An Improved Continuous Suturing Technique Using a Suture Hook for Subscapularis Repair

Summary

Subscapularis tendon tears remain challenging in orthopedic surgery. Conventional sutures cause uneven load distribution, while advanced methods improve outcomes but complicate procedures. A unique hybrid technique using a sewing machine-style suture with a single-portal approach is introduced here, offering stronger fixation, reduced trauma, enhanced outcomes, and improved convenience for effective subscapularis repair.

Abstract

Subscapularis tendon injuries often pose substantial challenges in arthroscopic repair, with traditional techniques frequently limited by prolonged surgical time, uneven tension distribution, and increased complication risk. Although advanced suture-passing and suturing methods can improve biomechanical outcomes, they generally require complex instrumentation. A hybrid approach is presented here that integrates a continuous sewing machine-like suture technique with a single-portal spinal needle method for subscapularis repair. The sewing machine-like technique facilitates efficient loop formation, which ensures even tension distribution and allows precise suture placement through flexible puncture points. The single-portal approach minimizes invasiveness, reduces tissue trauma, and streamlines the surgical process. Collectively, these techniques enhance the biomechanical strength, shorten operative time, and align with the principles of modern minimally invasive surgery. This improved and innovative strategy represents a promising alternative to conventional methods, with the potential to improve clinical outcomes. Further clinical validation and long-term follow-up are required to confirm its efficacy.

Introduction

Rotator cuff injuries involving the subscapularis tendon pose significant challenges due to the tendon's unique anatomical position, limited surgical exposure, and critical role in maintaining shoulder stability and function¹. These tears often cause severe pain, functional impairment, and reduced quality of life². Current arthroscopic repair techniques aim to address these challenges but are limited by complex instrumentation, lengthy operative times, and suboptimal biomechanical outcomes. Despite advancements in suture technology and minimally invasive methods, repair of subscapularis tendon tears remains technical....

Protocol

All procedures involving human participants were conducted in accordance with the ethical standards of the institutional and/or national research committee and with the principles outlined in the Declaration of Helsinki. Institutional Review Board (IRB) approval was obtained prior to initiation of the study, and written informed consent was obtained from all participants before enrollment. Patient confidentiality and privacy were strictly maintained throughout the study.

1. Preoperative preparation

1. MRI examination: Perform an MRI of the affected shoulder preoperatively to assess the extent of rotator cuff damage.
2. Addit....

Results

Preoperative imaging and diagnosis

A preoperative MRI examination of the patient revealed a tear in the superior 1/3 of the subscapular tendon and a tear in the supraspinatus tendon. These findings were critical in guiding the surgical approach and determining the extent of the tendon damage (Figure 1).

Arthroscopi.......

Discussion

The repair of subscapularis tendon tears remains a technically challenging endeavor due to the tendon's deep-seated anatomical position and critical biomechanical role. While traditional suture techniques provide satisfactory outcomes in many cases, their limitations highlight the need for innovation in this domain. The improved technique, combining the continuous sewing machine-like suture method with a single-portal approach, offers a promising alternative that addresses some of the key limitations associated with .......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
30° Arthroscope	Arthrex	https://www.arthrex.com	Used for arthroscopic visualization of the shoulder joint
Anchor devices	Arthrex	https://www.arthrex.com	Anchors for securing sutures to bone
CT scanner	Siemens	https://www.siemens-healthineers.com	Computed tomography scanner for preoperative bone quality assessment
High-strength sutures (e.g., FiberWire, Ethibond)	Arthrex	https://www.arthrex.com	High-strength sutures for tendon fixation
MRI scanner	Siemens	https://www.siemens-healthineers.com/magnetic-resonance-imaging	Magnetic resonance imaging scanner for preoperative and follow-up evaluation
Radiofrequency (RF) device	Arthrex	https://www.arthrex.com	Used for clearing the rotator cuff interval and soft tissue debridement
Shoulder traction system	Smith & Nephew	https://www.smith-nephew.com	Used for patient positioning and shoulder traction during surgery
Surgical clamps	Medtronic	https://www.medtronic.com/	Used for clamping and assisting with suture handling
Suture hook	Arthrex	https://www.arthrex.com	Used for continuous suture passing during tendon repair