Partial subscapularis tear: State-of-the-art

Area of Science:

• Orthopedic Surgery
• Shoulder Joint Biomechanics
• Rotator Cuff Pathology

Background:

• The subscapularis (SSC) muscle is vital for shoulder stability and internal rotation.
• Partial SSC tears, caused by trauma or degeneration, vary in severity and location.
• These tears often involve the superolateral margin and may associate with biceps or anterosuperior lesions.

Purpose of the Study:

• To review current diagnostic and management strategies for partial subscapularis tears.
• To discuss the evolving trend towards operative management for these distinct pathologies.
• To evaluate the efficacy of different surgical repair techniques and timing.

Main Methods:

• Literature review of partial subscapularis tear classification, diagnosis, and treatment.
• Analysis of surgical techniques including single-row, double-row, and hybrid constructs.
• Discussion on the timing of repair, considering SSC muscle retraction and mobilization challenges.

Main Results:

• Partial SSC tears are increasingly recognized as a distinct pathology requiring specific approaches.
• A shift towards operative management is observed, with early repair advocated due to rapid SSC retraction.
• The 2-anchor interconnected double-row technique offers superior superolateral coverage and protection.

Conclusions:

• Early surgical intervention for partial SSC tears is crucial for restoring shoulder function.
• Advancements in repair techniques, particularly double-row constructs, improve outcomes.
• Future research should focus on injury prevention, early diagnosis, and targeted interventions.