Isolated tears of the subscapularis occur less commonly than those
involving the superior and posterior components of the rotator cuff.
The purpose of the present study was to evaluate the structural
integrity and clinical outcomes after arthroscopic repair of
isolated subscapularis tears.
A prospective study of seventeen consecutive patients who were
managed with an all-arthroscopic repair of the subscapularis tendon
was performed. The study group included thirteen men and four women
who had an average age of forty-seven years at the time of surgery.
The average interval from the onset of symptoms to the time of
surgery was twenty-four months. Thirteen tears were traumatic, and
four were degenerative. Seven patients had a tear involving the
superior third of the tendon, six had a tear involving the superior
two-thirds of the tendon, and four had complete separation of the
subscapularis from its insertion on the lesser tuberosity. Clinical
findings were assessed for all patients preoperatively and
postoperatively with use of the Constant and University of
California at Los Angeles scoring systems, and all patients had
postoperative computed tomographic arthrography studies to evaluate
the structural integrity of the repair.
The average duration of follow-up was twenty-nine months. When the
preoperative findings were compared with the most recent findings,
the average relative Constant score had improved from 58% to 96% (p
< 0.05), the average University of California at Los Angeles
score had improved from 16 to 32 points (p < 0.05), the average
pain score had improved from 5.9 to 13.5 points (p < 0.05), the
average forward flexion had improved from 146 degrees to 175 degrees
(p < 0.05), the average external rotation had improved from 50
degrees to 60.3 degrees (p < 0.05), the average internal rotation
had improved from the level of the sacrum to L1-L2 (p < 0.05),
and the average abduction strength had improved from 7.4 to 15.6
points (p < 0.05). The structural integrity of the repair was
completely intact in fifteen patients and was partially reruptured
in two patients on the basis of computed tomographic arthrography.
Progression of fatty infiltration of the subscapularis was not
observed in any patient. Subjectively, twelve patients were very
satisfied with the result, four were satisfied, and one was not
LEVEL OF EVIDENCE
Arthroscopic repair of an isolated subscapularis tear can yield
marked improvements in shoulder function, can significantly reduce
pain, and can result in a durable structural repair.
Therapeutic Level IV.