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Techniques and Tips for Identification of Comma Tissue in Subscapularis Tears.

ABSTRACT: Identifying and repairing subscapularis tears can be challenging for the arthroscopic surgeon and is commonly related to the difficulty in accurately recognizing the distorted anatomy that may be encountered. Defining and differentiating this anterior glenohumeral joint anatomy are often made even more challenging in clinical situations in which large, retracted subscapularis and anterosuperior tears are present. Identifying the "comma tissue" during the initial arthroscopic assessment is very helpful because it provides an important anatomic landmark that not only serves to orient the surgeon but also facilitates reduction and repair of these tears. Identification of the comma tissue is sometimes a critical surgical step in subscapularis repair, and we provide tips and techniques that can aid the surgeon in reliably and reproducibly recognizing and incorporating the comma tissue.

SUBMITTER: Aiken AJ

PROVIDER: S-EPMC7372305 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Techniques and Tips for Identification of Comma Tissue in Subscapularis Tears.

Aiken Alan J AJ Field Larry D LD

Arthroscopy techniques 20200603 7

Identifying and repairing subscapularis tears can be challenging for the arthroscopic surgeon and is commonly related to the difficulty in accurately recognizing the distorted anatomy that may be encountered. Defining and differentiating this anterior glenohumeral joint anatomy are often made even more challenging in clinical situations in which large, retracted subscapularis and anterosuperior tears are present. Identifying the "comma tissue" during the initial arthroscopic assessment is very h ...[more]

PMID: 32714791

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Project description:PurposeTo retrospectively investigate the mid-term outcomes after arthroscopic repair of isolated subscapularis tears with a relatively large number of patients and to compare them by tear size.MethodsMedical records were reviewed for patients who underwent arthroscopic rotator cuff repair between 2010 and 2017 at our institute. The inclusion criterion was isolated subscapularis tears that underwent arthroscopic rotator cuff repair. The exclusion criteria were (1) previous rotator cuff surgery, (2) lack of imaging studies or clinical evaluation data, (3) neuromuscular diseases, and (4) <2-year follow-up. Range of motion, American Shoulder and Elbow Society score, and bear-hug or belly-press test were assessed pre- and postoperatively. Repair integrity was evaluated with magnetic resonance imaging at postoperative1 year. The clinical and imaging study outcomes were compared between smaller (Lafosse types 1-3) and larger (types 4 and 5) tears.ResultsThe subjects included 38 males and 8 females with a mean age of 59 years (range, 25-77 years). The mean follow-up was 36 months (range, 24-96 months). There were 13 type 1, 10 type 2, 12 type 3, 6 type 4, and 5 type 5 shoulders. Postoperative American Shoulder and Elbow Society scores were significantly better in smaller tears than larger tears: 93 ± 8 and 75 ± 14, respectively (P = .003). Smaller tears showed better postoperative internal rotation than larger tears (P = .004). Significant decrease of positive bear-hug or belly-press test was observed in smaller tears (preoperative, 25; postoperative, 11; P < .001), but there was no significant improvement in larger tears (preoperative, 11; postoperative, 9). The retear rate was significantly greater in larger tears (64%) than smaller tears (6%, P < .001).ConclusionsThe clinical and structural outcomes after arthroscopic repair of isolated subscapularis tears were better in smaller tears than larger tears with a mid-term follow-up. Larger tears showed high retear rates with poorer improvement in active range of internal rotation and subscapularis strength.Level of evidenceLevel III, retrospective, comparative study.

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Techniques and Tips for Identification of Comma Tissue in Subscapularis Tears.

Publications

Techniques and Tips for Identification of Comma Tissue in Subscapularis Tears.

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