A classification for partial subscapularis tendon tears

Abstract

The aim of the study was to analyze partial subscapularis tendon (SSC) tears and provide a descriptive classification. Methods The retrospective study included 50 patients with arthroscopically confirmed partial SSC tears. Internal rotation (IR) force measurements and IR ROM have been made and compared to the healthy contralateral side. Then the footprint of the SSC was routinely investigated by arthroscopy with standardized measurement of the bony footprint lesion. The partial tears were classified according to the mediolateral and craniocaudal extension of the rupture in the transverse and coronal plane, respectively. Results Partial SSC tears could be classified into split lesions (type 1, n = 11) and 3 further groups depending on the mediolateral peeled-off length of the bony footprint (type 2: < 10 mm, n = 20; type 3: 10-15 mm, n = 10; type 4: > 15 mm, n = 9). Type 2-4 could be further divided depending on the craniocaudal peeled-off length of the bony footprint (group A: < 10 mm, group B: 10-15 mm, group C: > 15 mm). Significantly decreased IR strength was shown for types 2-4 (p < 0.05) but not for split lesions as compared to healthy side. Types 1-4 showed significant decreased active IR ROM and all except type 3 (n.s.) which showed decreased passive IR ROM compared to the healthy side (p < 0.05). Conclusion We present a novel classification for partial SSC tears for a more detailed and reproducible description. This can help to improve the current knowledge about the appropriate treatment. It could be shown that partial tears of the subscapularis can have an impact on IR strength and motion.

Association Between Medial Displacement of the Middle Glenohumeral Ligament and Subscapularis Tear Severity

“…This implied that the retraction of the subscapularis tendon is not obvious when there is only a minor tear (Lafosse grades I and II). This result was similar to observations described by Martetschla ¨ger et al, 26 which showed that a small tear size (<10 mm) in the coronal plane is associated with a shorter tear length (<10 mm) in the axial plane. In addition, in an arthroscopic finding discussed by Collotte and Nove-Josserand, 12 most MGHLs insert distally to the lateral or intermediate part of the subscapularis.…”

Subscapularis tendon tear classification and diagnosis: A systemic review and meta-analysis

“…Seven studies were found on the classification of subscapularis tendon tears ( 3 – 6 , 29 , 30 ). The different classification types are listed in Table 2 .…”

Quantitative MRI indicators and features for partial subscapularis tendon tears on conventional shoulder MRI

“…In our clinical practice, the false-positive fissure sign is more common at the more medial slices to lesser tuberosity, because the tendon already departs the footprint area and joint effusion is easy to flow into the interspace between tendon and humerus head. Subsequently, we continued to define two subtypes of fissure sign according to the orientation of fluid-filled gap, parallel or vertical to the short axis of SSC tendon at footprint corresponding with the tendon detachment and split tear of SSC, respectively [ 4 , 7 , 22 , 23 ].…”

“…1 ), the transverse fluid-filled gap in the interface between cortex and tendon; type B (Fig. 2 ), the vertical fluid-filled gap into the tendon surface involving both sides of SSC [ 7 , 22 , 23 ]. Thinning of the SSC tendon.…”

“…The incidence of SSC tears ranges from 27% to 43% in arthroscopy, and partial SSC tears was 19–50% in cadaveric and arthroscopic studies [ 4 – 6 ]. The SSC tear combined with other rotator cuff tears is common, with a reported incidence of 19–49%, and the isolated subscapularis tear is rare, with a prevalence of 4–6% [ 7 – 9 ]. Despite its critical role in the glenohumeral joint, the SSC tendon was long known as “the forgotten tendon”, of which partial tears were thought as the “hidden lesions” [ 10 ].…”