Reconstruction of 25 and 50 % subscapularis tears: a single anchor with a double-mattress suture is sufficient for the reconstruction

Abstract

A single double-loaded suture anchor provides sufficient biomechanical strength even in Fox/Romeo grade III tears of the subscapularis tendon. However, a modified suture configuration is recommended, especially in grade III tears as the suture-tendon interface is the weakest point of the construct.

Are Knotted or Knotless Techniques Better for Reconstruction of Full-Thickness Tears of the Superior Portion of the Subscapularis Tendon? A Study in Cadavers

“…(455 N). Regarding the amount of the measured maximal failure load, our results differed from those of Lorbach et al [36]; the specimens in our study that were treated with a knotted reconstruction technique had a higher maximal failure load than those from the study by Lorbach et al [36]. This difference can be explained by the different way in which the subscapularis tendon was fixed in the testing machine.…”

“…This difference can be explained by the different way in which the subscapularis tendon was fixed in the testing machine. Although the force transmission from the muscle clamp was directly transferred to the subscapularis tendon in our study, Lorbach et al [36] used a tape between the clamp and the subscapularis. Dyrna et al [21] found that a double-row technique using a superolaterally placed anchor resulted in a higher load to failure than did a conventional single-row technique regardless of the defect size.…”

“…These two failure modes can represent two very different challenges for the surgeon, which can be addressed in very different ways. In Lorbach et al [36], the most frequent failure modes in the group of specimens with a 25% defect of the subscapularis tendon were fracture of the footprint and anchor dislocation. In the group of specimens with 50% defects, cutting out the suture from the tendon was the most frequent failure mode.…”

Single-Portal, Single-Anchor Repair of a Superior Third Subscapularis Tear Using a Self-Punching Knotless Soft Suture Anchor

“…34 Although there have been various proposals for the number of anchors needed for various tears, a biomechanical study determined that a single anchor for subscapularis tears that involved up to 50% of the subscapularis tendon provided adequate stability and fixation. 35 This surgical technique and accompanying technical video demonstrates an efficient repair for a complete, upper-third subscapularis tendon tear using a single knotless, soft-suture anchor through a single anterior working portal. Some advantages include providing the physician with the ability to provide tension to the repair under direct visualization after anchor insertion, avoiding potential complications associated with e4 traditional suture anchors, and obtaining overall time efficiency because surgical instruments that are typically involved with the use of traditional suture anchors are not required.…”

“… 34 Although there have been various proposals for the number of anchors needed for various tears, a biomechanical study determined that a single anchor for subscapularis tears that involved up to 50% of the subscapularis tendon provided adequate stability and fixation. 35 …”