Arthroscopic Repair of Isolated Subscapularis Tears: A Systematic Review of Technique-Specific Outcomes

To systematically review the literature to identify all studies reporting outcomes of arthroscopically repaired isolated subscapularis tears, to (1) report outcomes across all repair techniques, (2) compare outcomes by arthroscopic technique, and (3) highlight the frequency and management of associated long head of biceps pathology, and the influence of these concomitant procedures on outcomes following arthroscopic subscapularis repair. Methods: A systematic literature review was conducted using the MEDLINE, Embase, and Scopus databases with the following term: (isolated repair AND arthroscopic subscapularis tear). Only studies evaluating the techniques and outcomes of isolated subscapularis repair were included. Data were extracted, including patient characteristics, surgical technique, and out-comes. Descriptive analysis was provided for the available literature. Results: Eight studies were included in this review. Uniformly, improvements in patient-reported outcome scores were substantial after arthroscopic subscapularis repair. Constant Total scores improved in each individual study from preoperative to postoperative (range, Delta 18.8-Delta 49.8 points), as did Strength (range, Delta 1.3-Delta 13.7 points), Pain (range, Delta 7.6-Delta 8.9 points), Range of Motion (range, Delta 7.3-Delta 13.3 points), and Activities of Daily Living (range, Delta 8.7-Delta 10.2 points) subscores. Significant improvements were seen in most individual studies for belly- press (Delta 21.6 N or Delta 1.9 out of 5) and lift- off strength (Delta 24.3 N or Delta 1.7-Delta 1.9 out of 5), range of motion in forward flexion (29.1 degrees-37.0 degrees), external rotation (10.3 degrees-16.0 degrees), and internal rotation. Complications were relatively infrequent overall, with 5 studies reporting no complications, and the remaining 3 studies with rerupture rates between 4.8% and 11.8%. Studies that used only double-row repair reported fewer complications (0% vs 5%-10%) and better outcome scores than single-row repair, similar to those studies that uniformly performed biceps tenodesis compared with no biceps intervention. Conclusions: This descriptive study highlights that arthroscopic subscapularis repair appears to be a reasonable option for the treatment of isolated tears of the subscapularis to obtain successful functional and patientreported clinical outcomes. Its findings also pose the question of whether future prospective, comparative studies will find double-row surgical fixation and concomitant biceps tenodesis surgery to be superior to single-row fixation and leaving the biceps alone.