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. 2023 Jun 12;12(7):e1091-e1095.
doi: 10.1016/j.eats.2023.02.047. eCollection 2023 Jul.

Arthroscopic Subscapularis Repair With Preserved Biceps Anatomy

Jeffrey D Hassebrock  1 , Stephen M Sylvia  1 , Timothy P McCarthy  1 , Jonathan T Bravman  1
Affiliations

Arthroscopic Subscapularis Repair With Preserved Biceps Anatomy

Jeffrey D Hassebrock et al. Arthrosc Tech. .

Abstract

Arthroscopic subscapularis repair continues to improve with the advancement of surgical technique and critical focus on careful intraoperative evaluation. As identification of these tears increases, there is an expected increase in repair rates as well. Anatomically, the upper border of the subscapularis and the long head of the biceps (LHB) tendon are in close relation. Many surgeons have advocated concomitant LHB tenotomy versus tenodesis in conjunction with operative subscapularis tears. We hypothesized that in the setting of a preserved anatomic biceps pulley and no LHB pathology, isolated subscapularis repair would result in excellent clinical outcomes when compared with subscapularis repair and biceps tenotomy or tenodesis.

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Figures

Fig 1
Fig 1
Right shoulder view from posterior portal, with patient in beach-chair position, identifying subscapularis tear. An arthroscopic cuff grasper is visualized coming through the anterior working portal. (MGHL, middle glenohumeral ligament.)
Fig 2
Fig 2
Right shoulder view from posterior portal, with patient in beach-chair position, showing subscapularis tear with interval reduction by cuff grasper through anterior working portal. (MGHL, middle glenohumeral ligament.)
Fig 3
Fig 3
Right shoulder view from posterior portal, with patient in beach-chair position, showing probe through anterior working portal attempting to subluxate long head of biceps medially.
Fig 4
Fig 4
Right shoulder view from posterior portal, with patient in beach-chair position, with loop grasper through anterior working portal, showing full-thickness tear of upper border of subscapularis with retained intact biceps pulley tissue.
Fig 5
Fig 5
Right shoulder view from posterior portal, with patient in beach-chair position, with loop grasper working through anterior portal, showing interval reduction of upper-border subscapularis tear. The reconstituted and appropriately tensioned upper rolled border of the subscapularis can be seen.
Fig 6
Fig 6
Right shoulder view from posterior portal, with patient in beach-chair position, showing placement of double-loaded anchor through anterior working portal into debrided footprint of lesser tuberosity.
Fig 7
Fig 7
Right shoulder view from posterior portal, with patient in beach-chair position, showing restored subscapularis tear with 2 luggage-tag sutures tied through anterior working portal restoring upper rolled border of subscapularis tendon. A probe through the anterior working portal is retracting the long head of the biceps to allow visualization of the preserved biceps pulley tissue.
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