Arthroscopic repair of the subscapularis tendon: indications, limits and technical features (original) (raw)
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Arthroscopic subscapularis tendon repair
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2002
Purpose: Our objective was to evaluate the preliminary results of 25 consecutive arthroscopic subscapularis tendon repairs. Type of Study: Case series. Methods: All 25 shoulders had longer than 3 months follow-up, with an average of 10.7 months (range, 3 to 48 months). The average age was 60.7 years (range, 41 to 78 years). The average time from onset of symptoms to surgery was 18.9 months (range, 1 to 72 months). The shoulders were evaluated using a modified UCLA score, Napoleon test, lift-off test, radiographs, and magnetic resonance imaging (MRI). Indications for surgery included clinical and/or MRI evidence of a rotator cuff tear. An arthroscopic suture anchor technique devised by the senior author (S.S.B.) was used for repair. Results: UCLA scores increased from a preoperative average of 10.7 to a postoperative average of 30.5 (P Ͻ .0001). By UCLA criteria, excellent and good results were obtained in 92% of patients, with 1 fair and 1 poor result. Forward flexion increased from an average 96.3°preoperatively to an average 146.1°postoperatively (P ϭ .0016). Eight of 9 patients with a positive Napoleon test had complete tears of the subscapularis. All 7 patients with a negative Napoleon test had a tear of the upper half only. The lift-off test could not be performed reliably due to pain or restricted motion in 19 of the 25 patients. Eight patients had isolated tears of the subscapularis. The remaining 17 patients had associated rotator cuff tears with an average total tear size of 5 ϫ 8 cm. Ten patients had proximal migration of the humerus preoperatively. Eight of these 10 patients had durable reversal of proximal humeral migration following surgery. These 8 patients improved their overhead function from a preoperative "shoulder shrug" with attempted elevation of the arm to functional overhead use of the arm postoperatively. Conclusions: (1) The senior author has been able to consistently perform arthroscopic repair of torn subscapularis tendons, with good and excellent results, in 92% of patients. (2) The Napoleon test is useful in predicting not only the presence of a subscapularis tear, but also its general size. (3) Combined tears of the subscapularis, supraspinatus, and infraspinatus tendons are frequently associated with proximal humeral migration and loss of overhead function. Arthroscopic repair of these massive tears can produce durable reversal of proximal humeral migration and restoration of overhead function.
Indian journal of orthopaedics
Rotator cuff tears are a common cause of shoulder pain and dysfunction. More recently, there has been a renewed interest in understanding the subscapularis tears. There are multiple articles in the literature showing the short term results of isolated subscapularis tendon repair. However, the midterm and long term outcome studies for arthroscopic subscapularis repair are few. This study evaluates the functional outcome after arthroscopic subscapularis repair. The records of 35 patients who underwent an arthroscopic subscapularis repair between May 2008 and June 2012 were included in this retrospective study. The records of all patients were reviewed. There were 22 males and 13 female patients with mean age of 58.2 years (range 41-72 years). All patients had a complete history, physical examination, and radiographs of their shoulders. Visual analogue scale (VAS), range of movements, power of cuff muscles, and modified University of California at Los Angeles (UCLA) score were assessed...
Short term results of arthroscopic repair of subscapularis tendon tear
Medical Journal of the Islamic Republic of Iran, 2009
Background: Despite being the largest rotator cuff tendon of the shoulder, the function and clinical relevance of subscapularis pathology has been largely ignored in the literature. Although many studies have focused on subscapularis tears recently, majority of them reported techniques for open repair. The advent of arthroscopy and arthroscopic repair techniques has opened new frontiers in the diagnosis and repair of torn rotator cuff tendons, including the subscapularis. In this article, we review shortterm results of arthroscopic subscapularis repair. Method: Ten patients with subscapularis tendon tear of the rotator cuff were studied prospectively including 8 men and 2 women with an average age of 49.7±12.8 years and an average delay in treatment of 23.3 months. Clinical outcomes, including the UCLA score were assessed in all patients after 3 months of the surgery. Results: 6 patients were followed regularly for more than 6 months, while other 4 patients had a follow-up period of more than a year. The pain score improved from 1.75 to 9 and the UCLA score from 8.8 to 30.6. Conclusions: Arthroscopic repair of subscapularis tendon tear results in significant subjective and objective improvement and high levels of patient satisfaction.
Editorial Commentary: Precise Repair of Partial Subscapularis Tendon Tears Is Essential
Arthroscopy, 2019
The subscapularis is a very important anatomic structure that is essential for maintaining proper glenohumeral joint mechanics and shoulder function. It establishes a force couple with the infraspinatus and teres minor to stabilize the glenohumeral joint in the transverse plane. The subscapularis muscle also opposes the deltoid with humerus abduction and elevation. Recent advances in imaging and arthroscopy techniques have led to greater detection of subscapularis tendon tears. Furthermore, there have been detailed descriptions of the subscapularis insertional anatomy showing that the subscapularis tendon has 4 different facets of insertion to the lesser tuberosity. The tear patterns of the subscapularis are also different from that of the supraspinatus tendon where the complete isolated subscapularis tendon tear is not common. However, the subscapularis partial tear combined with supraspinatus or 3 tendon tears is more common, with most being first-facet tears. Clinically, upper-portion subscapularis partial tendon tears may be considered relatively benign, but biomechanically these tears result in increased external rotation and altered glenohumeral kinematics. Therefore, in my opinion, it is very important to precisely repair these partial subscapularis tendon tears for anatomic, structural, and functional restoration of the shoulder.
Medium-Term Clinical Outcome of the Arthroscopic Repair of Isolated Subscapularis Tendon Tear
Annals of Military and Health Sciences Research
Background: There have been many studies on arthroscopic rotator cuff surgery outcomes. However, few studies have investigated the outcomes of the arthroscopic repair of isolated subscapularis tendon tear. Objectives: This study aimed to evaluate the medium-term clinical outcomes of the arthroscopic repair of an isolated subscapularis tendon tear in a four-year follow-up. Methods: This prospective cohort study was performed on all patients with shoulder pain who had isolated subscapularis tendon on magnetic resonance imaging and underwent arthroscopic evaluation and repair at Besat Hospital, Hamadan, Iran, during 2011 - 2017. The mean follow-up time was 4 years. The modified UCLA, Quick DASH, and visual analogue scale (VAS) were measured, and the belly-press test and lift-off test were completed in the examination. Data were analyzed by the SPSS software version 24. Results: Out of 11 patients, three were female (27.3%), and seven were male (72.7%). The mean age of patients was 59.4...
Biomechanical evaluation of subscapularis repair used during shoulder arthroplasty
Journal of Shoulder and Elbow Surgery, 2007
Dysfunction of the subscapularis after total shoulder replacement has become concerning and may represent poor tendon healing after surgical repair. The objectives of this study were to evaluate the restoration of subscapularis footprint anatomy and failure strength for subscapularis repair via transosseous tunnels and a second anatomic repair via combined transosseous tunnels and direct tendon-to-tendon repair. Six matched pairs of fresh-frozen human cadaveric shoulders were used, with one shoulder from each pair randomly assigned to a transosseous repair and the contralateral shoulder assigned to a combined transosseous tunnel and direct tendon-to-tendon repair. The repair footprint was digitized. Cyclic loading to the tendon repair was performed followed by a constant ramp displacement to complete failure. The transosseous tunnel repair insertional footprint area (228.6 mm 2 ) was significantly less than that of the native footprint (697.3 mm 2 ), and the footprint centroid moved 9.1 mm medially ( P ϭ .0001) and 5.5 mm superiorly ( P ϭ .003). The combined repair required a statistically significantly greater number of cycles ( P ϭ .028) to reach a 5-mm gap (205.7 Ϯ 65.1) than did the isolated transosseous tunnel technique (76.4 Ϯ 34.2). A similar greater number of cycles was observed for the 10-mm gap ( P ϭ .01) for combined repair (307.5 Ϯ 82.4) compared with isolated transosseous repair (166.2 Ϯ 85.8). This study has shown that transosseous tunnel repair alters subscapularis insertional anatomy, resulting in weaker strength of fixation and less contact area when compared with combined transosseous tunnel and direct tendon-to-tendon repair. (J Shoulder Elbow Surg 2007;16:59S-64S.) The deltopectoral surgical approach to the glenohumeral joint for total shoulder replacement (TSR) involves takedown and subsequent repair of the subscapularis tendon. Repair of the subscapularis for TSR has been most commonly achieved via bone tunnels or direct tendon-to-tendon repair. Recently, dysfunction of the subscapularis after TSR has become concerning, with rates as high as 67%. 5,7,10 This clinical dysfunction may represent poor healing of the subscapularis after surgical repair. The objectives of this study were to evaluate the restoration of subscapularis footprint anatomy and failure strength for subscapularis repair via bone tunnels and a second anatomic repair via combined bone tunnels and tendon-to-tendon repair.
Interstitial Tear of the Subscapularis Tendon, Arthroscopic Findings and Technique of Repair
The archives of bone and joint surgery, 2016
Tears of the subscapularis tendon have been significantly recognized as a source of shoulder pain and dysfunction in the past decade, thanks to arthroscopic evaluation of the shoulder and biomechanical and anatomical studies of the tendon. Current classification of subscapularis tendon tear is based on insertion site of the tendon. Recently, a classification for non-insertional types of subscapularis tendon tear has been published. Interstitial tear of subscapularis tendon has not been described in classifications available in the literature. This report describes significant interstitial tear of the subscapularis tendon. This tear looks normal in superior, bursal and articular sides. Then its specific arthroscopic findings as "Air bag sign" and repair technique of the pathology is explained.
Arthroscopy Techniques, 2015
Restoration of subscapularis function is essential for long-term maintenance of good clinical results for both traumatic and nontraumatic rotator cuff tears. The anatomic repair of partially and completely torn tendons from the footprint at the lesser tuberosity is the goal of surgical repair. The described technique, with a combination of an interlocking stitch and additional mattress sutures using a double-loaded suture anchor, provides reduction of the retracted tendon, sufficient pullout strength, and compression of the tendon to the footprint to facilitate healing.
Rehabilitation Following Subscapularis Tendon Repair
International Journal of Sports Physical Therapy, 2019
Subscapularis (SSC) tendon tears are less common than tears of the remaining rotator cuff tendons, but one with serious consequences given its function as one of the main internal rotators and anterior stabilizers. Mild fraying involving the upper third of the tendon can be treated non-operatively; however, more substantive tears usually require repair in cases of pain or functional impairment. Given the importance of the subscapularis tendon in maintaining stability of the glenohumeral joint and performing internal rotation of the arm, surgical intervention with emphasis on repair may be recommended to eliminate pain and restore strength. Postoperative rehabilitation through phased progression is utilized to avoid premature stress on the healing tissue while enabling early return to daily activities. The purpose of this clinical commentary is to provide an evidence-based description of postoperative rehabilitation following SSC tendon repair with guidance for safe and effective return to activity and sports.