Arthroscopic Subscapularis Repair

Authors: Fox & Romeo

References: Presented at AAOS 2003

Abstract
Introduction: Arthroscopic repair of the subscapularis is a challenging new technique. This paper reports the results of an all-arthroscopic technique of subscapularis repair. Methods: 18 consecutive patients underwent an arthroscopic subscapularis repair with 14 patients available for follow-up. The tears were classified as type I: partial-thickness tear, type II: complete tear of upper 25% of tendon, type III: complete tear of upper 50% of tendon, and type IV: complete rupture of tendon. All shoulders were evaluated using the ASES Shoulder Index, Simple Shoulder Test, Constant Score, Rowe scale, and SF-12. All patients underwent an arthroscopic subscapularis repair using bone anchors and nonabsorbable suture for fixation. Results: The average age was 56 years (32-85 years old). Average follow-up was 27 months (14-45 months). A history of trauma was present for 71% of the tears. In 64% of the cases, MRI interpretation found no subscapularis tear present. Three had an associated supraspinatus tear. One patient fell 2 weeks after surgery and required a second arthroscopic repair. There were no other complications. Forward elevation improved from 138 degrees to 161 degrees; external rotation from 70 to 86 degrees. ASES score improved from 46 to 82. Simple shoulder test improved from 7 to 10. Constant score was 75 for the operative side, 79 for the unaffected shoulder. 79% of patients rated function as good to excellent on the Rowe function subscale. Discussion: All-arthroscopic subscapularis repair has proven successful based on a comprehensive assessment of results. The procedure is technically challenging but safe.