Systematic Review| Volume 28, ISSUE 9, P1306-1314, September 2012

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Outcomes of Arthroscopic and Open Surgical Repair of Isolated Subscapularis Tendon Tears


      Reports of the results of subscapularis repairs make up a very small minority of the published literature on rotator cuff repairs, yet subscapularis tears cause significant pain and dysfunction for patients. The goals of this study were to systematically review the published results after subscapularis repair and to compare arthroscopic versus open techniques when appropriate.


      The Cochrane, PubMed, and Embase databases were reviewed for studies evaluating isolated subscapularis repairs. If a study reported outcomes for both subscapularis and supraspinatus tears, a subgroup analysis of isolated subscapularis tears was necessary for inclusion in this review. Other inclusion criteria included a minimum of 1-year follow-up.


      We found 3 arthroscopic repair studies and 6 open repair studies that met all inclusion criteria. The mean patient age was 49.2 years, and the mean time from injury to surgical repair was 11.1 months. Constant scores were consistent between groups, with a mean postoperative score of 88.1. Pain scores improved significantly after repair, with a mean of 13.4 (on a scale ranging from 0 to 15, with 15 being no pain) in the arthroscopic repair group and 11.5 in the open repair group. Concomitant procedures were common, with biceps tenodesis being the most common, having been performed in 54.8% of shoulders, followed by biceps tenotomy and biceps recentering. Healing was reported in 90% to 95% of shoulders.


      Subscapularis tears can cause significant morbidity and often occur as traumatic injury in a younger population. Pain and function can be restored with repair, with excellent healing rates. The characteristic injury pattern suggested by a review of the literature is 1 where such tears are full thickness yet involve a portion of the tendon in the craniocaudal dimension. Concomitant procedures are common and can affect the results, because biceps tenotomy and tenodesis have been shown to significantly improve pain as well. All studies were Level IV, which introduced selection bias.

      Level of Evidence

      Level IV, systematic review of Level IV studies.
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        • Smith J.G.
        Pathological appearances of seven cases of injury of the shoulder joint, with remarks.
        Lond Med Gaz. 1834; 14: 220-285
        • Richards D.P.
        • Burkhart S.S.
        • Lo I.K.
        Subscapularis tears: Arthroscopic repair techniques.
        Orthop Clin North Am. 2003; 34: 485-498
        • Ticker J.B.
        • Burkhart S.S.
        Why repair the subscapularis?.
        Arthroscopy. 2011; 27: 1123-1128
        • Lo I.K.
        • Burkhart S.S.
        The comma sign: An arthroscopic guide to the torn subscapularis tendon.
        Arthroscopy. 2003; 19: 334-337
        • Gerber C.
        • Krushell R.J.
        Isolated rupture of the tendon of the subscapularis muscle.
        J Bone Joint Surg Br. 1991; 73: 389-394
        • Piasecki D.P.
        • Nicholson G.P.
        Tears of the subscapularis tendon in athletes—Diagnosis and repair techniques.
        Clin Sports Med. 2008; 27: 731-745
        • Sakurai G.
        • Ozaki J.
        • Tomita Y.
        • Kondo T.
        • Tamai S.
        Incomplete tears of the subscapularis tendon associated with tears of the supraspinatus tendon: Cadaveric and clinical studies.
        J Shoulder Elbow Surg. 1998; 7: 510-515
        • Flury M.P.
        • John M.
        • Goldhahn J.
        • Schwyzer H.K.
        • Simmen B.R.
        Rupture of the subscapularis tendon (isolated or in combination with supraspinatus tear): When is a repair indicated?.
        J Shoulder Elbow Surg. 2006; 15: 659-664
        • Lyons R.P.
        • Green A.
        Subscapularis tendon tears.
        J Am Acad Orthop Surg. 2005; 13: 353-363
        • Deutsch A.
        • Altchek D.W.
        • Veltri D.M.
        • Potter H.G.
        • Warren R.F.
        Traumatic tears of the subscapularis tendon.
        Am J Sports Med. 1997; 25: 13-22
        • Adams C.R.
        • Schoolfield J.D.
        • Burkhart S.S.
        Accuracy of preoperative magnetic resonance imaging in predicting a subscapularis tendon tear based on arthroscopy.
        Arthroscopy. 2010; 26: 1427-1433
        • Burkhart S.S.
        • Tehrany A.M.
        Arthroscopic subscapularis tendon repair: Technique and preliminary results.
        Arthroscopy. 2002; 18: 454-463
        • Amstutz H.C.
        • Sew Hoy A.L.
        • Clarke I.C.
        UCLA anatomic total shoulder arthroplasty.
        Clin Orthop Relat Res. 1981; 7: 20
        • Constant C.R.
        • Murley A.H.
        A clinical method of functional assessment of the shoulder.
        Clin Orthop Relat Res. 1987; 160: 164
        • Leggin B.G.
        • Michener L.A.
        • Shaffer M.A.
        • Brenneman S.K.
        • Iannotti J.P.
        • Williams Jr, G.R.
        The Penn shoulder score: Reliability and validity.
        J Orthop Sports Phys Ther. 2006; 36: 138-151
        • Michener L.A.
        • McClure P.W.
        • Sennett B.J.
        American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: Reliability, validity, and responsiveness.
        J Shoulder Elbow Surg. 2002; 11: 587-594
        • Matsen F.A.
        • Parsons M.
        Effectiveness evaluation and the shoulder.
        WB Saunders, Philadelphia2004
        • L'Insalata J.C.
        • Warren R.F.
        • Cohen S.B.
        • Altchek D.W.
        • Peterson M.G.
        A self-administered questionnaire for assessment of symptoms and function of the shoulder.
        J Bone Joint Surg Am. 1997; 79: 738-748
        • Adams C.R.
        • Schoolfield J.D.
        • Burkhart S.S.
        The results of arthroscopic subscapularis tendon repairs.
        Arthroscopy. 2008; 24: 1381-1389
        • Lafosse L.
        • Lanz U.
        • Saintmard B.
        • Campens C.
        Arthroscopic repair of subscapularis tear: Surgical technique and results.
        Orthop Traumatol Surg Res. 2010; 96: S99-S108
        • Musil D.
        • Sadovský P.
        • Stehlík J.
        Arthroscopic repair of subscapularis tendon tear.
        Acta Chir Orthop Traumatol Cech. 2010; 77 (in Czech): 228-234
        • Kreuz P.C.
        • Remiger A.
        • Erggelet C.
        • Hinterwimmer S.
        • Niemeyer P.
        • Gächter A.
        Isolated and combined tears of the subscapularis tendon.
        Am J Sports Med. 2005; 33: 1831-1837
        • Fuchs B.
        • Gilbart M.K.
        • Hodler J.
        • Gerber C.
        Clinical and structural results of open repair of an isolated one-tendon tear of the rotator cuff.
        J Bone Joint Surg Am. 2006; 88: 309-316
        • Bennett W.F.
        Arthroscopic repair of isolated subscapularis tears: A prospective cohort with 2- to 4-year follow-up.
        Arthroscopy. 2003; 19: 131-143
        • Bartl C.
        • Salzmann G.M.
        • Seppel G.
        • et al.
        Subscapularis function and structural integrity after arthroscopic repair of isolated subscapularis tears.
        Am J Sports Med. 2011; 39: 1255-1262
        • Lafosse L.
        • Jost B.
        • Reiland Y.
        • Audebert S.
        • Toussaint B.
        • Gobezie R.
        Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears.
        J Bone Joint Surg Am. 2007; 89: 1184-1193
        • Gerber C.
        • Hersche O.
        • Farron A.
        Isolated rupture of the subscapularis tendon.
        J Bone Joint Surg Am. 1996; 78: 1015-1023
        • Bartl C.
        • Scheibel M.
        • Magosch P.
        • Lichtenberg S.
        • Habermeyer P.
        Open repair of isolated traumatic subscapularis tendon tears.
        Am J Sports Med. 2011; 39: 490-496
        • Edwards T.B.
        • Walch G.
        • Sirveaux F.
        • et al.
        Repair of tears of the subscapularis.
        J Bone Joint Surg Am. 2005; 87: 725-730
        • Kreuz P.C.
        • Remiger A.
        • Lahm A.
        • Herget G.
        • Gächter A.
        Comparison of total and partial traumatic tears of the subscapularis tendon.
        J Bone Joint Surg Br. 2005; 87: 348-351
        • Goutallier D.
        • Postel J.M.
        • Bernageau J.
        • Lavau L.
        • Voisin M.C.
        Fatty muscle degeneration in cuff ruptures.
        Clin Orthop Relat Res. 1994; 78: 83
        • Beall D.P.
        • Williamson E.E.
        • Ly J.Q.
        • et al.
        Association of biceps tendon tears with rotator cuff abnormalities: Degree of correlation with tears of the anterior and superior portions of the rotator cuff.
        AJR Am J Roentgenol. 2003; 180: 633-639
        • Arai R.
        • Sugaya H.
        • Mochizuki T.
        • Nimura A.
        • Moriishi J.
        • Akita K.
        Subscapularis tendon tear: An anatomic and clinical investigation.
        Arthroscopy. 2008; 24: 997-1004
        • Szabó I.
        • Boileau P.
        • Walch G.
        The proximal biceps as a pain generator and results of tenotomy.
        Sports Med Arthrosc. 2008; 16: 180-186
        • Lafosse L.
        • Brozska R.
        • Toussaint B.
        • Gobezie R.
        The outcome and structural integrity of arthroscopic rotator cuff repair with use of the double-row suture anchor technique.
        J Bone Joint Surg Am. 2007; 89: 1533-1541
        • Park J.Y.
        • Lhee S.H.
        • Choi J.H.
        • Park H.K.
        • Yu J.W.
        • Seo J.B.
        Comparison of the clinical outcomes of single- and double-row repairs in rotator cuff tears.
        Am J Sports Med. 2008; 36: 1310-1316
        • Charousset C.
        • Grimberg J.
        • Duranthon L.D.
        • Bellaiche L.
        • Petrover D.
        Can a double-row anchorage technique improve tendon healing in arthroscopic rotator cuff repair?: A prospective, nonrandomized, comparative study of double-row and single-row anchorage techniques with computed tomographic arthrography tendon healing assessment.
        Am J Sports Med. 2007; 35: 1247-1253
        • Slabaugh M.A.
        • Nho S.J.
        • Grumet R.C.
        • et al.
        Does the literature confirm superior clinical results in radiographically healed rotator cuffs after rotator cuff repair?.
        Arthroscopy. 2010; 26: 393-403
        • Nho S.J.
        • Slabaugh M.A.
        • Seroyer S.T.
        • et al.
        Does the literature support double-row suture anchor fixation for arthroscopic rotator cuff repair?.
        Arthroscopy. 2009; 25: 1319-1328
        • Zanetti M.
        • Weishaupt D.
        • Jost B.
        • Gerber C.
        • Hodler J.
        MR imaging for traumatic tears of the rotator cuff: High prevalence of greater tuberosity fractures and subscapularis tendon tears.
        AJR Am J Roentgenol. 1999; 172: 463-467
        • Shindle M.K.
        • Chen C.C.
        • Robertson C.
        • et al.
        Full-thickness supraspinatus tears are associated with more synovial inflammation and tissue degeneration than partial-thickness tears.
        J Shoulder Elbow Surg. 2011; 20: 917-927
        • Goutallier D.
        • Postel J.M.
        • Gleyze P.
        • Leguilloux P.
        • Van Driessche S.
        Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears.
        J Shoulder Elbow Surg. 2003; 12: 550-554
        • Mall N.A.
        • Kim H.M.
        • Keener J.D.
        • et al.
        Symptomatic progression of asymptomatic rotator cuff tears: A prospective study of clinical and sonographic variables.
        J Bone Joint Surg Am. 2010; 92: 2623-2633
        • Lafosse L.
        • Reiland Y.
        • Baier G.P.
        • Toussaint B.
        • Jost B.
        Anterior and posterior instability of the long head of the biceps tendon in rotator cuff tears: A new classification based on arthroscopic observations.
        Arthroscopy. 2007; 23: 73-80
        • Boileau P.
        • Baqué F.
        • Valerio L.
        • Ahrens P.
        • Chuinard C.
        • Trojani C.
        Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears.
        J Bone Joint Surg Am. 2007; 89: 747-757