Arthroscopic Repair of Traumatic Combined Rotator Cuff Tears Involving the Subscapularis Tendon

Abstract

Arthroscopic repair with use of the suture anchor technique is a safe and effective procedure for the treatment of combined rotator cuff tears involving the subscapularis tendon; it can alleviate shoulder pain and improve function and the range of motion. The postoperative integrity of the repair correlates with the clinical results. Patient age and the degree of tendon retraction can affect the integrity of the repair.

Functional and structural comparisons of the arthroscopic knotless double-row suture bridge and single-row repair for anterosuperior rotator cuff tears

“…19 A previous anatomic study of the subscapularis footprint indicated that the tendon portion occupied the superior two-thirds of the attachment, and the muscular portion occupied the inferior one-third. 18 These anatomic findings were used to grade tears of the superior one-third (the superior half of the tendon portion) as grade 1 and the superior two-thirds of the attachment (the entire tendon portion) as grade 2; tears affecting all tendon and muscle portions were recorded as grade 3.…”

“…Manual muscle strength, Neer and Hawkins impingement, supraspinatus, 20 infraspinatus, 12 liftoff, 9,19 belly-press, 9,19 and Speed tests were performed. All patients were evaluated at the latest follow-up by an orthopedic surgeon other than the primary surgeon.…”

“…The single-row technique with a simple suture style was performed as previously described by Ide et al 17,19 A titanium screwin anchor double-loaded nonabsorbable suture was used for grade 1 subscapularis repairs and 2 suture anchors were used for grade 2 subscapularis repairs (Fig. 1, A).…”

“…Several authors 1,[3][4][5]7,19,[22][23][24]27,33,35 have reported the outcomes of arthroscopic or open repair for anterosuperior RCT; arthroscopic single-row repair was useful and the repair integrity correlated with the clinical results; however, a relatively high rate (30%) of failed subscapularis repair was also noted. 19 The primary advantage of the transosseous-equivalent (TOE) repair technique, which was introduced in 2006 by Park et al, 29 is its ability to overcome the challenge of failed repairs of combined tears. Biomechanical tests have shown that the TOE repair technique is superior to the unlinked double-row and single-row methods for the repair of the supraspinatus 30,32 and subscapularis.…”

Partial and Full-Thickness RCT: Modern Repair Techniques

“…Although others have proposed an alternative pathoanatomy for this arthroscopic finding, the reduction of the tissue that represents the comma tissue to the remnant subscapularis has been shown to recreate the intraarticular aspect of the torn subscapularis while concurrently reducing the leading edge of the supraspinatus [85]. Short-term and long-term results of isolated subscapularis and combined rotator cuff tears involving the subscapularis have consistently been shown to lead to good or excellent results in the vast majority of cases, with structurally intact repairs evaluated via ultrasound and magnetic resonance imaging reported as high as 93% [86][87][88][89][90][91][92]. Additionally, the reduction of the comma tissue to the torn subscapularis tendon can help reduce the leading edge of supraspinatus tears when found concomitantly.…”