Arthroscopic Subscapularis Repair Using a Subacromial View

Abstract

As a result of the continued improvement in arthroscopic equipment and techniques, subscapularis tears are now more reliably identified and are being repaired at higher rates than previously reported. Whereas small upper-border subscapularis tears can usually be effectively managed using an intra-articular view, larger tears often cannot be fully visualized with a standard 30° arthroscope when viewed from the posterior portal. These tears may require either using a 70° arthroscope or viewing through the standard 30° arthroscope from a subacromial portal-site location to completely visualize the tear. This article illustrates and discusses the advantages of using a subacromial-space portal site to view and arthroscopically manage large subscapularis tears.

Fig 1

In a right shoulder being viewed from an extra-articular, subacromial portal, it is possible to visualize the subscapularis tendon looking directly in line with the tendon fibers (arrow). This allows for effective and safe mobilization of the tendon.

Fig 2

From the subacromial view, excellent visualization of the prepared lesser tuberosity (arrow) is obtained in a right shoulder with the patient in the beach-chair position. This allows for straightforward suture anchor placement and suture management without the necessity for humeral head manipulation.

Fig 3

The repaired subscapularis is shown, as viewed from the subacromial portal, in a right shoulder with the patient in the beach-chair position, after repair with double-row fixation using 2 medial anchors and 1 lateral anchor.

Fig 4

In a right shoulder with the patient in the beach-chair position, viewing from the subacromial portal, a massive anterosuperior tear involving the supraspinatus and subscapularis tendons is shown. Using the subacromial view, one can manage both tears without moving from an intra-articular viewing portal to a subacromial portal.