Purpose
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.
Methods
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.
Results
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.
Conclusions
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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Article info
Publication history
Published online: May 21, 2012
Accepted:
February 6,
2012
Received:
October 16,
2011
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
