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.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.