Subscapularis Tears in Our Younger Athlete

Abstract

1. Abstract <span style=font-size:10.0pt; font-family: times= new= roman,serif=>Background: Subscapularis tendon tears are rare in the pediatric population due to the presence of the growing physis. Historically, the use of arthroscopic subscapularis repair has only been described in the adult population. Hypothesis: The use of arthroscopy in the repair of subscapularis tendon tears in the skeletally immature population is a promising alternative to open repair. Study design: Case report. Methods: Two pediatric, skeletally immature patients were identified with complete subscapularis tendon tears resulting from athletic participation. Extent of rotator cuff pathology was evaluated through physical examination, X-rays, Magnetic Resonance Imaging (MRI), and diagnostic arthroscopy. Two different suture anchor systems were utilized for repair of the tendon tear in Case 1 and Case 2:Mitek Helix BR (DePuyMitek, Raynham, MA) and Peek Bio-Corkscrew (Arthrex, Naples, FL), respectively. Immediate adequacy of repair was confirmed through intraoperative range of motion evaluation. Postoperative recovery included relative immobilization and graded physical therapy exercises. Surgical outcome was gauged at three months postoperative with active range of motion evaluation and thorough clinical evaluation; followed by evaluation of return to sport after 1 year postoperatively. Results: The patient in Case 1 presented with an isolated one-centimeter retraction of the entire subscapularis tendon from the insertion. Pertinent positives on clinical exam were anterior shoulder pain, positive belly-press test, positive lift-off test, and internal rotation to vertebra T10. At ten weeks following repair, the patient denied pain and limitation; and, clinical evaluation revealed negative lift-off and belly-press test with internal rotation to vertebra T7. The patient in Case 2presented with a subscapularis tendon tear with an associated non-displaced avulsion fracture of the proximal humerus. The subscapularis tendon tear retracted approximately two-centimeters from the avulsed fragment. At twelve weeks following arthroscopic repair, the patient denied pain and limitation; and, clinical evaluation revealed no instability, negative belly-press test and internal rotation to vertebra T12. Both patients returned to a pre-injury level of athletic performance following arthroscopic repair. Conclusion: We present the cases for two reasons: first, because subscapularis tendon tears are rare in the pediatric population, and second, to describe the technique and outcome of arthroscopic repair of subscapularis tears in this specific population. In this report, we successfully described two arthroscopic surgical techniques to repair a rare pediatric injury and the postoperative outcomes that allowed early return to play. 2. Keywords: Arthroscopy; Pediatric; Rotator Cuff; Subscapularis