, ensuring sufficient excursion for transfer. The tendon was reinforced with No. 2 nonabsorbable sutures using a continuous running locking stitch technique to facilitate subsequent fixation.\\u003c/p\\u003e\\n\\u003cp\\u003eArthroscopically, the greater tuberosity was prepared by thorough debridement and decortication of the supraspinatus and infraspinatus footprint to enhance tendon-to-bone healing. The harvested LD tendon was then passed under the deltoid through the interval between the external rotators and the posterior border of the deltoid. Two triple-loaded suture anchors were inserted at the medial aspect of the prepared footprint, and the sutures were passed through the LD tendon in a mattress configuration. Final fixation was achieved using a double-row suture-bridge construct with three to four knotless anchors, providing secure tendon apposition and optimal contact pressure at the footprint.\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u003cstrong\\u003ePostoperative Rehabilitation\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFollowing surgery, the operated arm was immobilized in a 30\\u0026deg; abduction brace with the shoulder maintained in neutral rotation for four weeks. During this period, patients performed gentle self-assisted passive range of motion (ROM) exercises to prevent stiffness while protecting the repair. Between postoperative weeks 4 and 12, rehabilitation advanced to active-assisted and active ROM exercises with gradual restoration of functional mobility. From three months onward, a structured strengthening program was implemented to enhance dynamic stability and shoulder function. Heavy lifting and labor-intensive activities were restricted for at least six months postoperatively.\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u003cstrong\\u003eClinical Assessment\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll clinical and radiologic evaluations were conducted preoperatively and at the final follow-up. Pain intensity was assessed using the visual analog scale (VAS), and shoulder function was evaluated with patient-reported outcome measures (PROMs), including the Constant score and the American Shoulder and Elbow Surgeons (ASES) score. Active ROM was measured for forward elevation, abduction, external rotation at the side, and internal rotation behind the back. Internal rotation was recorded according to the highest spinal level reached by the thumb (0 = greater trochanter, 2 = buttock, 4 = lumbosacral junction, 6 = L3, 8 = T12, and 10 = T8). Radiologic evaluations included measurement of the acromiohumeral distance (AHD) and Hamada grade to assess subacromial space and arthritic progression. AHD was measured preoperatively and at the final follow-up as the shortest distance between the inferior border of the acromion undersurface and the apex of the humeral head on standardized true anteroposterior radiographs. MRI was obtained for all patients preoperatively and at the final follow-up. Fatty infiltration of the rotator cuff muscles was graded using the Goutallier[21] classification, and subscapularis tendon integrity was classified according to the Lafosse[22] classification. At the final follow-up, integrity of the transferred latissimus dorsi tendon was evaluated using MRI, with retear defined as loss of tendon continuity on postoperative MRI. To determine the clinical relevance of postoperative improvement, the minimal clinically important difference (MCID) was calculated for the VAS, Constant score, and ASES scores. Postoperative complications, including retear, infection, and progression of osteoarthritis, were also recorded.\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u003cstrong\\u003eStatistical Analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll statistical analyses were performed using SPSS software (version 26; IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean \\u0026plusmn; standard deviation, and categorical variables as frequencies and percentages. The Shapiro\\u0026ndash;Wilk test was used to assess the normality of data distribution. Between-group comparisons (Subscapularis Intact vs. Subscapularis Tear groups) were conducted using the independent t-test for continuous variables and the chi-square or Fisher\\u0026rsquo;s exact test for categorical variables. Paired t-tests were used to compare preoperative and postoperative outcomes within each group. The MCID was determined using the 0.5 standard deviation distribution method.[25] The primary significance level was set at \\u0026alpha; = 0.05. For secondary and multiple between-group comparisons, a Bonferroni correction was applied, and statistical significance was assessed using the corresponding adjusted p-value thresholds\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eSeven patients were excluded, including two who had died and five who were lost to follow-up or had incomplete data. A total of 53 patients (Subscapularis Intact Group, N = 34; Subscapularis Tear Group, N = 19) were included with a mean follow-up duration of 62.9 \\u0026plusmn; 12.9 months (range, 48\\u0026ndash;100 months). Baseline characteristics, including age, sex, symptom duration, dominant arm involvement, and comorbidities such as diabetes and hypertension, were comparable between groups. Fatty infiltration of the supraspinatus and infraspinatus muscles did not differ significantly between groups. [Table I]. Overall, the cohort demonstrated significant postoperative improvements in pain, PROM, and ROM compared with preoperative values. Radiographically, the AHD decreased from 8.3 \\u0026plusmn; 2.4 mm to 6.3 \\u0026plusmn; 3.1 mm (p \\u0026lt; 0.001), and the mean Hamada grade increased slightly from 1.2 \\u0026plusmn; 0.4 to 2.1 \\u0026plusmn; 1.1 (p \\u0026lt; 0.001) by final follow-up. [Table II]\\u003c/p\\u003e\\n\\u003cp\\u003eWhen comparing outcomes based on subscapularis integrity, both groups showed improvement in all parameters, including pain, PROMs, and ROM. However, the Subscapularis Intact group achieved superior postoperative Constant score (70.7 \\u0026plusmn; 8.9 vs. 62.3 \\u0026plusmn; 8.9, p = 0.002) and ASES scores (75.5 \\u0026plusmn; 8.8 vs. 66.7 \\u0026plusmn; 8.8, p = 0.001). Although gains in ROM were comparable between groups, preoperative internal rotation was significantly lower in the Subscapularis Tear group (p \\u0026lt; 0.001), a difference that was no longer observed postoperatively. [Table III] The proportion of patients achieving the MCID for VAS, Constant score, and ASES scores did not differ significantly between groups (all p \\u0026gt; 0.05). [Table IV]\\u003c/p\\u003e\\n\\u003cp\\u003eAt final MRI follow-up, retear rates were 17.6% in the Subscapularis Intact group and 26.3% in the Subscapularis Tear group (p = 0.465). Two patients in each group underwent conversion to lower trapezius tendon transfer due to symptomatic retear, while the remaining patients with retears were managed conservatively, as their symptoms were tolerable. Progression of arthritis (Hamada +1) showed no significant difference between the two groups (p = 0.459). However, progression to severe arthritis (Hamada grade \\u0026ge; 3) occurred in two patients from the Subscapularis Intact group, both of whom experienced retears and subsequently underwent conversion to reverse shoulder arthroplasty approximately three years postoperatively. [Table V]. \\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThis study evaluated the effect of subscapularis integrity on clinical outcomes after arthroscopic-assisted LD tendon transfer for PSIRCTs. Both groups\\u0026mdash;patients with intact subscapularis and those with subscapularis tears\\u0026mdash;showed significant postoperative improvement in pain, function, and ROM compared with preoperative status. However, patients with an intact subscapularis achieved significantly greater improvement in clinical outcome scores, including the Constant score and ASES scores, than those with subscapularis tears. Although retear and other complication rates did not show significant differences between groups, the overall findings indicate that subscapularis contributes to more favorable clinical recovery following posterior LD transfer.\\u003c/p\\u003e\\n\\u003cp\\u003ePosterior LD transfer has been widely recognized as an effective treatment option for PSIRCTs.[15, 16, 19, 26] Gerber et al.[16] reported on 57 shoulders with a mean follow-up of 147 months, demonstrating that LD transfer provided substantial and durable improvements in shoulder function and pain relief for PSIRCTs. Similarly, Kany et al.[19], in a cohort of 143 patients with a minimum follow-up of 10 years, found that LD transfer led to satisfactory clinical outcomes, although 18 of 147 shoulders (12%) required conversion to reverse shoulder arthroplasty. El-Azab et al.[15] also showed that pain relief and functional improvement were maintained for a mean of 9.3 years after LD transfer, with younger patients achieving better outcomes. The findings of the current study align with these previous reports. Posterior LD transfer resulted in significant improvements in pain, PROMs, and ROM. Radiographically, the AHD decreased from 8.3 \\u0026plusmn; 2.4 mm to 6.3 \\u0026plusmn; 3.1 mm (p \\u0026lt; 0.001), and the mean Hamada grade increased slightly from 1.2 \\u0026plusmn; 0.4 to 2.1 \\u0026plusmn; 1.1 (p \\u0026lt; 0.001) at final follow-up. These changes are comparable to those reported by Kany et al.[19], who observed a minimal decrease in subacromial space (0.3 \\u0026plusmn; 2.0 mm) at a minimum 10-year follow-up, and by Gerber et al.[16], who reported significant progression in Hamada stage (from 1.2 \\u0026plusmn; 0.5 to 2.0 \\u0026plusmn; 1.0) and a decrease in AHD (from 7.4 \\u0026plusmn; 1.9 mm to 4.9 \\u0026plusmn; 2.0 mm). El-Azab et al.[15] reported a mean Hamada grade increase from 1.7 (range, 0\\u0026ndash;2) preoperatively to 2.2 (range, 1\\u0026ndash;5) postoperatively (p \\u0026lt; 0.0001, effect size = 0.2). Overall, the present study supports the existing notion that posterior LD transfer provides durable clinical improvements, with radiographic changes and complication rates consistent with previously published literature.\\u003c/p\\u003e\\n\\u003cp\\u003eThe role of subscapularis integrity in the outcomes of posterior LD transfer remains an important topic, as the subscapularis acts as a critical anterior stabilizer and internal rotator, balancing the posteriorly directed forces of the supraspinatus and infraspinatus. When the subscapularis is intact, the transferred LD tendon can effectively restore the force couple between the anterior and posterior rotator cuff, facilitating smoother shoulder kinematics and improved external rotation strength.[24] Previous studies have reported mixed results regarding the effect of subscapularis status. El-Azab et al.[15] found no clinical difference in long-term outcomes between patients who underwent concomitant repair of partial subscapularis lesions and those with an intact subscapularis. Similarly, Cunningham et al.[26] compared LD transfer in patients with intact subscapularis (n = 22) versus those with tears (n = 26) and observed encouraging clinical scores and high patient satisfaction regardless of subscapularis integrity. However, Gerber et al.[16] showed inferior outcomes in the presence of subscapularis insufficiency, suggesting that LD transfer may be of limited benefit when subscapularis function is deficient. In the present study, patients with an intact subscapularis achieved significantly greater improvements in clinical outcomes, including Constant and ASES scores, compared with those with subscapularis tears. This finding emphasizes the importance of subscapularis integrity in optimizing the biomechanical and functional benefits of posterior LD transfer. Preoperative subscapularis pathology may be associated with altered anterior force balance and superior humeral head translation, which could potentially attenuate the biomechanical advantage of a posterior tendon transfer and contribute to less favorable restoration of glenohumeral mechanics. These observations are consistent with biomechanical principles and help clarify the role of subscapularis function in determining postoperative recovery after LD transfer.\\u003c/p\\u003e\\n\\u003cp\\u003eThis study has several limitations. First, its retrospective design and relatively small sample size may limit the generalizability of the results. Second, the assessment of subscapularis integrity relied on preoperative MRI and intraoperative evaluation, which may have introduced subjectivity and observational bias. Third, although postoperative MRI was used to confirm tendon integrity, quantitative muscle strength testing and electromyographic analysis were not performed. Fourth, it should also be noted that preoperative internal rotation was significantly worse in the Subscapularis Tear group. Although this difference was no longer present at final follow-up, it may have acted as a potential confounding factor when interpreting postoperative clinical outcome scores in this retrospective analysis. Fifth, baseline differences in subscapularis fatty infiltration between groups may have independently influenced postoperative functional outcomes, as greater fatty infiltration is associated with reduced muscle function regardless of tendon integrity. Sixth, postoperative structural integrity and strength of the subscapularis were not specifically assessed; therefore, the relationship between subscapularis healing status, muscle strength, and functional outcomes could not be directly evaluated. Seventh, concomitant procedures performed at the index surgery, including biceps-related procedures and partial rotator cuff repair when indicated, may have acted as additional confounding factors. Finally, longer follow-up would be required to evaluate the durability of functional recovery and the potential progression of glenohumeral arthropathy over time. Despite these limitations, the present study provides meaningful clinical evidence that subscapularis integrity significantly influences clinical outcomes following posterior LD transfer for irreparable posterior-superior rotator cuff tears.\\u003cbr\\u003e \\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003ePosterior LD transfer provides significant improvements in pain, function, and range of motion for patients with PSIRCTs. Although both groups demonstrated meaningful improvements, patients with an intact subscapularis tended to achieve significantly higher Constant and ASES scores compared with those with subscapularis tears.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eIRB / Informed Consent\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was approved by the Institutional Review Board. The requirement for informed consent was waived owing to the retrospective design of the study and the lack of additional harm to the patients.\\u0026nbsp;\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eC.H.B - Conceptualization, Data curation, Investigation, Methodology, Supervision, Validation, Writing - review and editing B.T.K - Conceptualization, Data curation, Investigation, Methodology, Supervision, Validation, Visualization Writing - review and editing , Writing - original draft J.G.K - Conceptualization, Data curation, MethodologyC.L - Conceptualization, Data curation, MethodologyP.H.H - Conceptualization, Data curation, MethodologyP.T.P - Conceptualization, Data curation, MethodologyS.J.K- Data curation, Methodology, Visualization\\u003c/p\\u003e\\u003ch2\\u003eAcknowledgement\\u003c/h2\\u003e\\u003cp\\u003eNone\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eKucirek NK, Hung NJ, Wong SE (2021) Treatment Options for Massive Irreparable Rotator Cuff Tears. Curr Rev Musculoskelet Med 14 (5):304-315. doi:10.1007/s12178-021-09714-7\\u003c/li\\u003e\\n\\u003cli\\u003eSheth MM, Shah AA (2023) Massive and Irreparable Rotator Cuff Tears: A Review of Current Definitions and Concepts. Orthop J Sports Med 11 (5):23259671231154452. doi:10.1177/23259671231154452\\u003c/li\\u003e\\n\\u003cli\\u003eLee KS, Kim DH, Chung SW, Yoon JP (2025) Current concepts in arthroscopic rotator cuff repair. Clin Shoulder Elb 28 (1):103-112. doi:10.5397/cise.2025.00010\\u003c/li\\u003e\\n\\u003cli\\u003eRho JY, Kwon YS, Choi S (2019) Current Concepts and Recent Trends in Arthroscopic Treatment of Large to Massive Rotator Cuff Tears: A Review. Clin Shoulder Elb 22 (1):50-57. doi:10.5397/cise.2019.22.1.50\\u003c/li\\u003e\\n\\u003cli\\u003eChoi S, Yang H, Kang H, Kim GM (2019) Treatment of Large and Massive Rotator Cuff Tears: Does Infraspinatus Muscle Tear Affect Repair Integrity? Clin Shoulder Elb 22 (4):203-209. doi:10.5397/cise.2019.22.4.203\\u003c/li\\u003e\\n\\u003cli\\u003eCartucho A (2022) Tendon transfers for massive rotator cuff tears. EFORT Open Rev 7 (6):404-413. doi:10.1530/eor-22-0023\\u003c/li\\u003e\\n\\u003cli\\u003eKany J (2020) Tendon transfers in rotator-cuff surgery. Orthop Traumatol Surg Res 106 (1s):S43-s51. doi:10.1016/j.otsr.2019.05.023\\u003c/li\\u003e\\n\\u003cli\\u003eReddy A, Gulotta LV, Chen X, Castagna A, Dines DM, Warren RF, Kontaxis A (2019) Biomechanics of lower trapezius and latissimus dorsi transfers in rotator cuff-deficient shoulders. J Shoulder Elbow Surg 28 (7):1257-1264. doi:10.1016/j.jse.2018.11.066\\u003c/li\\u003e\\n\\u003cli\\u003eClark NJ, Elhassan BT (2018) The Role of Tendon Transfers for Irreparable Rotator Cuff Tears. Curr Rev Musculoskelet Med 11 (1):141-149. doi:10.1007/s12178-018-9468-1\\u003c/li\\u003e\\n\\u003cli\\u003eHsu JE, Reuther KE, Sarver JJ, Lee CS, Thomas SJ, Glaser DL, Soslowsky LJ (2011) Restoration of anterior-posterior rotator cuff force balance improves shoulder function in a rat model of chronic massive tears. J Orthop Res 29 (7):1028-1033. doi:10.1002/jor.21361\\u003c/li\\u003e\\n\\u003cli\\u003eReuther KE, Thomas SJ, Tucker JJ, Sarver JJ, Gray CF, Rooney SI, Glaser DL, Soslowsky LJ (2014) Disruption of the anterior-posterior rotator cuff force balance alters joint function and leads to joint damage in a rat model. J Orthop Res 32 (5):638-644. doi:10.1002/jor.22586\\u003c/li\\u003e\\n\\u003cli\\u003eElhassan BT, Sanchez-Sotelo J, Wagner ER (2020) Outcome of arthroscopically assisted lower trapezius transfer to reconstruct massive irreparable posterior-superior rotator cuff tears. J Shoulder Elbow Surg 29 (10):2135-2142. doi:10.1016/j.jse.2020.02.018\\u003c/li\\u003e\\n\\u003cli\\u003eUlrich MN, Frantz TL, Everhart JS, Barlow JD, Jones GL, Bishop JY, Cvetanovich GL (2022) Superior Capsular Reconstruction: A Salvage Option for Massive Irreparable Rotator Cuff Tears with Pseudoparalysis or Subscapularis Insufficiency. Arthroscopy 38 (2):253-261. doi:10.1016/j.arthro.2021.05.018\\u003c/li\\u003e\\n\\u003cli\\u003eTakayama K, Yamada S, Kobori Y, Shiode H (2020) Association Between the Postoperative Condition of the Subscapularis Tendon and Clinical Outcomes After Superior Capsular Reconstruction Using Autologous Tensor Fascia Lata in Patients With Pseudoparalytic Shoulder. Am J Sports Med 48 (8):1812-1817. doi:10.1177/0363546520919956\\u003c/li\\u003e\\n\\u003cli\\u003eEl-Azab HM, Rott O, Irlenbusch U (2015) Long-term follow-up after latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears. J Bone Joint Surg Am 97 (6):462-469. doi:10.2106/jbjs.M.00235\\u003c/li\\u003e\\n\\u003cli\\u003eGerber C, Rahm SA, Catanzaro S, Farshad M, Moor BK (2013) Latissimus dorsi tendon transfer for treatment of irreparable posterosuperior rotator cuff tears: long-term results at a minimum follow-up of ten years. J Bone Joint Surg Am 95 (21):1920-1926. doi:10.2106/jbjs.M.00122\\u003c/li\\u003e\\n\\u003cli\\u003eVelasquez Garcia A, Nieboer MJ, de Marinis R, Morrey ME, Valenti P, Sanchez-Sotelo J (2024) Mid- to long-term outcomes of latissimus dorsi tendon transfer for massive irreparable posterosuperior rotator cuff tears: a systematic review and meta-analysis. J Shoulder Elbow Surg 33 (4):959-974. doi:10.1016/j.jse.2023.10.002\\u003c/li\\u003e\\n\\u003cli\\u003eValenti P, Reinares F, Maroun C, Choueiry J, Werthel JD (2019) Comparison of arthroscopically assisted transfer of the latissimus dorsi with or without partial cuff repair for irreparable postero-superior rotator cuff tear. Int Orthop 43 (2):387-394. doi:10.1007/s00264-018-4016-6\\u003c/li\\u003e\\n\\u003cli\\u003eKany J, Madoki A, Duerinckx Q, Miranda LA, van Rooij F, Saffarini M, Grimberg J (2024) Satisfactory Clinical Outcomes After Latissimus Dorsi Tendon Transfer for Irreparable Posterosuperior Massive Rotator Cuff Tears: A 10- to 20-Year Follow-up. Am J Sports Med 52 (14):3505-3511. doi:10.1177/03635465241290523\\u003c/li\\u003e\\n\\u003cli\\u003eGrimberg J, Kany J, Valenti P, Amaravathi R, Ramalingam AT (2015) Arthroscopic-assisted latissimus dorsi tendon transfer for irreparable posterosuperior cuff tears. Arthroscopy 31 (4):599-607.e591. doi:10.1016/j.arthro.2014.10.005\\u003c/li\\u003e\\n\\u003cli\\u003eGoutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res (304):78-83\\u003c/li\\u003e\\n\\u003cli\\u003eLafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R (2007) Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am 89 (6):1184-1193. doi:10.2106/jbjs.F.00007\\u003c/li\\u003e\\n\\u003cli\\u003eHamada K, Fukuda H, Mikasa M, Kobayashi Y (1990) Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res (254):92-96\\u003c/li\\u003e\\n\\u003cli\\u003eBaek CH, Lee DH, Kim JG (2022) Latissimus dorsi transfer vs. lower trapezius transfer for posterosuperior irreparable rotator cuff tears. J Shoulder Elbow Surg 31 (9):1810-1822. doi:10.1016/j.jse.2022.02.020\\u003c/li\\u003e\\n\\u003cli\\u003eMalavolta EA, Yamamoto GJ, Bussius DT, Assun\\u0026ccedil;\\u0026atilde;o JH, Andrade-Silva FB, Gracitelli MEC, Ferreira Neto AA (2022) Establishing minimal clinically important difference for the UCLA and ASES scores after rotator cuff repair. Orthop Traumatol Surg Res 108 (2):102894. doi:10.1016/j.otsr.2021.102894\\u003c/li\\u003e\\n\\u003cli\\u003eCunningham JG, Ebert JR, Campbell P, Falconer T (2022) Does subscapularis integrity influence outcome following latissimus dorsi tendon transfer for irreparable cuff tears? A comparative series of 48 patients. J Orthop 31:129-133. doi:10.1016/j.jor.2022.04.017\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"598\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"4\\\" valign=\\\"top\\\" style=\\\"width: 598px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTable I. Demographics\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eVariables\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003eSSC Intact (n=34)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003eSSC Tear (n=19)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003eP-value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eSex, Male / Female, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e23 (67.6) / 11 (32.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e15 (78.9) / 4 (21.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e0.391\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eAge (year)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e61.4 \\u0026plusmn; 6.5 (38-75)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e61.6 \\u0026plusmn; 5.0 (52-69)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e0.899\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eFollow-up (month)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e60.9 \\u0026plusmn; 9.1 (48-93)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e66.4 \\u0026plusmn; 17.3 (48-100)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e0.133\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eLength of Symptoms (month)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e11.2 \\u0026plusmn; 3.6 (6-20)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e12.1 \\u0026plusmn; 3.6 (7-21)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e0.403\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eDominant arm involvement, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e25 (73.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e14 (73.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e0.990\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eDM, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e8 (23.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e4 (21.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e0.840\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eHTN, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e8 (23.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e3 (15.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e0.515\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eSmoking, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e3 (8.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e4 (21.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e0.215\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eSSC tear Lafosse classification, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eType 1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e5 (26.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eType 2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e10 (52.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eType 3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e4 (21.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003ePreoperative SSC FI grade, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eGrade 0 or 1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e25 (73.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e5 (26.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eGrade 2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e9 (26.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e14 (73.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003ePreoperative SSP FI grade, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e0.174\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eGrade 3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e21 (61.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e8 (42.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eGrade 4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e13 (38.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e11 (57.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003ePreoperative ISP FI grade, n (%)\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e0.154\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eGrade 3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e11 (32.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e10 (52.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eGrade 4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e23 (67.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e9 (47.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003ePreoperative Teres minor FI grade, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e0.275\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eGrade 0 or 1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e24 (70.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e16 (84.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eGrade 2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e3 (8.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e2 (10.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eGrade 3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e6 (17.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e0 (0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 253px;\\\"\\u003e\\n \\u003cp\\u003eGrade 4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e1 (2.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 134px;\\\"\\u003e\\n \\u003cp\\u003e1 (5.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 77px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eSSC, Subscapularis; DM, Diabetes Mellitus; HTN, Hypertension; SSC, Subscapularis; SSP, Supraspinatus; ISP, Infraspinatus; FI, Fatty Infiltration; Unless otherwise noted, values are mean \\u0026plusmn; standard deviation (range);\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" align=\\\"\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"4\\\" valign=\\\"top\\\" style=\\\"width: 601px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTable II. Clinical Outcome of Entire Cohort\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eVariables\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003ePreoperative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003ePostoperative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003eP-value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eVAS score\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e5.0 \\u0026plusmn; 1.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e2.2 \\u0026plusmn; 1.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eConstant score\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e47.6 \\u0026plusmn; 6.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e67.7 \\u0026plusmn; 9.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eASES score\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e51.9 \\u0026plusmn; 6.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e72.3 \\u0026plusmn; 9.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eActive ROM (degree)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eFE (\\u0026deg;)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e110 \\u0026plusmn; 17\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e135 \\u0026plusmn; 30\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eABD (\\u0026deg;)\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e89 \\u0026plusmn; 20\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e113 \\u0026plusmn; 31\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eER at side (\\u0026deg;)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e21 \\u0026plusmn; 10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e34 \\u0026plusmn; 9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eIR at back \\u0026dagger;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e4.6 \\u0026plusmn; 1.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e5.6 \\u0026plusmn; 1.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eAHD, mean \\u0026plusmn; SD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e8.3 \\u0026plusmn; 2.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e6.3 \\u0026plusmn; 3.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eHamada grade, mean \\u0026plusmn; SD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e1.2 \\u0026plusmn; 0.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e2.1 \\u0026plusmn; 1.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eVAS, Visual Analog Scale; ASES, American Shoulder and Elbow Surgeons; ROM, range of motion; FE, forward elevation; ABD, abduction; ER, external rotation; IR, internal rotation; AHD, Acromion Humeral Distance. Unless otherwise noted, values are mean \\u0026plusmn; standard deviation; * The significant P value is below .05.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026dagger; Internal rotation was measured as the level that could be reached by the thumb; 0, greater trochanter; 2, buttock; 4, lumbosacral junction; 6, L3; 8, T12; and 10, T8\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" align=\\\"\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"4\\\" valign=\\\"top\\\" style=\\\"width: 601px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTable III. Clinical Outcome Between the Two Groups\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eVariables\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003eSSC Intact (n=34)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003eSSC Tear (n=19)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003eP-value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eVAS score\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003ePreoperative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e4.9 \\u0026plusmn; 1.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e5.2 \\u0026plusmn; 1.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e0.295\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003ePostoperative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e2.1 \\u0026plusmn; 1.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e2.4 \\u0026plusmn; 1.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e0.564\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eP-value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eConstant score\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003ePreoperative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e48.7 \\u0026plusmn; 6.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e45.6 \\u0026plusmn; 6.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e0.092\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003ePostoperative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e70.7 \\u0026plusmn; 8.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e62.3 \\u0026plusmn; 8.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e0.002*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eP-value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eASES score\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003ePreoperative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e53.2 \\u0026plusmn; 7.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e49.5 \\u0026plusmn; 5.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e0.066\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003ePostoperative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e75.5 \\u0026plusmn; 8.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e66.7 \\u0026plusmn; 8.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e0.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eP-value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eActive ROM (degree)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eFE (\\u0026deg;)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003ePreoperative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e112 \\u0026plusmn; 19\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e105 \\u0026plusmn; 13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e0.170\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003ePostoperative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e138 \\u0026plusmn; 29\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e129 \\u0026plusmn; 32\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e0.305\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eP-value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e0.003\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eABD (\\u0026deg;)\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003ePreoperative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e92 \\u0026plusmn; 20\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e83 \\u0026plusmn; 18\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e0.115\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003ePostoperative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e116 \\u0026plusmn; 29\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e108 \\u0026plusmn; 32\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e0.386\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eP-value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e0.008\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eER at side (\\u0026deg;)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003ePreoperative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e22 \\u0026plusmn; 11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e19 \\u0026plusmn; 7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e0.309\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003ePostoperative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e34 \\u0026plusmn; 9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e33 \\u0026plusmn; 11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e0.582\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eP-value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eIR at back \\u0026dagger; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003ePreoperative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e5.3 \\u0026plusmn; 1.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e3.2 \\u0026plusmn; 0.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003ePostoperative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e5.8 \\u0026plusmn; 1.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e5.2 \\u0026plusmn; 1.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e0.203\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eP-value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e0.180\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eAHD (mm)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003ePreoperative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e8.1 \\u0026plusmn; 2.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e8.8 \\u0026plusmn; 2.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e0.254\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003ePostoperative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e6.3 \\u0026plusmn; 3.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e6.4 \\u0026plusmn; 3.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e0.928\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eP-value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e0.005\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eHamada grade\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003ePreoperative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e1.2 \\u0026plusmn; 0.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e1.1 \\u0026plusmn; 0.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e0.137\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003ePostoperative\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e2.1 \\u0026plusmn; 1.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e2.1 \\u0026plusmn; 1.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e0.772\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 180px;\\\"\\u003e\\n \\u003cp\\u003eP-value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 140px;\\\"\\u003e\\n \\u003cp\\u003e0.001*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 141px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eSSC, Subscapularis; VAS, Visual Analog Scale; ASES, American Shoulder and Elbow Surgeons; ROM, range of motion; FE, Forward Elevation; ABD, abduction; ER, External Rotation; IR, Internal Rotation; AHD, Acromion Humeral Distance; Unless otherwise noted, values are mean \\u0026plusmn; standard deviation; * The significance level was set at 0.002 for continuous data and 0.006 for categorical data using Bonferroni correction.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026dagger; Internal rotation was measured as the level that could be reached by the thumb; 0, greater trochanter; 2, buttock; 4, lumbosacral junction; 6, L3; 8, T12; and 10, T8\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" align=\\\"\\\" width=\\\"602\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"9\\\" valign=\\\"top\\\" style=\\\"width: 99.6678%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTable IV. Minimal Clinically Important Difference\\u003c/strong\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 132px;\\\"\\u003e\\n \\u003cp\\u003eVariables\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"8\\\" valign=\\\"top\\\" style=\\\"width: 470px;\\\"\\u003e\\n \\u003cp\\u003eMCID Achieved, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 132px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 156px;\\\"\\u003e\\n \\u003cp\\u003eSSC Intact (n=34)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"4\\\" valign=\\\"top\\\" style=\\\"width: 157px;\\\"\\u003e\\n \\u003cp\\u003eSSC Tear\\u0026nbsp;(n=19)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 157px;\\\"\\u003e\\n \\u003cp\\u003eP-value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 132px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003eValue\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003eAchieved (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003eValue\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003eAchieved (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 132px;\\\"\\u003e\\n \\u003cp\\u003eVAS score\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e0.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e32 (94.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e0.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e17 (89.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 157px;\\\"\\u003e\\n \\u003cp\\u003e0.548\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 132px;\\\"\\u003e\\n \\u003cp\\u003eConstant score\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e6.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e30 (88.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e5.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e16 (84.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 157px;\\\"\\u003e\\n \\u003cp\\u003e0.685\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 132px;\\\"\\u003e\\n \\u003cp\\u003eASES score\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e6.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e28 (82.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e5.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 78px;\\\"\\u003e\\n \\u003cp\\u003e17 (89.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" valign=\\\"top\\\" style=\\\"width: 157px;\\\"\\u003e\\n \\u003cp\\u003e0.497\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"9\\\" valign=\\\"top\\\" style=\\\"width: 602px;\\\"\\u003e\\n \\u003cp\\u003eSSC, Subscapularis; MCID, Minimal Clinically Important Difference; VAS, Visual Analog Scale; ASES, American Shoulder and Elbow Surgeons;\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" align=\\\"\\\" width=\\\"595\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"4\\\" valign=\\\"top\\\" style=\\\"width: 595px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTable V. Complications\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 265px;\\\"\\u003e\\n \\u003cp\\u003eVariables\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003eSSC Intact (n=34)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003eSSC Tear (n=19)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003eP-value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 265px;\\\"\\u003e\\n \\u003cp\\u003eRe-tear, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e6 (17.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e5 (26.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.465\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 265px;\\\"\\u003e\\n \\u003cp\\u003eInfection, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e2 (5.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e1 (5.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.927\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 265px;\\\"\\u003e\\n \\u003cp\\u003eProgression to Arthritis (Hamada +1) , n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e18 (52.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e8 (42.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.459\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 265px;\\\"\\u003e\\n \\u003cp\\u003eProgression to Severe Arthritis (Hamada \\u0026ge;3), n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e2 (5.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0 (0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 110px;\\\"\\u003e\\n \\u003cp\\u003e0.290\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"4\\\" valign=\\\"top\\\" style=\\\"width: 595px;\\\"\\u003e\\n \\u003cp\\u003eSSC, Subscapularis\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"european-journal-of-orthopaedic-surgery-and-traumatology\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"ejos\",\"sideBox\":\"Learn more about [European Journal of Orthopaedic Surgery \\u0026 Traumatology](http://link.springer.com/journal/590)\",\"snPcode\":\"590\",\"submissionUrl\":\"https://submission.springernature.com/new-submission/590/3\",\"title\":\"European Journal of Orthopaedic Surgery \\u0026 Traumatology\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false},\"keywords\":\"Posterior–superior irreparable rotator cuff tear, Latissimus dorsi transfer, Subscapularis, Shoulder function, Tendon transfer\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-9115678/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-9115678/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003ePurpose\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003ePosterior latissimus dorsi (LD) transfer is widely used to treat posterior–superior irreparable rotator cuff tears (PSIRCTs), but the impact of subscapularis integrity on postoperative outcomes remains debated. This study aimed to evaluate the effect of subscapularis integrity on clinical and radiologic outcomes following arthroscopic-assisted posterior LD transfer.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis retrospective study included patients who underwent arthroscopic-assisted posterior LD transfer for PSIRCTs and were classified into Subscapularis Intact and Subscapularis Tear groups. Surgical indications included PSIRCTs, intact or repairable subscapularis, and minimal glenohumeral arthritis. Clinical assessments comprised VAS, Constant score, ASES score, and active range of motion (ROM). Radiologic evaluations included acromiohumeral distance (AHD), Hamada grade, and integrity of the transferred tendon. Postoperative complications and the achievement of minimal clinically important differences (MCID) were also recorded.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eA total of 53 patients were included, classified into the Subscapularis Intact group (n = 34) and the Subscapularis Tear group (n = 19). At a mean follow-up of 62.9 ± 12.9 months, both groups demonstrated significant improvements in pain, patient-reported outcome measures (PROMs), and range of motion (ROM). Patients with an intact subscapularis achieved higher postoperative Constant scores (70.7 ± 8.9 vs. 62.3 ± 8.9, p = 0.002) and ASES scores (75.5 ± 8.8 vs. 66.7 ± 8.8, p = 0.001) than those with tears. Retear rates (17.6% vs. 26.3%, p = 0.465) and overall complications were similar between groups. Radiographically, the acromiohumeral distance decreased and the Hamada grade increased slightly in both groups, consistent with previously reported outcomes.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003ePosterior LD transfer provides significant improvements in pain, function, and range of motion for patients with PSIRCTs. Although both groups demonstrated meaningful improvements, patients with an intact subscapularis tended to achieve significantly higher Constant and ASES scores compared with those with subscapularis tears.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eLevel of Evidence\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eIV, Retrospective Case-series\\u003c/p\\u003e\",\"manuscriptTitle\":\"Effect of Subscapularis Integrity on Functional Recovery After Posterior Latissimus Dorsi Tendon Transfer for Posterior–Superior Irreparable Rotator Cuff Tears\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-05-08 19:36:24\",\"doi\":\"10.21203/rs.3.rs-9115678/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"reviewerAgreed\",\"content\":\"101098764534962761442943212272169068102\",\"date\":\"2026-05-15T16:26:47+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2026-04-30T03:58:31+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2026-03-30T07:34:47+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2026-03-30T07:34:19+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"European Journal of Orthopaedic Surgery \\u0026 Traumatology\",\"date\":\"2026-03-13T14:12:01+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"european-journal-of-orthopaedic-surgery-and-traumatology\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"ejos\",\"sideBox\":\"Learn more about [European Journal of Orthopaedic Surgery \\u0026 Traumatology](http://link.springer.com/journal/590)\",\"snPcode\":\"590\",\"submissionUrl\":\"https://submission.springernature.com/new-submission/590/3\",\"title\":\"European Journal of Orthopaedic Surgery \\u0026 Traumatology\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false}}],\"origin\":\"\",\"ownerIdentity\":\"88582d06-2ed7-4d46-8d17-6db243f76ab3\",\"owner\":[],\"postedDate\":\"May 8th, 2026\",\"published\":true,\"recentEditorialEvents\":[{\"type\":\"reviewerAgreed\",\"content\":\"101098764534962761442943212272169068102\",\"date\":\"2026-05-15T16:26:47+00:00\",\"index\":24,\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"10\",\"date\":\"2026-04-30T03:58:31+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-05-08T19:36:24+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-05-08 19:36:24\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-9115678\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-9115678\",\"identity\":\"rs-9115678\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}