Surgical Techniques   |    
Repair of Tears of the Subscapularis
T. Bradley Edwards, MD1; Gilles Walch, MD2; François Sirveaux, MD3; Daniel Molé, MD3; Laurent Nové-Josserand, MD2; Aziz Boulahia, MD2; Lionel Neyton, MD2; Istvan Szabo, MD2; Bruce Lindgren, MS4; Daniel P. O'Connor, PhD5
1 Fondren Orthopedic Group, 7401 South Main Street, Houston, TX 77030. E-mail address: bemd@fondren.com
2 Department of Orthopaedic Surgery, Clinique Sainte Anne Lumière, 85 Cours Albert Thomas, 69003 Lyon, France
3 Department of Orthopaedic Surgery, Clinique de Traumatologie et d'Orthopédie, 49 Rue Hermite, 54000 Nancy, France
4 Department of Biostatistics, University of Minnesota, Room A454, Mayo Building MMC303, 420 Delaware Street Southeast, Minneapolis, MN 55455
5 Joe W. King Orthopedic Institute, Texas Orthopedic Hospital, 7401 South Main Street, Houston, TX 77030-4509
View Disclosures and Other Information
The original scientific article in which the surgical technique was presented was published in JBJS Vol. 87-A, pp. 725-730, April 2005
The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
The line drawings in this article are the work of Joanne Haderer Müller of Haderer & Müller (biomedart@haderermuller.com).
Investigation performed at the Department of Orthopaedic Surgery, Clinique Sainte Anne Lumière, Lyon, France

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Mar 01;88(1 suppl 1):1-10. doi: 10.2106/JBJS.E.00842
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BACKGROUND: Rotator cuff tears involving the subscapularis are less common than those involving the superior aspect of the rotator cuff. The purpose of the present study was to report the results of repair of isolated tears of the subscapularis.

METHODS: The records on eighty-four shoulders that had undergone open repair of the subscapularis tendon were reviewed. The mean age of the patients at the time of surgery was 53.2 years. The mean interval from the onset of symptoms to the time of surgery was 12.5 months. Fifty-seven tears were traumatic, and twenty-seven were degenerative. Twenty-three tears involved the superior one-third of the subscapularis tendon, forty-one tears involved the superior two-thirds, and twenty tears were complete. Fifty-four shoulders had a dislocation or subluxation of the long head of the biceps tendon, and ten shoulders had a rupture of the long head of the biceps tendon. Forty-eight shoulders underwent concomitant biceps tenodesis, thirteen shoulders underwent concomitant biceps tenotomy, and four shoulders underwent concomitant recentering of the biceps. Patients were evaluated clinically and radiographically at a mean of forty-five months (range, twenty-four to 132 months) postoperatively.

RESULTS: The mean Constant score increased from 55.0 points preoperatively to 79.5 points postoperatively. Seventy-five patients were satisfied or very satisfied with the result. Preoperatively, four shoulders had mild glenohumeral arthritis. Postoperatively, twenty-five shoulders had mild glenohumeral arthritis and two shoulders had moderate glenohumeral arthritis. Tenodesis or tenotomy of the biceps tendon at the time of subscapularis repair was associated with improved subjective and objective results, independent of the preoperative condition of the biceps tendon.

CONCLUSIONS: Repair of isolated subscapularis tears yields acceptable improvement in shoulder function in selected patients. Additionally, the results of the present study support routine tenodesis or tenotomy of the long head of the biceps tendon at the time of subscapularis repair.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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