Arthroscopic repair of traumatic isolated subscapularis tendon lesions (Lafosse Type III or IV): a prospective magnetic resonance imaging-controlled case series with 1 year of follow-up.
OBJECTIVE
The purpose of this study was to prospectively assess the efficacy of arthroscopic repair of isolated high-grade subscapularis (SSC) tendon lesions by means of clinical follow-up combined with magnetic resonance imaging investigations.


METHODS
Between January 2008 and September 2010, 11 patients (9 men and 2 women; mean age, 45 ± 10 years) with Lafosse type III or IV traumatic isolated SSC tendon lesions underwent arthroscopic repair including tenodesis of the long head of the biceps tendon. All patients were preoperatively assessed by clinical examination (Constant-Murley score [CMS]) and contrast-enhanced magnetic resonance arthrography. At 1 year of follow-up, specific clinical SSC tests, the CMS, and the loss of external rotation were evaluated. A native magnetic resonance investigation was performed to assess the structural integrity of the repair. The SSC muscle was compared with its preoperative condition regarding fatty infiltration and size (cross-sectional area). Patient satisfaction was graded from 1 (poor) to 4 (excellent).


RESULTS
The mean time interval from trauma to surgery was 3.7 months. A concomitant lesion of the biceps tendon was observed in 10 patients (91%). The mean CMS improved from 44 to 89 points (P < .001). The functional tests showed a significant increase in strength (P < .05) (belly-press test, 4.8 v 2.9; lift-off test, 4.8 v 2.9). The mean loss of external rotation at 0° of abduction was 10° compared with the contralateral side (P < .05). Patient satisfaction was high. Magnetic resonance imaging evaluation showed complete structural integrity of the tendon repair in all studies. The SSC showed a significant decrease in fatty infiltration and increase in the cross-sectional area.


CONCLUSIONS
Arthroscopic repair of higher-grade isolated SSC lesions provides reliable tendon healing accompanied by excellent functional results 1 year after surgery.


METHODS
Level IV, prospective therapeutic case series.
Department of Surgery, Waid Hospital Zurich, Zurich, Switzerland.
Patrick
P
Grueninger
Institute for Clinical Radiology, Waid Hospital Zurich, Zurich, Switzerland.
Nikola
N
Nikolic
Department of Surgery, Waid Hospital Zurich, Zurich, Switzerland.
Joerg
J
Schneider
Department of Surgery, Triemli Hospital Zurich, Zurich, Switzerland.
Thomas
T
Lattmann
Department of Surgery, Triemli Hospital Zurich, Zurich, Switzerland.
Andreas
A
Platz
Department of Internal Medicine, Waid Hospital Zurich, Zurich, Switzerland; Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland.
Corinne
C
Chmiel
Department of Surgery, Waid Hospital Zurich, Zurich, Switzerland. Electronic address: cmeier@hispeed.ch.
Christoph
C
Meier
D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000379:methods* / Q000523:psychology; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000293:injuries / Q000601:surgery; D017060:Patient Satisfaction; D010808:Physical Examination; D011446:Prospective Studies; D012399:Rotation; D017006:Rotator Cuff / Q000601:surgery; D000070636:Rotator Cuff Injuries; D012782:Shoulder; D053656:Tenodesis / Q000379:methods*; D014945:Wound Healing