Simplified Technique for Arthroscopic Repair of Upper Third Subscapularis Tear by Percutaneous Spinal Needle Suture Passing with a T Shape Loop

Summary

We present a simplified surgical technique combining percutaneous spinal needle suturing and a T-shaped suture loop construction for arthroscopic treatment of upper third subscapularis tears. This technique demonstrates dual clinical advantages, reducing operational complexity for surgeons and imposing less damage on patients, showing a promising application potential in clinical situations.

Abstract

The subscapularis tear is a commonly seen shoulder injury requiring arthroscopic repair. This article describes a simplified arthroscopic technique for repairing the upper third subscapularis injury. The procedure includes the steps of subscapularis tear identification, decortication of the footprint and freshening, percutaneous suture passage using a spinal needle, construction of a T-shaped suture loop, and placement of a single lateral row anchor. This technique replaces traditional suture-passing devices and traction sutures with a 12G spinal needle loaded with a high-tensile suture. Its novelty lies in the combination of a percutaneous spinal needle for suture passage and the construction of a T-shaped suture loop. The final construct, securing the tendon with the T-loop and a single lateral row anchor, provides robust compression at the insertion site. Our simplified technique offers distinct advantages of easier suturing passing operation, more convenient suture management, more flexible insertion site selection, less invasive to patients, and higher error tolerance for iatrogenic damage, and it should be a promising technique in clinical situations.

Introduction

The subscapularis, located in the anterior aspect of the shoulder, is the largest and most powerful rotator cuff muscle. It plays a critical role in proper shoulder function¹. Beyond its primary function as an internal rotator, the subscapularis also acts to pull the humeral head posteriorly on the glenoid and is an important dynamic and static anterior stabilizer of the glenohumeral joint. Studies have indicated that subscapularis injuries constitute approximately 30% to 50% of all rotator cuff injuries². The Lafosse classification system categorizes intraoperative findings of subscapularis tear into five types: A Type ....

Protocol

The procedure described here was conducted in compliance with the guidelines set out by the Ethics Committee of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. The patient provided informed consent.

1. Pre-operative preparations

1. The patient was prepared for surgery, and hair removal was done at the site. The patient was asked to abstain from eating for 8 h and drinking for 2 h before surgery. Hypertension was kept under control.
2. Standard arthroscopic equipment and the following instruments were prepared: Arm traction frame for shoulder joint surgery, saltwater rack, 30° arthr....

Results

The operation time was 30 min with an estimated blood loss of 10 mL. At 2 days after surgery, MRI showed the cyst near the subscapularis was completely resected and a satisfactory tension restoration of both the subscapularis and supraspinatus tendons (Figure 8). At 9 months after surgery, the patient had a satisfactory motion range restoration (active flexion:0-160°, active internal rotation: L1 level, active external rotation:0-45°;

Discussion

Subscapularis tear is a common form of rotator cuff injury and frequently necessitates arthroscopic repair. Historically, the subscapularis was first ignored as the forgotten tendon of the shoulder joint^9,10. Over the last two decades, the importance of the subscapularis muscle-tendon unit has gained recognition. It acts as the main internal rotator of the shoulder and is the single anterior stabilizer of the transversal force couple of the glenohumeral joint. Su.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
high-tensile suture (Orthocord Suture)	DePuy Mitek		high-tensile suture (#2 Violet W/ MO-7 1/2 Circle, Taper Point Needle, 22 mm)
lateral row anchor	Star Sports Medicine	AK7-D1	lateral row anchor (Tapscrew PK)
radiofrequency	BONSS	MC405
shaver	Star Sports Medicine	BB01SS