This prospective series from Lafosse evaluated 17 patients who underwent all-arthroscopic repair of isolated subscapularis tears at mean 29-month follow-up. It introduced a five-type arthroscopic classification system and assessed both functional outcomes and structural integrity using postoperative CT arthrography.
When you see anterior shoulder pain with weakness on the lift-off or belly-press test, the Lafosse classification tells you whether to fix it or transfer it. Types I through IV are repaired arthroscopically. Type V — an eccentric humeral head with Goutallier stage 3 or worse fatty infiltration. Is not a repair candidate. Offer tendon transfer or arthroplasty instead.
In the clinic, always perform both the lift-off and belly-press tests. Neither test alone is sufficient: lift-off sensitivity is 92%, belly-press only 71%, but together they catch 94% of tears. Get a CT arthrogram if you need to confirm the tear or plan repair.
Beach-chair positioning is not just convenience. It exposes the superior two-thirds of the subscapularis versus only 44% in lateral decubitus, which is essential for visualizing and repairing the most common tear patterns (Types II and III).
This prospective series from Lafosse evaluated 17 patients who underwent all-arthroscopic repair of isolated subscapularis tears at mean 29-month follow-up. It introduced a five-type arthroscopic classification system and assessed both functional outcomes and structural integrity using postoperative CT arthrography.
When you see anterior shoulder pain with weakness on the lift-off or belly-press test, the Lafosse classification tells you whether to fix it or transfer it. Types I through IV are repaired arthroscopically. Type V — an eccentric humeral head with Goutallier stage 3 or worse fatty infiltration. Is not a repair candidate. Offer tendon transfer or arthroplasty instead.
In the clinic, always perform both the lift-off and belly-press tests. Neither test alone is sufficient: lift-off sensitivity is 92%, belly-press only 71%, but together they catch 94% of tears. Get a CT arthrogram if you need to confirm the tear or plan repair.
Beach-chair positioning is not just convenience. It exposes the superior two-thirds of the subscapularis versus only 44% in lateral decubitus, which is essential for visualizing and repairing the most common tear patterns (Types II and III).