Subscapularis tears: arthroscopic repair techniques.

The subscapularis is an essential component of normal shoulder function. An intact subscapularis muscle provides the anterior moment for the transverse plane force couple. Any disruption of the subscapularis disrupts normal glenohumeral biomechanics. If this occurs the shoulder functions abnormally, leading to pain and disability. A thorough history and physical examination lead the surgeon to the diagnosis of a torn subscapularis. Radiographs and MRI are helpful in delineating the rotator cuff tear pattern and other intra-articular lesions and in determining subcoracoid stenosis. Advancements with arthroscopic techniques have enabled surgeons to deal with subscapularis tears arthroscopically. There are seven key points to arthroscopic subscapularis repair: (1) portal placement (posterior portal, anterior portal, anterolateral portal, and accessory anterolateral portal), (2) visualization of the pathology by using a 30 degree and a 70 degree arthroscope, (3) manipulating the arm into maximal internal rotation to assist in assessing the tendon's relationship to its footprint, (4) appropriate anchor placement, (5) suture passage through the tendon, (6) tying secure arthroscopic knots, and (7) appropriate rehabilitation that minimizes stress on the repair. With these principles in mind, the shoulder surgeon can address disruptions of the anterior rotator cuff by repairing the subscapularis, thus alleviating the disability associated with this overlooked and under-appreciated pathology.