Subscapularis Tendon Repair Using Suture Bridge Technique

Abstract

The subscapularis tendon plays an essential role in shoulder function. Although subscapularis tendon tears are less common than other rotator cuff tears, tears of the subscapularis tendon have increasingly been recognized with the advent of magnetic resonance imaging and arthroscopy. A suture bridge technique for the treatment of posterosuperior rotator cuff tears has provided the opportunity to improve the pressurized contact area and mean footprint pressure. However, suture bridge fixation of subscapularis tendon tears appears to be technically challenging. We describe an arthroscopic surgical technique for suture bridge repair of subscapularis tendon tears that obtains ideal cuff integrity and footprint restoration. Surgery using such a suture bridge technique is indicated for large tears, such as tears involving the entire first facet or more, tears with a disrupted lateral sling, and combined medium to large supraspinatus/infraspinatus tears.

Fig 1

The size of the subscapularis tendon tear is evaluated with a calibrated ruler.

Fig 2

The bone bed is prepared using a burr.

Fig 3

The coracohumeral ligament is released to allow better mobilization of the torn, retracted tendon to its footprint without tension.

Fig 4

A medial anchor is placed as inferiorly and medially as possible to the first facet.

Fig 5

A suture hook penetrates the full thickness of the subscapularis tendon from the bursal side toward the articular side.

Fig 6

Both limbs are tied with non-sliding knots (one post at the superior position and the other at the inferior position).

Fig 7

The same limbs from each tied knot are gathered to place one superiorly and the other inferiorly.

Fig 8

Subscapularis tendon completely repaired on bursal side.