Purpose
To systematically review the literature to (1) describe arthroscopic subscapularis
repair constructs and outcomes in patients with isolated and combined subscapularis
tears and (2) compare outcomes after single- and double-row subscapularis repair in
both of these settings.
Methods
A systematic review was performed using PRISMA guidelines. PubMed, SCOPUS, and Cochrane
Central Register of Controlled Trials were searched for Level I-IV evidence studies
that investigated outcomes after arthroscopic subscapularis repair for the treatment
of isolated subscapularis tears or subscapularis tears combined with posterosuperior
rotator cuff tears in adult human patients. Data recorded included study demographics,
repair construct, shoulder-specific outcome measures, and subscapularis retears. Study
methodological quality was analyzed using the MINORS score. Heterogeneity and low
levels of evidence precluded meta-analysis.
Results
The initial search yielded 811 articles (318 duplicates, 493 screened, 67 full-text
review). Forty-three articles (2406 shoulders, 57% males, mean age range 42 to 67.5
years, mean MINORS score 13.4 ± 4.1) were included and analyzed. Articles reported
on patients with isolated subscapularis tears (n = 15), combined tears (n = 17), or
both (n = 11). The majority of subscapularis repairs used single-row constructs (89.4%
of isolated tears, 88.9% of combined tears). All except for one study reporting on
outcome measures found clinically significant improvements after subscapularis repair,
and no clinically significant differences were detected in 5 studies comparing isolated
to combined tears. Subscapularis retear rates ranged from 0% to 17% for isolated tears
and 0% to 32% for combined subscapularis and posterosuperior rotator cuff tears. Outcomes
and retear rates were similar in studies comparing single-row to double-row repair
for isolated and combined subscapularis tears (P > .05 for all).
Conclusion
Arthroscopic subscapularis repair resulted in significant improvements across all
outcome measures, regardless of whether tears were isolated or combined or if repairs
were single or double row.
Level of Evidence
Level IV, systematic review of Level II-IV studies.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Arthroscopic management of subscapularis tears.Sports Med Arthrosc Rev. 2011; 19: 333-341
- The relative strengths of the rotator cuff muscles. A cadaver study.J Bone Joint Surg Br. 1993; 75: 137-140
- Arthroscopic subscapularis repair.J Am Acad Orthop Surg. 2014; 22: 80-89
- Tears of the Subscapularis Tendon.JBJS Rev. 2017; 5: 1
- 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
- The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear.Arthroscopy. 2006; 22: 1076-1084
- Arthroscopic repair of isolated subscapularis tears: A prospective cohort with 2- to 4-year follow-up.Arthroscopy. 2003; 19: 131-143
- Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears.J Bone Joint Surg Am. 2007; 89: 1184-1193
- Patient-Reported Outcomes After Isolated and Combined Arthroscopic Subscapularis Tendon Repairs.Arthroscopy. 2019; 35: 1779-1784
- Arthroscopic repair of subscapularis tears: preliminary data from a prospective multicentre study.Orthopaedics & traumatology, surgery & research : OTSR. 2012; 98: S193-200
- Arthroscopic Repair of Isolated Subscapularis Tears: A Systematic Review of Technique-Specific Outcomes.Arthroscopy. 2017; 33: 849-860
- Outcomes of single-row versus double-row arthroscopic rotator cuff repair: a systematic review and meta-analysis of current evidence.Arthroscopy. 2013; 29: 1437-1449
- Clinical and structural outcomes after arthroscopic single-row versus double-row rotator cuff repair: a systematic review and meta-analysis of level I randomized clinical trials.J Shoulder Elbow Surg. 2014; 23: 586-597
- Meta-analysis comparing single-row and double-row repair techniques in the arthroscopic treatment of rotator cuff tears.J Shoulder Elbow Surg. 2014; 23: 182-188
- Arthroscopic Rotator Cuff Repair: A Systematic Review of Overlapping Meta-Analyses.JBJS Rev. 2019; 7: e1
- Biomechanical evaluation of a single-row versus double-row repair for complete subscapularis tears.Knee Surg Sports Traumatol Arthrosc. 2009; 17: 1477-1484
- Arthroscopic Repair of the Isolated Subscapularis Full-Thickness Tear: Single- Versus Double-Row Suture-Bridge Technique.Am J Sports Med. 2019; 47: 1427-1433
- Functional and structural comparisons of the arthroscopic knotless double-row suture bridge and single-row repair for anterosuperior rotator cuff tears.J Shoulder Elbow Surg. 2015; 24: 1544-1554
- Comparison of Functional and Radiological Outcomes of Tears Involving the Subscapularis: Isolated Subscapularis Versus Combined Anterosuperior Rotator Cuff Tears.Orthop J Sports Med. 2020; 8 (2325967119899355)
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.BMJ. 2009; 339: b2535
- How to Write a Systematic Review.Am J Sports Med. 2014; 42: 2761-2768
- Shoulder scoring scales for the evaluation of rotator cuff repair.Clin Orthop Relat Res. 2004; : 107-114
- A standardized method for the assessment of shoulder function.J Shoulder Elbow Surg. 1994; 3: 347-352
- Comparison of the subjective shoulder value and the Constant score.J Shoulder Elbow Surg. 2007; 16: 717-721
- A review of the Constant score: modifications and guidelines for its use.J Shoulder Elbow Surg. 2008; 17: 355-361
- Methodological index for non-randomized studies (minors): development and validation of a new instrument.ANZ J Surg. 2003; 73: 712-716
- Reviews Pooling Heterogeneous, Low-Evidence, High-Bias Data Result in Incorrect Conclusions: But Heterogeneity is an Opportunity to Explore.Arthroscopy. 2018; 34: 3126-3128
- How to perform a meta-analysis with R: a practical tutorial.Evid Based Ment Health. 2019; 22: 153-160
- Conducting meta-analyses in R with the metafor package.J Stat Soft. 2010; 36: 1-48
Wang N. How to Conduct a Meta-Analysis of Proportions in R: A Comprehensive Tutorial. 2018.
- Outcome of arthroscopic subscapularis tendon repair: Are the results improving with improved techniques and equipment?: A retrospective case series.Indian J Orthop. 2016; 50: 297-302
- Isolated subscapularis repair for massive rotator cuff tear.Orthopedics. 2014; 37: e962-967
- Is routine coracoplasty necessary in isolated subscapularis tears?.Joint diseases & related surgery. 2019; 30: 112-116
- Subscapularis function and structural integrity after arthroscopic repair of isolated subscapularis tears.Am J Sports Med. 2011; 39: 1255-1262
- Arthroscopic repair of anterosuperior (supraspinatus/subscapularis) rotator cuff tears: a prospective cohort with 2- to 4-year follow-up. Classification of biceps subluxation/instability.Arthroscopy. 2003; 19: 21-33
- Long-term outcome of a consecutive series of subscapularis tendon tears repaired arthroscopically.Arthroscopy. 2012; 28: 1587-1591
- 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.Arthroscopy. 2014; 30: 665-672
- Arthroscopic Repair of Massive Cuff Tears With Large Subscapularis Tendon Ruptures (Lafosse III/IV): A Prospective Magnetic Resonance Imaging-Controlled Case Series of 26 Cases With a Minimum Follow-up of 1 Year.Arthroscopy. 2015; 31: 2173-2182
- Arthroscopic repair of isolated subscapularis tears: clinical outcome and structural integrity with a minimum follow-up of 4.6 years.J Shoulder Elbow Surg. 2019; 28: 2171-2180
- Arthroscopic reconstruction of isolated subscapularis tears: clinical results and structural integrity after 24 months.Arthroscopy. 2012; 28: 1805-1811
- Arthroscopic subscapularis repair using single-row mattress suture technique: clinical results and structural integrity.J Shoulder Elbow Surg. 2018; 27: 711-719
- Clinical Outcomes and Tendon Integrity in Patients With Chronic Retracted Subscapularis Tear After Arthroscopic Single-Row Oblique Mattress Suture Repair Technique.Arthroscopy. 2019; 35: 1973-1981
- Arthroscopic Repair of Isolated Partial- and Full-Thickness Upper Third Subscapularis Tendon Tears: Minimum 2-Year Outcomes After Single-Anchor Repair and Biceps Tenodesis.Arthroscopy. 2017; 33: 1286-1293
- Arthroscopic percutaneous repair of anterosuperior rotator cuff tear including biceps long head: a 2-year follow-up.Clin Orthop Surg. 2012; 4: 284-292
- Intra-articular repair of an isolated partial articular-surface tear of the subscapularis tendon.Am J Sports Med. 2005; 33: 1825-1830
- Arthroscopic Repair of Anterosuperior Massive Rotator Cuff Tears: Does Repair Integrity Affect Outcomes?.Am J Sports Med. 2017; 45: 1762-1768
- Isolated Subscapularis Repair in Irreparable Posterosuperior Massive Rotator Cuff Tears Involving the Subscapularis Tendon.Am J Sports Med. 2017; 45: 1269-1275
- Concomitant coracoplasty during arthroscopic subscapularis repair does not yield better clinical outcomes and structural integrity.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 56-62
- Arthroscopic repair of anterosuperior rotator cuff tears: in-continuity technique vs. disruption of subscapularis-supraspinatus tear margin: comparison of clinical outcomes and structural integrity between the two techniques.J Bone Joint Surg Am. 2014; 96: 2056-2061
- Arthroscopic repair of a significant (>50%) partial-thickness subscapularis tear concomitant with a full-thickness supraspinatus tear: technical considerations for subscapularis repair (transtendon technique versus tear completion).J Shoulder Elbow Surg. 2015; 24: 875-881
- Arthroscopic repair of large subscapularis tendon tears: 2- to 4-year clinical and radiographic outcomes.Arthroscopy. 2013; 29: 1471-1478
- Comparison of Clinical and Structural Outcomes by Subscapularis Tendon Status in Massive Rotator Cuff Tear.Am J Sports Med. 2017; 45: 2555-2562
- Does a subscapularis tear combined with a posterosuperior rotator cuff tear affect postoperative functional outcomes?.J Shoulder Elbow Surg. 2020; 29: 2523-2529
- Arthroscopic treatment of isolated subscapolaris lesions: our experience.Acta Biomed. 2014; 85: 20-24
- Clinical and structural results of arthroscopic repair of isolated subscapularis tear.J Bone Joint Surg Am. 2012; 94: e125
- Clinical Relevance of Classifying Massive Rotator Cuff Tears: Results Based on Functional and Radiological Findings After Arthroscopic Repair.Am J Sports Med. 2017; 45: 157-166
- Combined Subscapularis Tears in Massive Posterosuperior Rotator Cuff Tears: Do They Affect Postoperative Shoulder Function and Rotator Cuff Integrity?.Am J Sports Med. 2016; 44: 183-190
- The outcomes and affecting factors after arthroscopic isolated subscapularis tendon repair.J Shoulder Elbow Surg. 2017; 26: 2143-2151
- Arthroscopic treatment of anterosuperior rotator cuff tears.Orthopedics. 2013; 36: e1394-1400
- Long-term Results After Arthroscopic Repair of Isolated Subscapularis Tears.Am J Sports Med. 2017; 45: 759-766
- Surgical Outcomes after Arthroscopic Single Row Anchor Repair for Subscapularis Tears Concomitant with Injury of the Long Head of the Biceps Tendon.Orthop Surg. 2020; 12: 498-504
- Repair Integrity and Functional Outcomes After Arthroscopic Suture Bridge Subscapularis Tendon Repair.Arthroscopy. 2018; 34: 2541-2548
- Clinical outcome and structural integrity of all-arthroscopic repair of degenerative subscapularis tendon tears.Knee Surg Sports Traumatol Arthrosc. 2013; 21: 1620-1625
- Strength recovery after arthroscopic anterosuperior cuff repair: analysis of a consecutive series.Musculoskelet Surg. 2015; 99: S37-42
- Repair of Lafosse I subscapularis lesions brings no benefit in anterosuperior rotator cuff reconstruction.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 4021-4031
- Anterior rotator cable disruption does not affect outcomes in rotator cuff tear with subscapularis involvement.Knee Surg Sports Traumatol Arthrosc. 2020;
- Arthroscopic subscapularis repair.Oper Tech Orthop. 2002; 12: 209-217
- Subscapularis Tendon Tear Classification Based on 3-Dimensional Anatomic Footprint: A Cadaveric and Prospective Clinical Observational Study.Arthroscopy. 2015; 31: 19-28
- Investigating minimal clinically important difference for Constant score in patients undergoing rotator cuff surgery.J Shoulder Elbow Surg. 2013; 22: 1650-1655
- Minimal Clinically Important Difference, Substantial Clinical Benefit, and Patient Acceptable Symptomatic State After Arthroscopic Rotator Cuff Repair.Am J Sports Med. 2020; 48: 2650-2659
- Current concepts in arthroscopic rotator cuff repair.Am J Sports Med. 2003; 31: 308-324
- Outcomes of Single-Row Versus Double-Row Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-Analysis of Current Evidence.Arthroscopy. 2013; 29: 1437-1449
- Double-Row Arthroscopic Subscapularis Repair: A Surgical Technique.Arthrosc Tech. 2018; 7: e805-e809
Article info
Publication history
Published online: May 27, 2021
Accepted:
May 12,
2021
Received:
January 25,
2021
Footnotes
The authors report the following potential conflicts of interest or sources of funding: G.D.A. reports personal fees form Cytonics, Fida Pharma, RobiconMD, Sideline Sports Doc; nonfinancial support from Arthrex Inc. and Stryker; and other from Cytonics. M.T.F. reports grants from Smith & Nephew, National Institutes of Health, Major League Baseball, RTJ, and Arthrex; personal fees from Smith & Nephew. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2021 by the Arthroscopy Association of North America
