Outcomes of Arthroscopic and Open Surgical Repair of Isolated Subscapularis Tendon Tears

Purpose: Reports of the results of subscapularis repairs make up a very small minority of the published literature on rotator cuff repairs, yet subscapularis tears cause significant pain and dysfunction for patients. The goals of this study were to systematically review the published results after subscapularis repair and to compare arthroscopic versus open techniques when appropriate. Methods: The Cochrane, PubMed, and Embase databases were reviewed for studies evaluating isolated subscapularis repairs. If a study reported outcomes for both subscapularis and supraspinatus tears, a subgroup analysis of isolated subscapularis tears was necessary for inclusion in this review. Other inclusion criteria included a minimum of 1-year follow-up. Results: We found 3 arthroscopic repair studies and 6 open repair studies that met all inclusion criteria. The mean patient age was 49.2 years, and the mean time from injury to surgical repair was 11.1 months. Constant scores were consistent between groups, with a mean postoperative score of 88.1. Pain scores improved significantly after repair, with a mean of 13.4 (on a scale ranging from 0 to 15, with 15 being no pain) in the arthroscopic repair group and 11.5 in the open repair group. Concomitant procedures were common, with biceps tenodesis being the most common, having been performed in 54.8% of shoulders, followed by biceps tenotomy and biceps recentering. Healing was reported in 90% to 95% of shoulders. Conclusions: Subscapularis tears can cause significant morbidity and often occur as traumatic injury in a younger population. Pain and function can be restored with repair, with excellent healing rates. The characteristic injury pattern suggested by a review of the literature is 1 where such tears are full thickness yet involve a portion of the tendon in the craniocaudal dimension. Concomitant procedures are common and can affect the results, because biceps tenotomy and tenodesis have been shown to significantly improve pain as well. All studies were Level IV, which introduced selection bias. Level of Evidence: Level IV, systematic review of Level IV studies.