Arthroscopic subscapularis repair using single-row mattress suture technique: clinical results and structural integrity

Background: Rupture of the subscapularis (SSC) tendon, isolated or combined, is rare, and the treatment modalities are controversial. The purpose of this study was to evaluate, by magnetic resonance imaging (MRI), the clinical outcomes and structural integrity of the SSC tendon after all-arthroscopic repair with single-row mattress suture for isolated or combined SSC tendon tears. Methods: This study included 68 patients who underwent all-arthroscopic repair using single-row mattress suture for isolated or combined SSC tendon tears between April 2011 and January 2013. The patients were evaluated by the visual analog scale for pain, American Shoulder and Elbow Surgeons score, Constant shoulder score, and SSC muscle strength measurement. MRI was used for assessment of the postoperative integrity of the SSC tendon. Results: With a mean follow-up of 29.5 +/- 4.0 months, the preoperative Constant shoulder and American Shoulder and Elbow Surgeons scores were 50.3 +/- 21.0 and 46.6 +/- 18.3, respectively, which improved at the last follow-up to 75.7 +/- 16.6 and 81.3 +/- 18.1, respectively, with statistical significance (P <.001). Belly-press and bear-hug test results showed some improvement in the last follow-up (>2 years) compared with the presurgical state (P =.125 and.650). A statistically significant SSC muscle strength deficit persisted in the postoperative state (P =.015). MRI evaluation showed a retear rate of 8.8%. Conclusions: Arthroscopic repair of isolated or combined SSC tears with the single-row mattress suture technique results in significant clinical improvements and enduring tendon integrity, although SSC strength remains reduced from that on the normal side. Level of evidence: Level IV; Case Series; Treatment Study (C) 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.