Double-Row Arthroscopic Subscapularis Repair: A Surgical Technique

Abstract

The subscapularis is the strongest rotator cuff muscle in the shoulder. Until recently, most surgical repairs were performed through an open approach. Furthermore, the reporting of arthroscopic repair techniques and outcomes is fairly limited. This is likely due to the difficulty involved in all-arthroscopic repairs and the relative rarity of this injury compared with injuries of the other rotator cuff tendons. Arthroscopic subscapularis repair can be challenging, even for an expert surgeon, and attempting a double-row repair adds further complexity. Given these issues, this article provides techniques to allow for successful arthroscopic double-row subscapularis repair and avoid potential complications. The key features of an arthroscopic double-row repair include portal placement, surgical technique, and tips to avoid potential pitfalls, all of which are discussed.

Arthroscopic Subcoracoid Decompression, Coracoplasty, and Subscapularis Repair for Subscapularis Tears in the Setting of Subcoracoid Impingement

“…There have been numerous techniques published regarding arthroscopic treatment of subscapularis pathology; however, we believe that this technique is both simple and reproducible with excellent results, as reported by Katthagen et al and others. [9][10][11][12][13][14][15][16][17][18] Additionally, our stepwise approach with decompression of the subcoracoid space allows for safe manipulation of the subscapularis tendon in proximity to the neurovascular structures medially and inferiorly.…”

“…10 The spinal needle method avoids the cost of other high-end suture passing devices that some authors have advocated, and it also negates the need for establishment of an anterosuperolateral portal, as is described by Howlett et al 13 Although most subscapularis tears associated with subcoracoid impingement can be treated with the technique described in this article, the same methods can be applied to larger tears, for which a double-row technique and multiple rows of linked anchors can be used. 11 Lastly, there is no need for knot-tying, which creates more consistency, 19 decreases the risk for soft tissue irritation, and reduces the risk for loss of repair tension. 17 Several other techniques have been presented; however, they have similar pitfalls as mentioned above.…”

“…and others. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 Additionally, our stepwise approach with decompression of the subcoracoid space allows for safe manipulation of the subscapularis tendon in proximity to the neurovascular structures medially and inferiorly.…”

Radiofrequency in arthroscopic shoulder surgery: a systematic review

“…The most common adverse events of RF use are thermal inju- [16,[44][45][46][47][48][49]69]. All four studies reporting these adverse events specify second-degree burns as related to direct contact of the irrigation fluid from outflow tubing rather than from contiguous, elevated intraarticular temperatures [65][66][67][68].…”

Quadriceps Tendon Repair Using Double-Row Suture Anchor Fixation

“… 6 , 7 , 8 Double-row repairs have also been described for subscapularis tears, shoulder capsulolabral repair, medial epicondylitis, and hip abductor repair with varying results. 9 , 10 , 11 , 12 Conceptually, double-row repairs increase construct stiffness, better re-create broad anatomic footprints, and provide compression of tendon to bone via suture bridges. Despite this, there is a paucity of data describing significant clinical benefits to double-row repairs.…”