DOI QR코드

DOI QR Code

Rotating Arm Internally Can Change the Arthroscopic Diagnosis of a Partial-thickness Tear of the Subscapularis

  • Kim, Hyungsuk (Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Song, Hyun Seok (Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kang, Seung Gu (Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Han, Sung Bin (Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2019.08.04
  • Accepted : 2019.08.11
  • Published : 2019.09.01

Abstract

Background: The aims of this study were (1) to examine the footprint of the subscapularis tendon using the traditional posterior portal and $30^{\circ}$ arthroscope by simple internal rotation of the arm during surgery, and (2) to classify the pattern of a subscapularis partial-thickness tear. Methods: This study analyzed a total of 231 patients with a partial-thickness subscapularis tear from 550 consecutive patients undergoing an arthroscopic operation who had a visualization of the subscapularis tendon footprint by internal rotation of the arm. First, the patients were classified into four categories according to the tear pattern: (1) stable lamination, (2) unstable lamination, (3) avulsion, and (4) laminated avulsion. Randomized arthroscopic videos were reviewed blindly by two independent orthopedic surgeons. The pattern of the tear of the subscapularis at the neutral position and after internal rotating the arm were assessed and compared with the treatment decision (level IV case series). Results: Stable lamination, unstable lamination, avulsion, and laminated avulsion were observed in 9.1% (n=21), 20.8% (n=48), 41.1% (n=95), and 29.0% (n=67) of cases, respectively. In 145 out of 231 cases (62.8%), the decision was changed after inspecting the footprint after internal rotation of the arm, and the treatment method was changed in 116 (50.2%) cases. Conclusions: In a subscapularis tendon partial-thickness tear, inspecting the footprint of the subscapularis tendon is essential to diagnosing and deciding on the appropriate treatment. In addition, simply internal rotating the arm during surgery when using the traditional posterior portal and $30^{\circ}$ arthroscope can be a valuable method.

Keywords

References

  1. Tung GA, Yoo DC, Levine SM, Brody JM, Green A. Subscapularis tendon tear: primary and associated signs on MRI. J Comput Assist Tomogr. 2001;25(3):417-24. doi: 10.1097/00004728-200105000-00015.
  2. Deutsch A, Altchek DW, Veltri DM, Potter HG, Warren RF. Traumatic tears of the subscapularis tendon. Clinical diagnosis, magnetic resonance imaging findings, and operative treatment. Am J Sports Med. 1997;25(1):13-22. doi: 10.1177/036354659702500104.
  3. Flury MP, John M, Goldhahn J, Schwyzer HK, Simmen BR. Rupture of the subscapularis tendon (isolated or in combination with supraspinatus tear): when is a repair indicated? J Shoulder Elbow Surg. 2006;15(6):659-64. doi: 10.1016/j.jse.2005.07.013.
  4. Arai R, Sugaya H, Mochizuki T, Nimura A, Moriishi J, Akita K. Subscapularis tendon tear: an anatomic and clinical investigation. Arthroscopy. 2008;24(9):997-1004. doi: 10.1016/j.arthro.2008.04.076.
  5. Burkhart SS, Tehrany AM. Arthroscopic subscapularis tendon repair: technique and preliminary results. Arthroscopy. 2002;18(5):454-63. doi: 10.1053/jars.2002.30648.
  6. Cash CJ, MacDonald KJ, Dixon AK, Bearcroft PW, Constant CR. Variations in the MRI appearance of the insertion of the tendon of subscapularis. Clin Anat. 2009;22(4):489-94. doi: 10.1002/ca.20789.
  7. Adams CR, Schoolfield JD, Burkhart SS. Accuracy of preoperative magnetic resonance imaging in predicting a subscapularis tendon tear based on arthroscopy. Arthroscopy. 2010;26(11):1427-33. doi: 10.1016/j.arthro.2010.02.028.
  8. Gerber C, Krushell RJ. Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg Br. 1991;73(3):389-94. https://doi.org/10.1302/0301-620X.73B3.1670434
  9. Walch G, Nove-Josserand L, Levigne C, Renaud E. Tears of the supraspinatus tendon associated with "hidden" lesions of the rotator interval. J Shoulder Elbow Surg. 1994;3(6):353-60. doi: 10.1016/S1058-2746(09)80020-7.
  10. Curtis AS, Burbank KM, Tierney JJ, Scheller AD, Curran AR. The insertional footprint of the rotator cuff: an anatomic study. Arthroscopy. 2006;22(6):609.e1. doi: 10.1016/j.arthro.2006.04.001.
  11. Arai R, Mochizuki T, Yamaguchi K, et al. Functional anatomy of the superior glenohumeral and coracohumeral ligaments and the subscapularis tendon in view of stabilization of the long head of the biceps tendon. J Shoulder Elbow Surg. 2010;19(1):58-64. doi: 10.1016/j.jse.2009.04.001.
  12. Wright JM, Heavrin B, Hawkins RJ, Noonan T. Arthroscopic visualization of the subscapularis tendon. Arthroscopy. 2001;17(7):677-84. doi: 10.1053/jars.2001.25274.
  13. Koo SS, Burkhart SS. Subscapularis tendon tears: identifying mid to distal footprint disruptions. Arthroscopy. 2010;26(8):1130-4. doi: 10.1016/j.arthro.2010.06.017.
  14. Ide J, Tokiyoshi A, Hirose J, Mizuta H. An anatomic study of the subscapularis insertion to the humerus: the subscapularis footprint. Arthroscopy. 2008;24(7):749-53. doi: 10.1016/j.arthro.2008.02.009.
  15. Adams CR, Schoolfield JD, Burkhart SS. The results of arthroscopic subscapularis tendon repairs. Arthroscopy. 2008;24(12):1381-9. doi: 10.1016/j.arthro.2008.08.004.
  16. Kim SH, Oh I, Park JS, Shin SK, Jeong WK. Intra-articular repair of an isolated partial articular-surface tear of the subscapularis tendon. Am J Sports Med. 2005;33(12):1825-30. doi: 10.1177/0363546505278259.
  17. Pfirrmann CW, Zanetti M, Weishaupt D, Gerber C, Hodler J. Subscapularis tendon tears: detection and grading at MR arthrography. Radiology. 1999;213(3):709-14. doi: 10.1148/radiology.213.3.r99dc03709.
  18. Nerot C, Jully JL, Gerard Y. [Rotator cuff ruptures with predominant involvement of the subscapular tendon]. Chirurgie. 1993-1994;119:404-10. French.
  19. Walch G, Boileau P, Noel E, Liotard JP, Dejour H. [Surgical treatment of painful shoulders caused by lesions of the rotator cuff and biceps, treatment as a function of lesions. Reflections on the Neer's concept]. Rev Rhum Mal Osteoartic. 1991;58(4):247-57. French.
  20. Bennett WF. Subscapularis, medial, and lateral head coracohumeral ligament insertion anatomy. Arthroscopic appearance and incidence of "hidden" rotator interval lesions. Arthroscopy. 2001;17(2):173-80. doi: 10.1053/jars.2001.21239.
  21. Burkhart SS, Brady PC. Arthroscopic subscapularis repair: surgical tips and pearls A to Z. Arthroscopy. 2006;22(9):1014-27. doi: 10.1016/j.arthro.2006.07.020.