Structural Integrity and Clinical Outcomes After Arthroscopic Repair of Isolated Subscapularis Tears

Lafosse, Laurent; Jost, Bernhard; Reiland, Youri; Audebert, Stéphane; Toussaint, B.; Gobezie, Reuben

doi:10.2106/jbjs.f.00007

Cited by 288 publications

(301 citation statements)

References 16 publications

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“…Although magnetic resonance imaging (MRI) has shown to be a useful tool for the diagnosis of supraspinatus and infraspinatus tendon tears,[1–6] we believe that subscapularis tendon tears are more difficult to recognize and are therefore underestimated. The prevalence of subscapularis tendon tears has not been widely studied,[78] and only a few authors have classified them. [79] To the best of our knowledge, no study to date has compared MRI findings with arthroscopic findings based on the same classification.…”

Section: Introductionmentioning

confidence: 99%

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

Garavaglia

Ufenast

Taverna

2011

Int J Shoulder Surg

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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

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Section: Introductionmentioning

confidence: 99%

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

Garavaglia

Ufenast

Taverna

2011

Int J Shoulder Surg

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“…In previous studies, the incidence rate of subscapularis tendon tear was 5.4% to 49.4% [2,6,8], and hyper-extension and hyper-external rotation forces by a direct force, sports injuries, and traffic accidents were reported as the injury mechanisms [1,9,18]. Gerber et al reported on a series of sixteen patients with isolated subscapularis repairs who were followed for a minimum of two years.…”

Section: Discussionmentioning

confidence: 99%

“…They reported that 18.7% of patients had required arthroscopic release because of deficit of external rotation of at least 30° [9]. It has been reported that the range of motion of external rotation is restricted after the repair of the subscapularis tendon tear [3,8], but no previous studies have investigated in detail how the difference in the size of full thickness subscapularis tendon tear affects glenohumeral joint motion after the repair.…”

Section: Discussionmentioning

confidence: 99%

“…It is also thought that the repair of subscapularis tendon tear affect the shoulder motion [1,3,6], but no studies have investigated the reduction in glenohumeral joint motion. Lafosse et al reported on a series of 17 patients who were managed with arthroscopic repair of an isolated subscapularis tear [8]. They indicated that postoperative range of motion on external rotation was decreased; however, postoperative Constant score and University of California at Los Angeles score were significantly improved.…”

Section: Introductionmentioning

confidence: 99%

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Glenohumeral joint motion after subscapularis tendon repair: an analysis of cadaver shoulder models

Sano

Aoki

Tanaka

et al. 2014

Journal of Orthopaedic Surgery and Research

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BackgroundAs for the surgical treatment of the rotator cuff tears, the subscapularis tendon tears have recently received much attention for the mini-open or arthroscopic repair. The results of surgical repair for the subscapularis tendon tear are satisfactory, but the range of external rotation is reported to be restricted after the repair. The purpose of this study was to evaluate the range of glenohumeral joint motion after repairs of various sizes of subscapularis tendon tears.MethodsUsing eight fresh frozen human cadaveric shoulders (mean age at death, 81.5 years), three sizes of subscapularis tendon tear (small, medium, and large) were made and then repaired. With the scapula fixed to the wooden jig, the end-range of glenohumeral motion was measured with passive movement applied through 1.0-Nm torque in the directions of scapular elevation, flexion, abduction, extension, horizontal abduction, and horizontal adduction. The passive end-ranges of external and internal rotation in various positions with rotational torque of 1.0 Nm were also measured. Differences in the ranges among the three type tears were analyzed.ResultsAs tear size increased, range of glenohumeral motion in horizontal abduction after repair decreased gradually and was significantly decreased with the large size tear (P < 0.01). The end-range of external rotation decreased progressively with increasing tear size in every glenohumeral position. The prominent decrease in external rotation (around 40° reduction from intact shoulders) was observed in shoulders after repair of large size tear at 30° to 60° of scapular elevation and abduction.ConclusionsAs the size of the subscapularis tendon tear increased, the passive ranges of horizontal abduction and external rotation of the glenohumeral joint after repair decreased significantly. In shoulders with a subscapularis tendon tear, it is necessary to consider the reduction of external rotation depending on tear size.

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“…Full-thickness subscapularis tears are classically described as types II to V according to Lafosse et al 21 A type II is a full thickness tear of the superior one-third of the tendon. A type III tear includes the superior two-thirds.…”

Section: Type B: Full Thickness Tendon Lesionmentioning

confidence: 99%

Classification of full-thickness rotator cuff lesions: a review

et al. 2016

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Rotator cuff lesions (RCL) have considerable variability in location, tear pattern, functional impairment, and repairability.Historical classifications for differentiating these lesions have been based upon factors such as the size and shape of the tear, and the degree of atrophy and fatty infiltration. Additional recent descriptions include bipolar rotator cuff insufficiency, ‘Fosbury flop tears’, and musculotendinous lesions.Recommended treatment is based on the location of the lesion, patient factors and associated pathology, and often includes personal experience and data from case series. Development of a more comprehensive classification which integrates historical and newer descriptions of RCLs may help to guide treatment further.Cite this article: Lädermann A, Burkhart SS, Hoffmeyer P, et al. Classification of full thickness rotator cuff lesions: a review. EFORT Open Rev 2016;1:420-430. DOI: 10.1302/2058-5241.1.160005.

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Structural Integrity and Clinical Outcomes After Arthroscopic Repair of Isolated Subscapularis Tears

Abstract: Therapeutic Level IV.

Cited by 288 publications

References 16 publications

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

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

Glenohumeral joint motion after subscapularis tendon repair: an analysis of cadaver shoulder models

Classification of full-thickness rotator cuff lesions: a review

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