Background: 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
Methods: 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.
Results: 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° to 175° (p < 0.05), the average external rotation had
improved from 50° to 60.3° (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
Conclusions: 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.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.