Defining surgical indications in subcoracoid cysts: 3D volumetric analysis and elastography guide tendon-preserving arthroscopic decompression
Abstract Background This prospective cohort study evaluates the impact of arthroscopic subcoracoid cyst decompression on subscapularis tendon elasticity and functional outcomes, while defining prognostic thresholds for surgical decision-making. Materials and methods This prospective cohort study eva...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-08-01
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| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-025-09068-y |
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| Summary: | Abstract Background This prospective cohort study evaluates the impact of arthroscopic subcoracoid cyst decompression on subscapularis tendon elasticity and functional outcomes, while defining prognostic thresholds for surgical decision-making. Materials and methods This prospective cohort study evaluated 46 patients (45–80 years) undergoing arthroscopic decompression for symptomatic subcoracoid cyst. Inclusion criteria required MRI-confirmed subcoracoid cysts and failure of ≥ 6 months of non-operative therapy, while exclusion criteria encompassed prior ipsilateral shoulder surgery, advanced osteoarthritis (Samilson-Prieto grade ≥ 2), irreparable rotator cuff tears, and subscapularis-repaired patients. Pre- and postoperative assessments included 3D MRI cyst volumetry using 3D Slicer 5.6.2, shear-wave elastography (SWE) for tendon stiffness (kPa/m/s) at five anatomical landmarks, coracohumeral distance (CHD) and patient-reported outcomes (QuickDASH, ASES scores). Statistical analyses utilized paired/independent t-tests, non-parametric equivalents, Spearman correlations, and multivariate regression (SPSS 25.0, Python 3.9), with significance set at p < 0.05. Results The cohort (mean age: 59.2 ± 7.5 years; 67.4% female) exhibited significant postoperative improvements. Cyst volume decreased by 72%, from 2.2 ± 1.5 cm³ to 0.62 ± 0.63 cm³ (p < 0.001), with residual cysts (> 0.5 cm³) correlating with persistent coracohumeral distance narrowing (p < 0.05). Subscapularis tendon stiffness, quantified via SWE, declined by 31% (38.6 ± 8.2 kPa to 26.6 ± 5.4 kPa, p < 0.001), with greater elasticity gains observed in patients with larger baseline cysts (> 2.2 cm³; p < 0.05). Functional outcomes improved markedly: QuickDASH scores decreased by 53% (64.16 ± 20.42 to 30.06 ± 17.77) and ASES scores increased by 109% (38.06 ± 19.72 to 79.59 ± 12.08; p < 0.001). A preoperative cyst volume threshold of 2.2 cm³ predicted advanced intraoperative pathology (Lafosse Stage I/II tears in 78.2% of cases; p < 0.05), while postoperative Lafosse stage downgrading (78% to Stage 0; p < 0.001) correlated with coracohumeral distance expansion (p < 0.05). Multivariate regression identified cyst volume (p < 0.05) and surgical decompression (p < 0.05) as independent predictors of elastographic recovery. Residual cyst volumes (> 0.5 cm³) attenuated both biomechanical (p < 0.05) and functional improvements (p < 0.05), underscoring the imperative for complete intraoperative excision. Discussion Arthroscopic subcoracoid cyst decompression restores subscapularis tendon elasticity and shoulder function, with larger cysts (> 2.2 cm³) signaling advanced pathology. Complete cyst excision is critical, as residual volumes impair recovery. SWE emerges as a vital biomarker for postoperative monitoring. |
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| ISSN: | 1471-2474 |