Advanced Subscapularis Repair Techniques

The subscapularis muscle plays an essential role in full, pain-free shoulder function. Injuries to the subscapularis tendon exist on a spectrum of severity. In the evaluation of the injured and/or painful shoulder, careful scrutiny of the subscapularis tendon on advanced shoulder imaging in all planes facilitates detection of subscapularis pathology. Specific surgical techniques of subscapularis tendon repair, including arthroscopic and open approaches, are tailored to tear size, pattern, retraction, tissue quality and concomitant pathologies. Smaller, upper border tears of the subscapularis tendon may be treated with a single-row repair construct while tears greater than 2cm are typically treated with a double-row repair. Surgical pearls include adequate debridement of the rotator interval, identification of the comma tissue in retracted tears, use of a lateral viewing portal during arthroscopic repair, and gentle decortication of the lesser tuberosity footprint. While unrecognized subscapularis tendon tears is associated with worse clinical outcomes in the setting of multi-tendon tears, further study is needed to identify additional strategies to improve rotator cuff tendon healing following surgical repair.