Although the biomechanical importance of the subscapularis tendon has been recognized in biomechanical 1 and clinical studies, 2 it has long received little attention in the medical literature, 3 and has been called the "forgotten tendon". 4 Only 1% of rotator cuff tears affect only the subscapularis, 5,6 but more than half of all patients with supraspinatus tears present an associated tear of this tendon. 7,8 The accuracy of magnetic resonance imaging (MRI) is usually lower for detection of subscapularis tears than for rotator cuff tears overall, 9,10 with sensitivity ranging from 25% to 94% 5,11 and specificity from 67% to 100%. [12][13][14] Studies evaluating the diagnosis of subscapularis tears are important for clinical practice, with implications for prognosis and surgical planning. Among the published studies, some have included low magnetic field MRI, 7,13,15,16 small samples, 15,17 diagnosis not restricted to rotator cuff disorders, 7,12,14-16,18-21 and use of intra-articular 11,14,19 or intravenous 15,20 contrast. These factors can generate bias in data interpretation.
OBJECTIVEThe objective of the present study was to evaluate the accuracy of preoperative high magnetic field MRI without the use of contrast, compared with arthroscopic inspection, for identifying subscapularis tears, in cases undergoing rotator cuff repair.
METHODSThis was a diagnostic test study comparing the findings from preoperative MRI (index test) with those from shoulder arthroscopy (reference standard) for diagnosing subscapularis tears.Operative data were collected in a standardized manner from consecutive patients between January 2013 and August 2017, by three surgeons at the same institution.