Original Article| Volume 30, ISSUE 6, P665-672, June 2014

Arthroscopic Repair of Traumatic Isolated Subscapularis Tendon Lesions (Lafosse Type III or IV): A Prospective Magnetic Resonance Imaging–Controlled Case Series With 1 Year of Follow-Up


      The purpose of this study was to prospectively assess the efficacy of arthroscopic repair of isolated high-grade subscapularis (SSC) tendon lesions by means of clinical follow-up combined with magnetic resonance imaging investigations.


      Between January 2008 and September 2010, 11 patients (9 men and 2 women; mean age, 45 ± 10 years) with Lafosse type III or IV traumatic isolated SSC tendon lesions underwent arthroscopic repair including tenodesis of the long head of the biceps tendon. All patients were preoperatively assessed by clinical examination (Constant-Murley score [CMS]) and contrast-enhanced magnetic resonance arthrography. At 1 year of follow-up, specific clinical SSC tests, the CMS, and the loss of external rotation were evaluated. A native magnetic resonance investigation was performed to assess the structural integrity of the repair. The SSC muscle was compared with its preoperative condition regarding fatty infiltration and size (cross-sectional area). Patient satisfaction was graded from 1 (poor) to 4 (excellent).


      The mean time interval from trauma to surgery was 3.7 months. A concomitant lesion of the biceps tendon was observed in 10 patients (91%). The mean CMS improved from 44 to 89 points (P < .001). The functional tests showed a significant increase in strength (P < .05) (belly-press test, 4.8 v 2.9; lift-off test, 4.8 v 2.9). The mean loss of external rotation at 0° of abduction was 10° compared with the contralateral side (P < .05). Patient satisfaction was high. Magnetic resonance imaging evaluation showed complete structural integrity of the tendon repair in all studies. The SSC showed a significant decrease in fatty infiltration and increase in the cross-sectional area.


      Arthroscopic repair of higher-grade isolated SSC lesions provides reliable tendon healing accompanied by excellent functional results 1 year after surgery.

      Level of Evidence

      Level IV, prospective therapeutic case series.
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        • 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.
        • Krushell R.J.
        Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases.
        J Bone Joint Surg Br. 1991; 73: 389-394
        • Edwards T.B.
        • Walch G.
        • Sirveaux F.
        • et al.
        Repair of tears of the subscapularis.
        J Bone Joint Surg Am. 2005; 87: 725-730
        • Gerber C.
        • Hersche O.
        • Farron A.
        Isolated rupture of the subscapularis tendon.
        J Bone Joint Surg Am. 1996; 78: 1015-1023
        • Burkhart S.S.
        • Tehrany A.M.
        Arthroscopic subscapularis repair: Technique and preliminary results.
        Arthroscopy. 2002; 18: 454-463
        • Adams C.R.
        • Schoolfield J.D.
        • Burkhart S.S.
        The results of arthroscopic subscapularis tendon repairs.
        Arthroscopy. 2008; 24: 1381-1389
        • 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
        • Heikenfeld R.
        • Gigis I.
        • Chytas A.
        • Listringhaus R.
        • Godolias G.
        Arthroscopic reconstruction of isolated subscapularis tears: Clinical results and structural integrity after 24 months.
        Arthroscopy. 2012; 28: 1805-1811
        • Lanz U.
        • Fullick R.
        • Bongiorno V.
        • Saintmard B.
        • Campens C.
        • Lafosse L.
        Arthroscopic repair of large subscapularis tendon tears: 2- to 4-year clinical and radiographic outcomes.
        Arthroscopy. 2013; 29: 1471-1478
        • Toussaint B.
        • Audebert S.
        • Barth J.
        • et al.
        Arthroscopic repair of subscapularis tears: Preliminary data from a prospective multicentre study.
        Orthop Traumatol Surg Res. 2012; 98: S193-S200
        • Nové-Josserand L.
        • Hardy M.-B.
        • Ogassawara R.L.N.
        • Carrillion Y.
        • Godenèche A.
        Clinical and structural results of arthroscopic repair of isolated subscapularis tear.
        J Bone Joint Surg Am. 2012; 94: e125
        • Lafosse L.
        • Van Raebroeckx A.
        • Brzoska R.
        A new technique to improve tissue grip: “The lasso-loop stitch.”.
        Arthroscopy. 2006; 22 (Available online at 1246.e1-1246.e3
        • Constant C.R.
        • Murley A.H.
        A clinical method of functional assessment of the shoulder.
        Clin Orthop Relat Res. 1987; 214: 160-164
        • Goutallier D.
        • Postel J.M.
        • Bernageau J.
        • Lavau L.
        • Voisin M.C.
        Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan.
        Clin Orthop Relat Res. 1994; 304: 78-83
        • Fuchs B.
        • Weisshaupt D.
        • Zanetti M.
        • Hodler J.
        • Gerber C.
        Fatty degeneration of the muscles of the rotator cuff: Assessment by computed tomography versus magnetic resonance imaging.
        J Shoulder Elbow Surg. 1999; 8: 599-605
        • Zanetti M.
        • Gerber C.
        • Hodler J.
        Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging.
        Invest Radiol. 1998; 33: 163-170
        • Duc S.R.
        • Mengiardi C.W.A.
        • Jost B.
        • Hodler J.
        • Zanetti M.
        Diagnostic performance of MR arthrography after rotator cuff repair.
        AJR Am J Roentgenol. 2006; 186: 237-241
        • Mall N.A.
        • Chahal J.
        • Heard W.M.
        • et al.
        Outcomes of arthroscopic and open surgical repair of isolated subscapularis tendon tears.
        Arthroscopy. 2012; 28: 1306-1314
        • Wellmann M.
        • Wiebringhaus P.
        • Lodde I.
        • et al.
        Biomechanical evaluation of a single-row versus double-row repair for complete subscapularis tears.
        Knee Surg Sports Traumatol Arthrosc. 2009; 17: 1477-1484
        • Jo C.H.
        • Shin J.S.
        Changes in appearance of fatty infiltration and muscle atrophy of rotator cuff muscles on magnetic resonance imaging after rotator cuff repair: Establishing new time-zero traits.
        Arthroscopy. 2013; 29: 449-458