Subscapularis Tendon Tears: Classification, Diagnosis and Repair

Abstract

Rotator cuff tears include a panel of tendon lesions, and superior cuff tears are often comb- ined with subscapularis lesions that are more difficult to repair. We propose in this chapter to describe the Lafosse subscapularis tears classification and to describe the arthroscopic repair that can be performed easily with a needle as shuttle. The advantages of these surgical techniques are simplicity, safety and quickness. The procedure is performed under general anaesthesia with the patient in beach chair position. A classic arthroscopic posterior portal is used to perform glenohumeral exploration, and cuff tendons are analysed. Once subscap- ularis tear is confirmed, the tendon must be released after repair with anterolateral portal. Then, a triple-loaded anchor is positioned at the edge of the bicipital groove to perform both biceps tenodesis and subscapularis repair. repair, the concept of “ à la carte ” surgery is applicable, meaning that surgeon may repair all tendon torn in the same procedure to restore anatomy. The clinical outcomes of recent studies confirm that successful arthroscopic repair of the tendon can lead to an improvement in shoulder function and strength, as well as a reduction in pain. We recommend arthroscopic single or double-row repair using spinal needle as shuttle, after biceps tenotomy or tenodesis.