Subscapularis tendon disruption after Bankart reconstruction for anterior instability

After undergoing a Bankart repair with a subscapularis tendon and capsular incising technique, four patients were identified who had failure of their subscapularis tendon repair. All had a traumatic event or injury to their shoulder between 1 day and 4 months after operation. The patients presented with findings including recurrent instability, weakness in internal rotation, an abnormal liftoff test, and increased external rotation of the affected extremity. Surgical exploration demonstrated failure of the Bankart repair in two cases in addition to failure of the subscapularis tendon repair in all four. In one patient magnetic resonance imaging was diagnostic of subscapularis tendon disruption. After reoperation was performed, stability was achieved in three of four patients, return of normal internal rotation strength in two, and a normal liftoff test in two. Prompt reexploration and repair of the subscapularis tendon-capsule complex is recommended.