A modified classification and treatment strategy for subscapular tendon tears under arthroscopy

Abstract

Background: Given the increasing anatomical study of the subscapular (SSC) tendon and its adjacent anatomical structure, the present study proposed a modified arthroscopic classification system. Methods: Between April 2018 and April 2021, 119 of 312 rotator cuff tears with isolated SSC tears or SSC tears associated with supraspinatus (SP) or infraspinatus tendon (IS) tears diagnosed by the author were considered potentially eligible for inclusion in this prospective study. In addition to routine arthroscopic examination, the present study carefully identified the SSC tear and adjacent long head biceps(LHB) and pulley as well as performed corresponding treatment according to the lesion. All procedures were performed by the author as a single surgeon. Results: This study modified SSC tears classification defined by Habermeyer Pinto eight types according to tears size and bicipital pulley lesions : Type I tears are located in the superior third of the first facet footprint of the SSC tendon; Type Ia tears accompany an intact LHB pulley or superior glenohumeral ligament(SGHL)lesion , while Type Ib tears accompany a medial coracohumeral ligaments(mCHL) tear or SGHL lesion. Type II tears are defined as the detachment of SSC exceeding one-third of the first facet footprint but not exceeding the whole; Type IIa tears accompany an intact LHB pulley or SGHL lesion, while Type IIb tears accompany a mCHL tear or SGHL lesion. Type III tears are defined as SSC detachment exceeding the first facet footprint but not exceeding the second facet footprint; Type IIIa tears accompany an intact LHB pulley or SGHL lesion, while Type IIIb tears accompany a mCHL tear or SGHL lesion. Type IV tears are defined as SSC detachment exceedingthe second facet footprint regardless of the tendon quality and retraction; Type IVa tears accompany an intact LHB pulley or SGHL lesion, while Type IVb tears accompany a mCHL tear or SGHL lesion Conclusions: On the basis of these observations, this modified arthroscopic classification of SSC tears was more concise and provided guideline according to tear type and obtained satisfactory early-and mid-stage clinical results.