J Korean Orthop Assoc.  2010 Oct;45(5):392-398.

Arthroscopic Repair of Combined Rotator Cuff Tears Involving the Subscapularis Tendon

• Kim YK
• Kim DW
• Noh YT
• Lee SB

Abstract

PURPOSE
Subscapularis tendon tears associated with supraspinatus tendon tears are often found during rotator cuff repair. However, there have been only a few reports about both subscapularis and rotator cuff repair. The authors conducted arthroscopic repair for cuff tear associated with subscapularis tendon tear and assessed its outcomes. MATERIALS AND
METHODS
We evaluated 320 cases of arthroscopic repair following rotator cuff tear between June 2006 and January 2009 at Gil Medical Center. Out of 66 cases (21%) associated with subscapularis tear, forty cases of bone to tendon repair using suture anchor were selected except for 26 cases of tendon to tendon repair. Clinical outcomes of 25 cases followed up for over a year were finally assessed. Clinical outcomes were evaluated using the following measures: range of shoulder motion, muscle strength, belly press test, Visual Analogue Scale (VAS) on pain, and University of California Los Angeles (UCLA) score.
RESULTS
The average VAS pain scale improved from 5.3 preoperatively to 1.4 postoperatively. Internal rotation strength increased from its preoperative level, 4.1 to 4.2 in postoperative 6 months and to 4.6 at last follow-up. Range of internal rotation increased from the second lumbar level at postoperative 6 months to the 11th thoracic level at last follow-up. UCLA score had significantly improved from 17.4 to 30.8 (p<0.05).
CONCLUSION
It is recommended that concurrent repair of the subscapularis tendon during rotator cuff repair for a satisfactory treatment result.

Keyword

rotator cuff tear; associated subscapularis tendon tear; arthroscopic repair

MeSH Terms

California
Follow-Up Studies
Los Angeles
Muscle Strength
Rotator Cuff
Shoulder
Suture Anchors
Tendons

Figure

• 

  Figure 1 Repair of subscapularis tendon. (A) Arthroscopic photograph from a posterior viewing portal shows tear of upper portion of subscapularis tendon. (B) The torn end was held with grasper to evaluate tension around the repair. (C) A corkscrew suture anchor was inserted through the anterior portal at insertional area of subscapularis tendon. (D) After knot tying, upper border of subscapuaris tendon was reconstructed.

• 

  Figure 2 Repair of subscapularis using two anterior portals. (A) The completely torn and retracted subscapularis tendon (arrow). (B) The capsular attachment of torn subscapularis tendon was released through the anterolateral portal. (C) A metallic suture anchor was inserted through the anteromedial portal. (D) The subscapularis tendon was repaired without excessive tension.

• 

  Figure 3 Concomitant lesions of long head of biceps tendon. (A) Partial tear of biceps tendon. (B) Partial tear of biceps tendon in the intertubercular groove including tear of the supraspinatus tendon (arrow). (C) Biceps tendon was dislocated medially with disrupted pulley integrity and tear of upper subscapularis tendon (arrow).

Reference

1. Flury MP, John M, Goldhahn J, Schwyzer HK, Simmen BR. Rupture of the subscapularis tendon (isolated or in combination with supraspinatus tear): when is a repair indicated? J Shoulder Elbow Surg. 2006. 15:659–664.

2. Warner JJ, Higgins L, Parsons IM 4th, Dowdy P. Diagnosis and treatment of anterosuperior rotator cuff tears. J Shoulder Elbow Surg. 2001. 10:37–46.

3. Bales C, Anderson K. Arthroscopic double-row repair of full-thickness rotator cuff tears using a suture bridge technique. Oper Tech Sports Med. 2007. 15:144–149.

4. Frank JB, ElAttrache NS, Dines JS, Blackburn A, Crues J, Tibone JE. Repair site integrity after arthroscopic transosseous-equivalent suture-bridge rotator cuff repair. Am J Sports Med. 2008. 36:1496–1503.

5. Gerber C, Hersche O, Farron A. Isolated rupture of the subscapularis tendon. J Bone Joint Surg Am. 1996. 78:1015–1023.

6. Bennett WF. Arthroscopic repair of anterosuperior (supraspinatus/subscapularis) rotator cuff tears: a prospective cohort with 2- to 4-year follow-up. Classification of biceps subluxation/instability. Arthroscopy. 2003. 19:21–33.

7. Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R. Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am. 2007. 89:1184–1193.

8. Adams CR, Schoolfield JD, Burkhart SS. The results of arthroscopic subscapularis tendon repairs. Arthroscopy. 2008. 24:1381–1389.

9. Ide J, Tokiyoshi A, Hirose J, Mizuta H. Arthroscopic repair of traumatic combined rotator cuff tears involving the subscapularis tendon. J Bone Joint Surg Am. 2007. 89:2378–2388.

10. Arai R, Sugaya H, Mochizuki T, Nimura A, Moriishi J, Akita K. Subscapularis tendon tear: an anatomic and clinical investigation. Arthroscopy. 2008. 24:997–1004.

11. Bennett WF. Subscapularis, medial, and lateral head coracohumeral ligament insertion anatomy. Arthroscopic appearance and incidence of "hidden" rotator interval lesions. Arthroscopy. 2001. 17:173–180.

12. Deutsch A, Altchek DW, Veltri DM, Potter HG, Warren RF. Traumatic tears of the subscapularis tendon. Clinical diagnosis, magnetic resonance imaging findings, and operative treatment. Am J Sports Med. 1997. 25:13–22.

13. Pfirrmann CW, Zanetti M, Weishaupt D, Gerber C, Hodler J. Subscapularis tendon tears: detection and grading at MR arthrography. Radiology. 1999. 213:709–714.

14. Werner A, Mueller T, Boehm D, Gohlke F. The stabilizing sling for the long head of the biceps tendon in the rotator cuff interval. A histoanatomic study. Am J Sports Med. 2000. 28:28–31.

15. Habermeyer P, Magosch P, Pritsch M, Scheibel MT, Lichtenberg S. Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. J Shoulder Elbow Surg. 2004. 13:5–12.

16. Walch G, Nové-Josserand L, Boileau P, Levigne C. Subluxations and dislocations of the tendon of the long head of the biceps. J Shoulder Elbow Surg. 1998. 7:100–108.

17. Tung GA, Yoo DC, Levine SM, Brody JM, Green A. Subscapularis tendon tear: primary and associated signs on MRI. J Comput Assist Tomogr. 2001. 25:417–424.

18. Barth JR, Burkhart SS, De Beer JF. The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear. Arthroscopy. 2006. 22:1076–1084.

19. Nove-Josserand L, Levigne C, Noël E, Walch G. Isolated lesions of the subscapularis muscle. Apropos of 21 cases. Rev Chir Orthop Reparatrice Appar Mot. 1994. 80:595–601.

20. Burkhart SS, Brady PC. Arthroscopic subscapularis repair: surgical tips and pearls A to Z. Arthroscopy. 2006. 22:1014–1027.