Lengthening of the subscapularis tendon as a sign of partial tearing in continuity

Meyer, Dominik C.; Zimmermann, Stefan M.; Wieser, Karl; Bensler, Susanne; Gerber, Christian; Germann, Marco

doi:10.1016/j.jse.2015.06.014

Cited by 21 publications

(16 citation statements)

References 14 publications

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“…6 Several studies have investigated the efficacy of MRI in diagnosing a tear in the subscapularis tendon. 1,9,24,25 They have commonly stated that the rate of making an accurate diagnosis of a subscapularis tendon tear using MRI is much less than that of a posterosuperior rotator cuff tear, and partial-thickness tears are more difficult to diagnose than full-thickness tears. Malavolta et al 24 recently analyzed the accuracy of MRI in identifying tears among 14 studies and found that the overall sensitivity and specificity thereof were 0.68 and 0.90, respectively.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Revision Rotator Cuff Repair: The Role of Previously Neglected Subscapularis Tears

et al. 2021

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Background: Concomitant full-thickness tear of the subscapularis tendon is often neglected during primary posterosuperior rotator cuff repair, and its significance has not been investigated by any previous clinical study. Purpose: To investigate (1) the clinical and radiological outcomes of revision arthroscopic rotator cuff repair and (2) the number of neglected concomitant subscapularis full-thickness tears in the revision of posterosuperior rotator cuff retears and their structural integrity after repair. Study Design: Case series, Level of evidence, 4. Methods: This study retrospectively examined 58 patients who underwent arthroscopic rotator cuff revision for a retear of a previously repaired posterosuperior rotator cuff. Preoperative and postoperative functional scores and active range of motion (ROM) were assessed. The initial and most recent follow-up magnetic resonance imaging scans before revision and arthroscopic findings at the time of primary repair were reviewed to determine whether the concomitant subscapularis tear was newly developed or preexisting. Final confirmation of the tendon’s full-thickness tear was made during the revision procedure. Results: At final follow-up, mean functional shoulder scores and ROM improved significantly compared with the preoperative values ( P < .001). Among the 58 revision cases, 25 (43.1%) had a neglected full-thickness tear of the subscapularis tendon. The fatty infiltration grade of the neglected subscapularis tear progressed from a mean of 1.1 before primary repair to a mean of 1.6 before revision, and the change indicated statistically significant deterioration ( P < .001). Despite clinical improvement after revision surgery, the retear rate was considerable in the re-repaired cuff tendons (37.9%) as well as for the repaired concomitant subscapularis tears (24%). Conclusion: Among revision rotator cuff repairs, 43.1% had neglected subscapularis tears, and fatty infiltration of these initially neglected subscapularis tendons showed further progression at the time of revision. The retear rate after the repair of neglected subscapularis tears was higher than expected. Thus, detecting and treating subscapularis tear via meticulous preoperative evaluation and thorough inspection during primary arthroscopy are essential.

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Section: Discussionmentioning

confidence: 99%

Arthroscopic Revision Rotator Cuff Repair: The Role of Previously Neglected Subscapularis Tears

et al. 2021

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“…Mobilizing the tendon back to its anatomic position brings the MGHL into view, validating the test and allowing the repositioning to be assessed after repair. The invisible MGHL test is also positive for retracted tears of the articular layer of the subscapularis tendon (Lafosse stages 2 and 3), which have only recently been individuated 12,14 and represent a potential diagnostic pitfall (Figures 2 and 3). In these cases, the tear is difficult to detect during exploration of the joint because the superior horizontal border of the subscapularis remains in place, falsely suggesting that the whole tendon is intact.…”

Section: Discussionmentioning

confidence: 99%

“…It is for these types of tears that in our view the MGHL is the most helpful, where the superficially elongated rather than torn aspect of the tendon can lead to diagnostic and treatment errors. 14 The invisible MGHL test reveals the retraction and detachment of just the articular layer of the subscapularis because of the unusual insertion of the MGHL onto the articular surface of the subscapularis tendon (see Figure 2, B and C). Furthermore, the predominant retraction of the articular layer of the subscapularis can be explained by the histological structure of the tendon, which consists of 2 distinct layers with different collagen fiber orientations and independent musculotendinous junctions.…”

Section: Discussionmentioning

confidence: 99%

The Invisible MGHL Test: Diagnostic Value and Benefits for the Repair of Retracted Subscapularis Tears

et al. 2020

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Background: Some full-thickness subscapularis tendon tears and partial tears of the deep layer are difficult to characterize, leading to misdiagnosis. Purpose: To evaluate the association between displacement of the middle glenohumeral ligament (MGHL) and retracted tears of the subscapularis tendon as a possible test to improve diagnosis. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Videos (N = 100) recorded during arthroscopic rotator cuff repair involving a torn subscapularis tendon were analyzed retrospectively to assess the association between the MGHL test (nonvisibility of the MGHL) and other objective anatomic criteria. The invisible MGHL test was defined as positive if the MGHL was initially nonvisible in the beach-chair position and appeared only when the subscapularis tendon was pulled back into position by using a 30° arthroscope from the standard posterior portal. The parameters considered during the initial exploration were (1) visibility of the horizontal part of the subscapularis tendon; (2) visibility of the MGHL in its usual position, crossing the superior border of the subscapularis tendon; (3) exposure of the lateral border of the subscapularis tendon (full-thickness retracted tear); and (4) complete or partial exposure of the lesser tuberosity of the humerus. Tendon retraction was evaluated in 3 stages according to the Patte classification. Results: The invisible MGHL test result was positive in 45% of cases. It was positive in 6% of cases (2 of 31) when there was no subscapularis tendon retraction and in 62% of cases (43 of 69) when there was partial or complete retraction ( P < .001). The invisible MGHL test was significantly associated with the width of the tear ( P < .001) and exposure of the lateral border of the subscapularis tendon (full-thickness retracted tear, P = .0002). After repair, the MGHL was visible in its anatomic position in 96% of cases. Conclusion: A positive invisible MGHL test is an alternative indication of subscapularis tendon retraction, and the relocation of the MGHL can also be used after repair to assess the proper anatomic repositioning of the subscapularis tendon.

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“…T1-T2-weighted and fatsuppressed T2-weighted images were performed underwent 3.0-T MRI with the arm in a neutral position. According to previous reports [14,[17][18][19][20][21], clinical experience, and clinical importance, seventeen imaging features were measured for further evaluation by two trained executors. The consensus was reached after deliberation and the average value of variables was obtained with multiple measurements.…”

Section: Imaging Characteristicsmentioning

confidence: 99%

Identifying Key Factors Associated with Subscapularis Tendon Tears and Developing a Risk Prediction Model to Assist Diagnosis

Wang

xue

2021

Preprint

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Background: Subscapularis (SSC) tendon tears can cause pain and restricted motion of the shoulder, but accurate diagnosis of this lesion on magnetic resonance imaging (MRI) is challenging, especially in small and partial tears. There are no studies that have established a method to reliably assess the risk of subscapularis tendon tears.Methods: Data on 460 patients who received shoulder arthroscopic surgery with preoperative shoulder MRI were collected retrospectively. Of these, patients with SSC tendon tears were defined as the SSC tear group, and patients with intact subscapularis tendon were enrolled in the non-SSC tear group. Logistic regression analysis was used to identify the risk factors of SSC tendon tears which were then incorporated into the nomogram. Results: Among 22 candidate factors, five independent factors including coracohumeral distance CHD (oblique sagittal) (OR, 0.75; 95%CI, [0.67-0.84]), fluid accumulation (Y-face) (OR, 2.29; 95%CI, [1.20-4.38]), long head of biceps tendon (LHB) dislocation/subluxation (OR, 3.62; 95%CI, [1.96-6.68]), number of posterosuperior (PS) rotator cuff tears (OR, 5.36; 95%CI, [3.12-9.22]), and MRI diagnosis (OR, 1.88; 95%CI, [1.06-3.32]) were identified as key predictors associated with subscapularis tendon tears. Incorporating these predictors, the nomogram achieved a good C index with a good agreement on the risk estimation of calibration plots. Higher total points of the nomogram were associated with a greater risk of subscapularis tendon tears. Conclusion: The diagnostic accuracy of conventional 3.0-T MRI for SSC tendon tears was insufficient. Our study revealed critical predictors associated with subscapularis tendon tears. When evaluating the severity of subscapularis tendon injury, more attention should be paid to these tear-related factors. We developed and validated s satisfactory prediction model to improve the diagnostic performance of MRI which was convenient for clinicians to reach a consensus on risk assessment and identify the SSC tendon tears.

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Lengthening of the subscapularis tendon as a sign of partial tearing in continuity

Cited by 21 publications

References 14 publications

Arthroscopic Revision Rotator Cuff Repair: The Role of Previously Neglected Subscapularis Tears

Arthroscopic Revision Rotator Cuff Repair: The Role of Previously Neglected Subscapularis Tears

The Invisible MGHL Test: Diagnostic Value and Benefits for the Repair of Retracted Subscapularis Tears

Identifying Key Factors Associated with Subscapularis Tendon Tears and Developing a Risk Prediction Model to Assist Diagnosis

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