Using a 70° Scope Facilitates Pick up Rates of Subscapularis Tears

Subscapularis tendon plays an important role in shoulder stability and functions. There has been much interest recently in the prevalence of subscapularis tears and outcomes following repair of subscapularis tears. We aimed to assess whether there is an increase in pick up rate of subscapularis tears in patients who underwent arthroscopic rotator cuff repair following routine additional use of a 70° arthroscope during shoulder arthroscopy.

A retrospective review of a single surgeons practice was performed to assess the frequency of identifying and repairing subscapularis tears among a cohort of 58 consecutive arthroscopic rotator cuff tears performed over a 12 months period. The patients' had an age ranged between 42 and 71 years (mean 54.4). The case mix was a combination of degenerative and traumatic tears. All-arthroscopic procedures had an additional assessment with a 70° arthroscope, in addition to routine assessment with a 30° arthroscope. The follow-up ranged from 30 to 120 days. The prevalence of subscapularis tendon tears was noted intraoperatively. This was compared to the pre-operative incidence as determined by the various clinical examination and radiological techniques.

Of the 58 arthroscopic rotator cuff repairs, subscapularis tear was identified in 25 patients (43.1%). Among the imaging modalities used pre-operative magnetic resonance imaging scanning reported a subscapularis tear in 71.4% and pre-operative ultrasound scanning reported a tear in 78.6.

The use of a 70° arthroscope can facilitate the recognition and management of subscapularis tears which may not be recognized with a routine 30° shoulder arthroscope. A combination of high index of suspicion, judicious use of pre-operative imaging and careful arthroscopic assessment aids identification of subscapularis tendon tears.