Repair Of Subscapularis Tendon Tears Research Articles

Open repair of subscapularis tendon tears leads to complete relief of symptoms in the majority of patients, but often fails to restore functional range of motion

Purpose To investigate the outcome of open subscapularis (SSC) repair in terms of complete relief of symptoms, regaining functional range of motion ((ROM), i.e. minimum ROM to complete all tasks of daily living) and retear rate. Methods Sixty-one patients who underwent open SSC repair between 2012 and 2019 were included in a retrospective cohort study. Primary outcome measures (complete relief of symptoms, obtaining functional ROM, SSC retears), were assessed at minimum 1-year follow-up. Prognostic factors for these outcome measures were identified. Results At final follow-up, 44 patients (72%) reported complete relief of symptoms. Pre-operatively, 23 patients (40%) had a functional ROM, which increased to 33 patients (54%) post-operatively. Eight Patients (13%) had a retear after a median follow-up of 21 months (range: 3-35). Lafosse type IV tears were associated with having persisting symptoms (OR 5, 95 confidence interval (CI) 1.2–17.9, p = 0.024) and retears (OR 7, 95 CI 1.9–37.7, p = 0.031). Conclusion The majority of patients reported complete relief of symptoms after SSC repair; however, only 54% obtained a functional ROM. Measuring outcome in terms of complete relief symptoms and regaining functional ROM is useful for the surgeon to evaluate the effect of surgical intervention and provides tangible information for patients.

Combined Intra-articular and Extra-articular Visualization for Repair of a Complete Subscapularis Tear: The “Blended View” Technique

Repair of subscapularis tendon tears can be a challenging task, even for an experienced arthroscopist. The complexity results not only from the difficulty in identifying these tears accurately but also because establishing orientation for visualization and repair of this often distorted anatomy can be difficult. Even after a subscapularis tear is identified and mobilized, restoration of the footprint can prove demanding due to the limited view of the subscapularis tendon’s lesser tuberosity insertion site, especially from the traditional posterior portal. Such visualization limitations often necessitate switching back and forth between 30° and 70° arthroscopes. A “blended view” technique is used routinely because it offers optimal visualization and access to the subscapularis tendon and the lesser tuberosity during full-thickness subscapularis repair.

Arthroscopic Knotless Repair of Complete Full-Thickness Tears of the Subscapularis Tendon Through a Single Portal

Arthroscopic repair of subscapularis tendon tears has shown to be a reliable and reproducible technique and is now considered the gold standard method over open repair. However, most arthroscopic techniques use several working portals and the procedure can be technically challenging and time-consuming, especially when knot-tying is required and when multiple anchors are used. Recently, single-portal knotless techniques have been popularized for upper-third lesions (e.g. Lafosse type 1 or 2 tears). Here, we describe a technique of repairing complete tears of the subscapularis tendon (Lafosse type 3 and 4) using knotless suture anchors through a single portal. This technique is quick and allows a safe anatomic footprint repair to the lesser tuberosity.

Comparing safety margin of innervation points of the subscapular nerves from the base and tip of the coracoid process

IntroductionArthroscopic procedures like repair of subscapularis tendon tears pose a potential risk of injury to subscapular nerves. Damage to these nerves can be minimized by knowledge of relationship of subscapular nerve with nearby bony landmark such as coracoid process. MethodsGross anatomic dissection of thirty embalmed human cadaveric shoulder specimens was performed; variations in number and origin of subscapular nerves were noted. Distance of point of entry of upper and lower subscapular nerves into the subscapularis muscle from base and tip of coracoid process was measured in both neutral and external rotation with 30° abduction positions of arm. Length and angulation of coracoid process of 48 dry scapulae were also evaluated. ResultsVariability in terms of origin was more commonly observed in lower than upper subscapular nerve. Minimum safe distance of subscapular nerves was 39mm medial to the base of a coracoid process with arm kept in neutral position and margin of safety reduced to 33mm if the arm is in 30° abduction with external rotation position. Range of distance of nerve entry into muscle from tip was very wide as compared to the base of coracoid process. Length of coracoid process ranged from 28 to 45mm, forward angulation of coracoid process ranged from 53°–86°. DiscussionGreater margin of safety for upper and lower subscapular nerves was observed with the arm in neutral position in comparison to 30° abduction with external rotation position and base of coracoid could be more dependable landmark than its tip.

Subscapularis Tears in Our Younger Athlete

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

Subscapularis Tendon Repair Using Suture Bridge Technique

The subscapularis tendon plays an essential role in shoulder function. Although subscapularis tendon tears are less common than other rotator cuff tears, tears of the subscapularis tendon have increasingly been recognized with the advent of magnetic resonance imaging and arthroscopy. A suture bridge technique for the treatment of posterosuperior rotator cuff tears has provided the opportunity to improve the pressurized contact area and mean footprint pressure. However, suture bridge fixation of subscapularis tendon tears appears to be technically challenging. We describe an arthroscopic surgical technique for suture bridge repair of subscapularis tendon tears that obtains ideal cuff integrity and footprint restoration. Surgery using such a suture bridge technique is indicated for large tears, such as tears involving the entire first facet or more, tears with a disrupted lateral sling, and combined medium to large supraspinatus/infraspinatus tears.

Subscapularis Repair With the Suture Shuttle Loop Technique

Successful techniques for arthroscopic repair of subscapularis tendon tears have been previously described in the literature. Recommendations regarding portal placement, tissue mobilization, and suture passage have been published. We present a novel technique that uses a shuttle suture passed with the Viper suture passer (Arthrex, Naples, FL) through a standard anterior arthroscopy portal. The described technique easily passes a suture through the subscapularis tendon while the surgeon visualizes suture placement from the posterior portal.

Les lésions du tendon du subscapulaire : étude descriptive et résultats des réparations chirurgicales

Although not well known, lesions of the subscapularis tendon are more common than usually reported. We conducted a descriptive study of 22 patients (23 shoulders) who underwent surgical repair of subscapularis tendon tears. Mean follow-up was 73 months. The findings were compared to the results of a prospective study published by one of us (RHC), who reviewed 97 other patients (105 shoulders) with a mean follow-up of 13.4 years after surgical repair of a rotator cuff tear. This comparison allowed us to identify the specific features of rotator cuff tears involving the subscapularis tendon. Subscapularis tears were more likely to be related to a shoulder injury and caused more severe functional impairment, as compared to lesions of the other tendons. Time to surgical treatment was shorter when the subscapularis was torn. Subscapularis tears required adaptation of the surgical approach and postoperative protection of external rotation for 4 to 6 weeks. Outcomes were less satisfactory when the subscapularis tendon was torn. However, outcomes in both studies were correlated to tear size. Outcomes were often favorable after isolated subscapularis tendon tears and less so when other tendons were involved too.

Tears in the subscapularis tendon: descriptive analysis and results of surgical repair

Although not well known, lesions of the subscapularis tendon are more common than usually reported. We conducted a descriptive study of 22 patients (23 shoulders), who underwent surgical repair of subscapularis tendon tears. Mean follow-up was 73 months. The findings were compared to the results of a prospective study published by one of us (R.H.C.), who reviewed 97 other patients (105 shoulders) with a mean follow-up of 13.4 years after surgical repair of a rotator cuff tear. This comparison allowed us to identify the specific features of rotator cuff tears involving the subscapularis tendon. Subscapularis tears were more likely to be related to a shoulder injury and caused more severe functional impairment, as compared to lesions of the other tendons. Time to surgical treatment was shorter when the subscapularis was torn. Subscapularis tears required adaptation of the surgical approach and postoperative protection of external rotation for 4–6 weeks. Outcomes were less satisfactory when the subscapularis tendon was torn. However, the outcomes in both studies were correlated to tear size. The outcomes were often favorable after isolated subscapularis tendon tears and less so when other tendons were involved.