The frequency of subscapularis tears in arthroscopic rotator cuff repairs: A retrospective study comparing magnetic resonance imaging and arthroscopic findings

Abstract

Purpose:With the advent of arthroscopic shoulder surgery the comprehension and description of rotator cuff tears have strongly evolved. Subscapularis tears are difficult to recognize and are underestimated. Our purpose is to report our observations concerning the relative frequency of subscapularis tears in patients undergoing arthroscopic rotator cuff repair and to compare the arthroscopic observations with the magnetic resonance imaging (MRI) findings.Materials and Methods:Retrospective cohort study including all patients undergoing arthroscopic rotator cuff repair was performed between March 2006 and March 2009 at our institution. Preoperative MRI findings, intraoperative arthroscopic findings, and details of surgical intervention were collected using medical charts.Results:We reviewed the medical charts of a total of 348 consecutive arthroscopic rotator cuff repairs. There were 311 supraspinatus tears (89%), 48 infraspinatus tears (14%), and 129 subscapularis tears (37%). MRI sensitivity and specificity were respectively 0.25 and 0.98 for subscapularis tendon tears, 0.67 and 1.0 for supraspinatus tears and 0.5 and 0.99 for infraspinatus tears.Conclusion:Subscapularis tears are frequent lesions and usually appear concomitantly with supra or infraspinatus lesions. We propose a classification of subscapularis tendon tears, based on our observations of the pathoanatomy of the tears. While concordance with MRI results are good for the supraspinatus, MRI often fails to diagnose the presence of subscapularis tears and infraspinatus tears

Subscapularis Tendon Tears: Classification, Diagnosis and Repair

“…MRI or computed tomography arthrogram is more reliable compared to ultrasonography for cuff assessment, LHBT (Figures 1-3) and fatty muscle belly infiltration ( Figure 4). In some cases however, it could fail to diagnose the presence of SSC tears [28], indirect signs, as LHBT subluxation must be analysed ( Figure 5). Diagnostic accuracy could be improved with MR arthrography in assessing rotator cuff tendon tears [29], essentially in the evaluation of SSC tears [30].…”

Upper Limb Nerve Supply

“…Tears of the subscapularis muscle and related tendon may have been underreported, and are more obvious nowadays due to the advancement of arthroscopic techniques (Garavaglia et al, 2011). Dependent on the cause and severity of the tear, surgery may be a required option due to the limitation of shoulder movement.…”

Clinical application of radial magnetic resonance imaging for evaluation of rotator cuff tear

“…imaging (MRI) for detecting RC injuries. The sensitivity and specificity of MRI in the diagnosis of RC tears have been shown to be very high, at 90% [4][5][6][7][8].…”