Lafosse and colleagues assessed tendon healing and clinical outcome after all‑arthroscopic repair of isolated subscapularis tears, and proposed a five‑type arthroscopic classification of these tears.
Prospective series of 17 consecutive patients drawn from 342 arthroscopic cuff repairs (May 2000 to July 2002) at the Alps Surgery Institute in Annecy, France, followed for a mean of 29 months (range 24 to 39).
Methods
Design
Prospective study of consecutive patients
Operated May 2000 to July 2002
Patients
17 patients with isolated subscapularis tears
Drawn from 342 arthroscopic cuff repairs
13 men and 4 women
Mean age 47 years (range 29 to 59)
13 traumatic tears and 4 degenerative tears
Mean 24 months from symptom onset to surgery
Basis
Tear depth and extent
Tendon retraction
Humeral head position
Fatty infiltration
Key Findings
At a mean of 29 months, CT arthrography showed an intact repair in 15 of 17 patients, and the 2 partial reruptures followed one Type III and one Type IV repair.
The age- and gender‑adjusted Constant score rose from 58% to 96.4% and the UCLA score from 16.2 to 32.1 points (both p < 0.001).
There were no infections, but 2 patients developed complex regional pain syndrome that resolved with medication and 2 biceps tenodeses failed.
No patient showed progression of subscapularis fatty infiltration on CT arthrography, and none developed postoperative stiffness.
Together, the modified lift‑off and belly‑press tests detected 16 of 17 tears, and 5 patients could not perform the lift‑off test before surgery because of pain or stiffness.
At final review, 12 patients were very satisfied, 4 were satisfied and 1 was not satisfied.
Board pearl
Type V is separated from Type IV by an eccentric, anteriorly displaced humeral head caused by loss of the cuff force couple, and the authors do not treat Type V tears with arthroscopic repair.
Arthroscopic types of subscapularis tearLafosse, J Bone Joint Surg Am 2007
Type I
Partial tear of the deep fibers of the superior third, with no retraction
Type II
Complete tear of the superior third, through both superficial and deep fibers
Type III
Complete tear of the superior two‑thirds, with the intact inferior third limiting retraction
Type IV
Complete tear of the whole tendon retracted to the glenoid rim, with the humeral head centered and fatty degeneration at stage 3 or less
Type V
Complete retracted tear with the humeral head eccentric and displaced anteriorly, coracoid impingement, and fatty degeneration at stage 3 or more
Authors' conclusion
Arthroscopic repair of an isolated subscapularis tear can yield marked improvements in shoulder function, can significantly reduce pain, and can result in a durable structural repair.
Lafosse and colleagues assessed tendon healing and clinical outcome after all‑arthroscopic repair of isolated subscapularis tears, and proposed a five‑type arthroscopic classification of these tears.
Prospective series of 17 consecutive patients drawn from 342 arthroscopic cuff repairs (May 2000 to July 2002) at the Alps Surgery Institute in Annecy, France, followed for a mean of 29 months (range 24 to 39).
Methods
Design
Prospective study of consecutive patients
Operated May 2000 to July 2002
Patients
17 patients with isolated subscapularis tears
Drawn from 342 arthroscopic cuff repairs
13 men and 4 women
Mean age 47 years (range 29 to 59)
13 traumatic tears and 4 degenerative tears
Mean 24 months from symptom onset to surgery
Basis
Tear depth and extent
Tendon retraction
Humeral head position
Fatty infiltration
Key Findings
At a mean of 29 months, CT arthrography showed an intact repair in 15 of 17 patients, and the 2 partial reruptures followed one Type III and one Type IV repair.
The age- and gender‑adjusted Constant score rose from 58% to 96.4% and the UCLA score from 16.2 to 32.1 points (both p < 0.001).
There were no infections, but 2 patients developed complex regional pain syndrome that resolved with medication and 2 biceps tenodeses failed.
No patient showed progression of subscapularis fatty infiltration on CT arthrography, and none developed postoperative stiffness.
Together, the modified lift‑off and belly‑press tests detected 16 of 17 tears, and 5 patients could not perform the lift‑off test before surgery because of pain or stiffness.
At final review, 12 patients were very satisfied, 4 were satisfied and 1 was not satisfied.
Board pearl
Type V is separated from Type IV by an eccentric, anteriorly displaced humeral head caused by loss of the cuff force couple, and the authors do not treat Type V tears with arthroscopic repair.
Arthroscopic types of subscapularis tearLafosse, J Bone Joint Surg Am 2007
Type I
Partial tear of the deep fibers of the superior third, with no retraction
Type II
Complete tear of the superior third, through both superficial and deep fibers
Type III
Complete tear of the superior two‑thirds, with the intact inferior third limiting retraction
Type IV
Complete tear of the whole tendon retracted to the glenoid rim, with the humeral head centered and fatty degeneration at stage 3 or less
Type V
Complete retracted tear with the humeral head eccentric and displaced anteriorly, coracoid impingement, and fatty degeneration at stage 3 or more
Authors' conclusion
Arthroscopic repair of an isolated subscapularis tear can yield marked improvements in shoulder function, can significantly reduce pain, and can result in a durable structural repair.