Histologic characteristics of the subscapularis tendon from muscle to bone: reference to subscapularis lesions

Tebaa, Eloïse; Tantot, Juliet; Isaac-Pinet, S.; Nové-Josserand, Laurent

doi:10.1016/j.jse.2018.11.045

Cited by 13 publications

(9 citation statements)

References 30 publications

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“…For an optimal approach, we propose an analysis based on the histology of the subscapularis tendon, particularly on the identification of the 2 distinct layers, to better recognize these lesions. 12 In closing, we would like to congratulate Monroe et al 5 again, for their excellent outcomes in their large series, which undoubtedly forms an important addition to the literature. However, further study will be required to support changes to current clinical practice.…”

Section: Lyon Francementioning

confidence: 85%

Editorial Commentary: Arthroscopic Subscapularis Repair: Are We Any Further Forward?

Nové-Josserand¹,

Vieira²

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Arthroscopic repair is a well-established treatment option for tears of the subscapularis tendon. However, it is clear that to further our understanding, additional study is required to more clearly define the influence of tear morphology, repair type, and associated pathologies and procedures on outcomes. It should be noted that there is rather sparse literature reporting long-term outcomesd10 years or moredafter surgery. Future studies should focus on these aspects and use validated and widely used outcome measures to detect important differences and allow comparison with previous studies.

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Section: Lyon Francementioning

confidence: 85%

Editorial Commentary: Arthroscopic Subscapularis Repair: Are We Any Further Forward?

Nové-Josserand¹,

Vieira²

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…2,3,22 In addition, a portion of the subscapularis tendon’s superficial fibers extend and attach to the transverse humeral ligament. 38 Kim et al 17 reported that, even in full-thickness tears, retraction is not clearly observed in many cases, indicating that detecting tears of the subscapularis tendon may be complicated and tears are often missed using ultrasonography or MRI, which are basic and important diagnostic tools for detecting lesions in the rotator cuff. Furthermore, even direct inspection via arthroscopy can frequently miss the tears unless the superior glenohumeral ligament is taken down or a 70° arthroscope is used during inspection.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Revision Rotator Cuff Repair: The Role of Previously Neglected Subscapularis Tears

et al. 2021

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Background: Concomitant full-thickness tear of the subscapularis tendon is often neglected during primary posterosuperior rotator cuff repair, and its significance has not been investigated by any previous clinical study. Purpose: To investigate (1) the clinical and radiological outcomes of revision arthroscopic rotator cuff repair and (2) the number of neglected concomitant subscapularis full-thickness tears in the revision of posterosuperior rotator cuff retears and their structural integrity after repair. Study Design: Case series, Level of evidence, 4. Methods: This study retrospectively examined 58 patients who underwent arthroscopic rotator cuff revision for a retear of a previously repaired posterosuperior rotator cuff. Preoperative and postoperative functional scores and active range of motion (ROM) were assessed. The initial and most recent follow-up magnetic resonance imaging scans before revision and arthroscopic findings at the time of primary repair were reviewed to determine whether the concomitant subscapularis tear was newly developed or preexisting. Final confirmation of the tendon’s full-thickness tear was made during the revision procedure. Results: At final follow-up, mean functional shoulder scores and ROM improved significantly compared with the preoperative values ( P < .001). Among the 58 revision cases, 25 (43.1%) had a neglected full-thickness tear of the subscapularis tendon. The fatty infiltration grade of the neglected subscapularis tear progressed from a mean of 1.1 before primary repair to a mean of 1.6 before revision, and the change indicated statistically significant deterioration ( P < .001). Despite clinical improvement after revision surgery, the retear rate was considerable in the re-repaired cuff tendons (37.9%) as well as for the repaired concomitant subscapularis tears (24%). Conclusion: Among revision rotator cuff repairs, 43.1% had neglected subscapularis tears, and fatty infiltration of these initially neglected subscapularis tendons showed further progression at the time of revision. The retear rate after the repair of neglected subscapularis tears was higher than expected. Thus, detecting and treating subscapularis tear via meticulous preoperative evaluation and thorough inspection during primary arthroscopy are essential.

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“…Furthermore, the predominant retraction of the articular layer of the subscapularis can be explained by the histological structure of the tendon, which consists of 2 distinct layers with different collagen fiber orientations and independent musculotendinous junctions. 5,22…”

Section: Discussionmentioning

confidence: 99%

The Invisible MGHL Test: Diagnostic Value and Benefits for the Repair of Retracted Subscapularis Tears

et al. 2020

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Background: Some full-thickness subscapularis tendon tears and partial tears of the deep layer are difficult to characterize, leading to misdiagnosis. Purpose: To evaluate the association between displacement of the middle glenohumeral ligament (MGHL) and retracted tears of the subscapularis tendon as a possible test to improve diagnosis. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Videos (N = 100) recorded during arthroscopic rotator cuff repair involving a torn subscapularis tendon were analyzed retrospectively to assess the association between the MGHL test (nonvisibility of the MGHL) and other objective anatomic criteria. The invisible MGHL test was defined as positive if the MGHL was initially nonvisible in the beach-chair position and appeared only when the subscapularis tendon was pulled back into position by using a 30° arthroscope from the standard posterior portal. The parameters considered during the initial exploration were (1) visibility of the horizontal part of the subscapularis tendon; (2) visibility of the MGHL in its usual position, crossing the superior border of the subscapularis tendon; (3) exposure of the lateral border of the subscapularis tendon (full-thickness retracted tear); and (4) complete or partial exposure of the lesser tuberosity of the humerus. Tendon retraction was evaluated in 3 stages according to the Patte classification. Results: The invisible MGHL test result was positive in 45% of cases. It was positive in 6% of cases (2 of 31) when there was no subscapularis tendon retraction and in 62% of cases (43 of 69) when there was partial or complete retraction ( P < .001). The invisible MGHL test was significantly associated with the width of the tear ( P < .001) and exposure of the lateral border of the subscapularis tendon (full-thickness retracted tear, P = .0002). After repair, the MGHL was visible in its anatomic position in 96% of cases. Conclusion: A positive invisible MGHL test is an alternative indication of subscapularis tendon retraction, and the relocation of the MGHL can also be used after repair to assess the proper anatomic repositioning of the subscapularis tendon.

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Histologic characteristics of the subscapularis tendon from muscle to bone: reference to subscapularis lesions

Cited by 13 publications

References 30 publications

Editorial Commentary: Arthroscopic Subscapularis Repair: Are We Any Further Forward?

Editorial Commentary: Arthroscopic Subscapularis Repair: Are We Any Further Forward?

Arthroscopic Revision Rotator Cuff Repair: The Role of Previously Neglected Subscapularis Tears

The Invisible MGHL Test: Diagnostic Value and Benefits for the Repair of Retracted Subscapularis Tears

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