[Arthroscopic repair of subscapularis tendon tear].

PURPOSE OF THE STUDY: In this study the arthroscopic reconstruction of a rupture of the subscapularis tendon is described and the results of the technique are evaluated, with the aim to show the advantages and effectiveness of this surgical procedure.

MATERIAL: Between 2006 and 2008, arthroscopic repair of the subscapularis tendon was carried out in 23 patients, 16 men and seven women, with an average age of 55 (range, 37-74) years. The dominant arm was treated more often (15x). All 23 patients treated by this diagnostic arthroscopic technique were included in the evaluation.

METHOD: With the patient in a lateral recumbent position, the arthroscope was introduced from a dorsal port, and the procedure was carried out through working ventral and anterosuperolateral ports. Following its identification, the subscapularis tendon was mobilised and an insertion site was prepared. Subsequently, a Fastin anchor (Mitek) was inserted. The tendon was stitched through using the mattress suture technique and firmly reinserted to the lesser tuberosity. If necessary, a coracoplasty was performed and the biceps long head tendon was managed.When more tendons of the rotator cuff were torn, the subscapularis tendon was treated first. A complete tear was treated with two anchors and a partial rupture with one Fastin anchor. Post-operative immobilisation lasted 6 weeks and was followed by a six-month rehabilitation therapy. The tears were assessed according to the system proposed by Lafosse et al. The outcomes were evaluated using the University of California at Los Angeles (UCLA) and Constant scoring systems at a minimum of 1 year after surgery.

RESULTS: The 23 patients undergoing arthroscopic repair of the subscapularis tendon were evaluated. The average follow-up was 24 months. The average pre-operative values for the Constant and UCLA scores were 44.4% (25-72%) and 13.8 points (8-24), respectively. Post-operatively, they improved to 84.75% (50-100%) for the Constant score and 28.6 points (17-35) for the UCLA score. The only post-operative complication involving persistent purulent secretion from the posterior port was successfully managed. All patients reported improvement as against the pre-operative condition, all were satisfied with the outcome and expressed their willingness to undergo the same surgery on the other shoulder, if need be.

DISCUSSION: Rupture of the subscapularis tendon is an infrequent injury to the rotator cuff and an isolated tear is rare. An exact clinical diagnosis of a subscapularis tendon tear is difficult. However, subscapularis tendon tears can be reliably diagnosed as well as treated by arthroscopy, including partial ruptures that are often misdiagnosed. Our results compare well with those reported in the international literature and are rated as very good.

CONCLUSIONS: Arthroscopy is the most suitable method to diagnose as well as manage ruptures of the subscapularis tendon classified as Lafosse grades I to IV. Arthroscopic tear repair results in a significant improvement in function of the shoulder joint and pain relief. Based on these results, the arthroscopic treatment of all Lafosse grade I-IV ruptures in our institution is recommended.