title: Subscapularis function and structural integrity after arthroscopic repair of isolated subscapularis tears.
abstract: BACKGROUND
  Results of arthroscopic repair of isolated subscapularis tendon tears have not been widely studied. A detailed evaluation of subscapularis function with subscapularis strength quantification has not been performed to date.
  
  
  OBJECTIVE
  To evaluate postoperative subscapularis muscle function and to assess the clinical outcome and structural tendon integrity with postoperative magnetic resonance imaging after arthroscopic repair of isolated subscapularis tears.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  In a prospective study, isolated subscapularis tendon tears in 21 patients were treated with an all-arthroscopic repair. The average age of the study population was 43 years. The mean interval between trauma and surgery was 5.8 months. In 19 patients, a traumatic event caused the onset of symptoms. Subscapularis muscle function was assessed with specific clinical tests and the Constant scoring system. Postoperative subscapularis strength was evaluated with a custom-made electronic force measurement plate. All patients underwent postoperative magnetic resonance imaging to assess structural integrity of the repair.
  
  
  RESULTS
  The average duration of follow-up was 27 months. The Constant score increased from 50 points preoperatively to 82 points postoperatively (P < .01). Most positive preoperative lift-off and belly-press tests were reversed by surgery, with a rate of 5 (24%) persistent positive tests after surgery. In operated shoulders, subscapularis strength in the belly-press (65 vs 87 N; P < .05) and the lift-off position (44 vs 68 N; P < .05) was significantly reduced compared with the contralateral shoulder. Magnetic resonance imaging revealed an intact repair in 20 patients. Atrophy of the upper subscapularis muscle portion was present in about one-fourth of the patients and in all patients with a positive postoperative belly-press test.
  
  
  CONCLUSIONS
  Arthroscopic repair of isolated subscapularis tendon tears achieves substantial improvement of shoulder function and a low rerupture rate. Despite excellent clinical results, a significant postoperative subscapularis strength deficit compared with the contralateral shoulder persists that can be quantified with use of the force measurement plate. Atrophy of the upper subscapularis muscle is present in 25% of the patients in the postoperative course.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Ulm University, Steinhövelstr 9, 89075 Ulm, Germany. christoph.bartl@uniklinik-ulm.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Bartl
authors.forename: Gian M
authors.initials: GM
authors.lastname: Salzmann
authors.forename: Gernot
authors.initials: G
authors.lastname: Seppel
authors.forename: Stefan
authors.initials: S
authors.lastname: Eichhorn
authors.forename: Konstantin
authors.initials: K
authors.lastname: Holzapfel
authors.forename: Klaus
authors.initials: K
authors.lastname: Wörtler
authors.forename: Andreas B
authors.initials: AB
authors.lastname: Imhoff
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D009133:Muscular Atrophy / Q000175:diagnosis; D011446:Prospective Studies; D020127:Recovery of Function; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000601:surgery; D013708:Tendon Injuries / Q000601:surgery*; D055815:Young Adult