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Huang P, Wang X, He C, Tang X. Arthroscopic Modified Subacromial Viewing Portal Repair of Upper Third of Subscapularis Tendon Partial-Thickness Tears. Arthrosc Tech 2024; 13:102924. [PMID: 38690343 PMCID: PMC11056780 DOI: 10.1016/j.eats.2024.102924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/15/2023] [Indexed: 05/02/2024] Open
Abstract
At present, the repair pattern of upper third of subscapularis tendon partial-thickness tears (upper-third tendon tears) is performed in the glenohumeral joint and conventional subacromial viewing portal, but the visualization of subscapularis tendon and footprint is poor when using a 30° scope. The modified subacromial viewing portal presented in this Technical Note is a modified surgical technique for the repair of upper-third tendon tears. Since the scope forms an angle of 70° with the subscapularis tendon and footprint of lesser tuberosity, satisfactory visualization can be obtained when using 30° scope; the predesigned surgical portal and working space without bony barrier can offer a smooth surgical procedure. Our surgical technique is described in pearls, pitfalls, advantages, and disadvantages.
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Affiliation(s)
- Peiguan Huang
- Second Affiliated Hospital, Department of Joint Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Xiaoxu Wang
- Second Affiliated Hospital, Department of Joint Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Chunrong He
- Second Affiliated Hospital, Department of Joint Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Xiaojun Tang
- Second Affiliated Hospital, Department of Joint Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
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黄 沛, 王 蓓, 谭 光, 王 晓, 洪 亮, 曾 智, 邱 明, 颜 虎, 何 春. [Short-term effectiveness of arthroscopic repair via modified subacromial viewing portal in treatment of Lafosse Ⅰ subscapularis tendon tears]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:22-27. [PMID: 38225836 PMCID: PMC10796221 DOI: 10.7507/1002-1892.202310081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/25/2023] [Accepted: 12/25/2023] [Indexed: 01/17/2024]
Abstract
Objective To investigate short-term effectiveness of arthroscopic repair via modified subacromial viewing portal (hereinafter referred to as modified viewing portal) in treatment of LafosseⅠsubscapularis tendon tears. Methods A clinical data of 52 patients with LafosseⅠsubscapularis tendon tears, who underwent the arthroscopic repair via modified viewing portal between October 2020 and November 2022 and met the selective criteria, was retrospectively analyzed. There were 15 males and 37 females with an average age of 63.4 years (range, 41-76 years). Twelve patients had trauma history and the other 40 patients had no obvious inducement. The main clinical symptom was shoulder pain and the hug resistance tests were positive in all patients. The interval between symptom onset and admission ranged from 3 to 26 months (mean, 7.2 months). The shoulder pain and function were evaluated by visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and University of California Los Angeles (UCLA) score before operation and at 12 months after operation. The shoulder range of motion (ROM) of forward flexion, abduction, and external rotation and the internal rotation strength were measured before operation and at 3 and 12 months after operation. MRI was performed at 3-6 months after operation to assess the tendon healing and the structural integrity and tension of reattached tendon. Patient's satisfactions were calculated at last follow-up. Results All incisions healed by first intention, no complication such as incision infection or nerve injury occurred. All patients were followed up 12-37 months (mean, 18.5 months). The VAS, UCLA, and ASES scores at 12 months after operation significantly improved when compared with those before operation ( P<0.05). The ROMs of abduction and forward flexion and the internal rotation strength at 3 and 12 months significantly improved when compared with those before operation ( P<0.05); and the ROMs at 12 months significantly improved compared to that at 3 months ( P<0.05). However, there was no significant difference ( P>0.05) in the ROM of external rotation at 3 months compared to that before operation; but the ROM at 12 months significantly improved compared to that before operation and at 3 months after operation ( P<0.05). Thirty-one patients underwent MRI at 3-6 months, of which 28 patients possessed intact structural integrity, good tendon tension and tendon healing; 3 patients underwent tendon re-tear. At last follow-up, 41 patients (78.8%) were very satisfied with the effectiveness, 7 were satisfied (13.5%), and 4 were dissatisfied (7.7%). Conclusion Arthroscopic repair via modified viewing portal for Lafosse Ⅰsubscapularis tendon tears, which can achieve the satisfactory visualization and working space, can obtain good short-term effectiveness with low overall re-tear risk.
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Affiliation(s)
- 沛冠 黄
- 南华大学附属第二医院关节外科(湖南衡阳 421000)Department of Joint Surgery, the Second Affiliated Hospital, University of South China, Hengyang Hunan, 421000, P. R. China
| | - 蓓 王
- 南华大学附属第二医院关节外科(湖南衡阳 421000)Department of Joint Surgery, the Second Affiliated Hospital, University of South China, Hengyang Hunan, 421000, P. R. China
| | - 光华 谭
- 南华大学附属第二医院关节外科(湖南衡阳 421000)Department of Joint Surgery, the Second Affiliated Hospital, University of South China, Hengyang Hunan, 421000, P. R. China
| | - 晓旭 王
- 南华大学附属第二医院关节外科(湖南衡阳 421000)Department of Joint Surgery, the Second Affiliated Hospital, University of South China, Hengyang Hunan, 421000, P. R. China
| | - 亮 洪
- 南华大学附属第二医院关节外科(湖南衡阳 421000)Department of Joint Surgery, the Second Affiliated Hospital, University of South China, Hengyang Hunan, 421000, P. R. China
| | - 智 曾
- 南华大学附属第二医院关节外科(湖南衡阳 421000)Department of Joint Surgery, the Second Affiliated Hospital, University of South China, Hengyang Hunan, 421000, P. R. China
| | - 明俊 邱
- 南华大学附属第二医院关节外科(湖南衡阳 421000)Department of Joint Surgery, the Second Affiliated Hospital, University of South China, Hengyang Hunan, 421000, P. R. China
| | - 虎勇 颜
- 南华大学附属第二医院关节外科(湖南衡阳 421000)Department of Joint Surgery, the Second Affiliated Hospital, University of South China, Hengyang Hunan, 421000, P. R. China
| | - 春荣 何
- 南华大学附属第二医院关节外科(湖南衡阳 421000)Department of Joint Surgery, the Second Affiliated Hospital, University of South China, Hengyang Hunan, 421000, P. R. China
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Takeshima M, Morihara T, Furukawa R, Ito H, Kida Y, Sukenari T, Takahashi K. Efficacy of biceps-radial-slice magnetic resonance images for the diagnosis of biceps and pulley lesions. J Shoulder Elbow Surg 2023; 32:2436-2444. [PMID: 37543281 DOI: 10.1016/j.jse.2023.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Injuries to the biceps reflection pulley lead to instability of the long head of the biceps tendon (LHBT). However, conventional magnetic resonance (MR) imaging (MRI) has low diagnostic accuracy for LHBT and pulley lesions. Here, we investigated the usefulness of novel biceps-radial MRI for evaluating LHBT and pulley lesions. METHODS Biceps-radial MR images of 84 patients (84 shoulders) were prospectively analyzed. The biceps-radial MRI protocol includes sequences acquired in radial planes perpendicular to the LHBT in the shoulder joint. All patients underwent shoulder arthroscopy, and the intraoperative LHBT and pulley lesion findings were compared to the preoperative evaluations. The diagnostic accuracies of the biceps-radial MR images and conventional MR images were determined. RESULTS A normal LHBT was observed in 30 (31.6%) patients, partial tears in 43 (52.6%), and complete tears in 11 (15.8%). Normal LHBT stability was present in 54 (61.4%) patients, subluxation in 24 (31.6%), and dislocation in 6 (7.0%). The biceps-radial MR (kappa coefficient: 0.94) and conventional MR (kappa coefficient: 0.68) images accurately identified LHBT tears. The biceps-radial MR images excellently agreed with the arthroscopic findings (kappa coefficient: 0.91), whereas the conventional MR images poorly agreed (kappa coefficient: 0.17) regarding LHBT instability. A normal medial wall of the pulley was observed in 26 (31.0%) patients, partial tears in 30 (35.7%), and complete tears in 28 (33.3%). A normal lateral wall of the pulley was observed in 30 (35.7%) patients, partial tears in 21 (25.0%), and complete tears in 33 (39.3%). The biceps-radial MR images excellently agreed with the arthroscopic findings (kappa coefficient: 0.89), whereas the conventional MR images moderately agreed (kappa coefficient: 0.50) regarding medial pulley lesions. The biceps-radial MR images excellently agreed with the arthroscopic findings (kappa coefficient: 0.95) and the conventional MR images moderately agreed (kappa coefficient: 0.56) regarding lateral pulley lesions. CONCLUSION Biceps-radial MRI allows for tracking of the LHBT and pulley from the supraglenoid tuberosity to the bicipital groove in the glenohumeral joint and accurate evaluations of LHBT and pulley lesions.
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Affiliation(s)
- Minoru Takeshima
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Toru Morihara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryuhei Furukawa
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hirotoshi Ito
- Department of Radiology, Kajiicho Medical Imaging Center, Kyoto, Japan
| | - Yoshikazu Kida
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tsuyoshi Sukenari
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Lee KC, Cho Y, Ahn KS, Park HJ, Kang YS, Lee S, Kim D, Kang CH. Deep-Learning-Based Automated Rotator Cuff Tear Screening in Three Planes of Shoulder MRI. Diagnostics (Basel) 2023; 13:3254. [PMID: 37892075 PMCID: PMC10606560 DOI: 10.3390/diagnostics13203254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
This study aimed to develop a screening model for rotator cuff tear detection in all three planes of routine shoulder MRI using a deep neural network. A total of 794 shoulder MRI scans (374 men and 420 women; aged 59 ± 11 years) were utilized. Three musculoskeletal radiologists labeled the rotator cuff tear. The YOLO v8 rotator cuff tear detection model was then trained; training was performed with all imaging planes simultaneously and with axial, coronal, and sagittal images separately. The performances of the models were evaluated and compared using receiver operating curves and the area under the curve (AUC). The AUC was the highest when using all imaging planes (0.94; p < 0.05). Among a single imaging plane, the axial plane showed the best performance (AUC: 0.71), followed by the sagittal (AUC: 0.70) and coronal (AUC: 0.68) imaging planes. The sensitivity and accuracy were also the highest in the model with all-plane training (0.98 and 0.96, respectively). Thus, deep-learning-based automatic rotator cuff tear detection can be useful for detecting torn areas in various regions of the rotator cuff in all three imaging planes.
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Affiliation(s)
- Kyu-Chong Lee
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea (C.H.K.)
| | - Yongwon Cho
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea (C.H.K.)
- Advanced Medical Imaging Institute, Korea University College of Medicine, Seoul 02841, Republic of Korea
- AI Center, Korea University Anam Hospital, Seoul 02841, Republic of Korea
| | - Kyung-Sik Ahn
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea (C.H.K.)
- Advanced Medical Imaging Institute, Korea University College of Medicine, Seoul 02841, Republic of Korea
- AI Center, Korea University Anam Hospital, Seoul 02841, Republic of Korea
| | - Hyun-Joon Park
- Institute for Healthcare Service Innovation, College of Medicine, Korea University, Seoul 02841, Republic of Korea; (H.-J.P.); (Y.-S.K.)
| | - Young-Shin Kang
- Institute for Healthcare Service Innovation, College of Medicine, Korea University, Seoul 02841, Republic of Korea; (H.-J.P.); (Y.-S.K.)
| | - Sungshin Lee
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea (C.H.K.)
| | | | - Chang Ho Kang
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea (C.H.K.)
- Advanced Medical Imaging Institute, Korea University College of Medicine, Seoul 02841, Republic of Korea
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Camenzind RS, Martin Becerra J, Tondelli TO, Gossing L, Serane-Fresnel J, Lafosse T, Lafosse L. Correlation between preoperative clinical examination and intraoperatively found subscapularis tendon tear. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:373-379. [PMID: 35006313 DOI: 10.1007/s00590-021-03197-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/29/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Analyze the diagnostic value for subscapularis (SSC) tendon tears, their correlation between pain and strength on clinical tests, and compare them with intraoperative arthroscopic findings to prove their diagnostic value. METHODS 110 consecutive patients undergoing arthroscopic rotator cuff repair were reviewed and allocated to isolated SSC (n = 39) and combined anterosuperior tendon tear (n = 71) groups and analyzed. Preoperative clinical testing included belly press (BPT), bear hug (BHT), lift-off (LOT), palm-up (PUT), and Jobe test (JT). All tests were performed in two categories: pain (in 4 categories: 0, 5, 10, and 15) and strength (from 0 to 5). The tendon tears were intraoperatively reviewed and classified. RESULTS Mean age was 59 years (SD 10). The sensitivity of the BHT was 88.2% and 74.5% for BPT, while specificity was only 41.9% for BHT and 45% for BPT. Sensitivity of JT was 90.5% and 87.5% for PUT, while specificity was only 41% for JT and 28.2% for PUT. A low positive correlation for an intraoperative SSC lesion and the strength of BPT (Spearman rank correlation - 0.425; p value < 0.0001) and the strength of BHT ( - 0.362; p value = 0.001) could be found. With linear regression analysis estimated by ordinary least squares, a correlation between BPT strength and surgical grade of SSC lesion (- 0.528; 95% CI, - 0.923 to - 0.133; pvalue < 0.01) was found. CONCLUSION The BHT showed a higher sensitivity for a SSC lesion, while the BPT had a higher correlation between preoperative testing, most notably internal rotation strength, and intraoperative surgical grade of the SSC tendon lesion. LEVEL OF EVIDENCE Level II, Prospective cohort study for Diagnostic tests.
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Affiliation(s)
- Roland Stefan Camenzind
- Alps Surgery Institute, Clinique Générale d'Annecy, 4 Chemin de la Tour la Reine, 74000, Annecy, France.
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Javier Martin Becerra
- Alps Surgery Institute, Clinique Générale d'Annecy, 4 Chemin de la Tour la Reine, 74000, Annecy, France
- Ortomove, Centro Medico ABC, Av carlos graef Fernández 154 consultorio 0071, Santa Fe Cuajimalpa, 05300, Mexico City, Mexico
| | - Timo O Tondelli
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Louis Gossing
- Alps Surgery Institute, Clinique Générale d'Annecy, 4 Chemin de la Tour la Reine, 74000, Annecy, France
- Department of Orthopaedic Surgery, Braine-l'Alleud-Waterloo Hospital, Centre Hospitalier Interregional Edith Cavell (CHIREC), Braine-l'Alleud, Belgium
| | - Julien Serane-Fresnel
- Alps Surgery Institute, Clinique Générale d'Annecy, 4 Chemin de la Tour la Reine, 74000, Annecy, France
- IECEM - Research Unit, Polyclinique Saint Côme, Compiègne, France
| | - Thibault Lafosse
- Alps Surgery Institute, Clinique Générale d'Annecy, 4 Chemin de la Tour la Reine, 74000, Annecy, France
| | - Laurent Lafosse
- Alps Surgery Institute, Clinique Générale d'Annecy, 4 Chemin de la Tour la Reine, 74000, Annecy, France
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The prevalence, classification, radiological and arthroscopic findings of intratendinous subscapularis tears. Knee Surg Sports Traumatol Arthrosc 2022; 31:1970-1977. [PMID: 36454292 DOI: 10.1007/s00167-022-07262-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/25/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE To investigate the clinical characteristics of intratendinous subscapularis (inSSC) tears. METHODS Retrospectively, 69 patients with arthroscopically confirmed inSSC tears were identified from 2018 to 2019. Preoperatively and at final follow-up, thorough physical examination was performed and clinical outcomes (American Shoulder and Elbow Surgeons [ASES] score; University of California, Los Angeles [UCLA] score; visual analogue scale [VAS] for pain; and Simple Shoulder Test [SST]) were recorded. Features of pre-operative magnetic resonance image (MRI) such as high signalling within the tendon substance, communication to the bicipital groove and long head of biceps tendon (LHBT) lesions were investigated. Characteristics of arthroscopic view were investigated. Bear-hug and internal rotation resistance test at 90° abduction and external rotation (IRRT90°) test were used to assess the SSC strength. RESULTS The mean follow-up was 2.4 (2-3) years. The prevalence of arthroscopically confirmed inSSC tears was 69/675 (10.2%) among arthroscopic rotator cuff repairs. Pre-operative physical examination found positive IRRT90° and bear-hug test in 41/60 (68.3%) and 42/69 (60.8%) patients, respectively. The Cohen kappa coefficient was interpreted to be substantial for the evaluation of all MRI parameters. According to the conditions of LHBT, inSSC tears were classified into 3 types: type I: without LHBT subluxation and tear; type II: with LHBT subluxation or tears and type III: with LHBT dislocation. At final follow-up, mean ASES, UCLA, VAS, and SST scores improved significantly from mean of 50.6 ± 14.7, 19.4 ± 3.07, 6.2 ± 2.0, and 6.1 ± 2.5 to mean of 90.7 ± 9.5, 32.2 ± 1.8, 1.4 ± 1.2 and 9.8 ± 2.2, respectively (P < 0.001). Bilateral symmetric strength was found by bear-hug and IRRT90° test in all patients postoperatively. CONCLUSION Understanding features of pre-operative MRI, physical examination and arthroscopic view is helpful to identify inSSC tears. Arthroscopic repair yielded satisfactory clinical outcomes in patients with inSSC tears. LEVEL OF EVIDENCE Level IV.
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Kim JH, Do WS, Lim JR, Yoon TH, Chun YM. Subscapularis tendon tears hidden by the medial biceps sling can be missed on arthroscopic examination. Arch Orthop Trauma Surg 2022; 143:3251-3258. [PMID: 36369526 DOI: 10.1007/s00402-022-04681-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION To investigate (1) the prevalence of "hidden lesions" and "non-hidden lesions" of subscapularis tendon tears requiring repair during arthroscopic examination that would be missed by a 30° arthroscope, but could be identified by a 70° arthroscope, from the standard posterior portal and (2) the correlation of preoperative internal rotation weakness and findings of magnetic resonance imaging (MRI) indicating hidden lesions. MATERIALS AND METHODS We retrospectively examined 430 patients who underwent arthroscopic subscapularis repair between was initially nonvisible with a 30° arthroscope but became visible only with a 70° arthroscope from the standard posterior portal. The preoperative and intraoperative findings of the hidden lesion group (n = 82) were compared with those of the non-hidden lesion group (n = 348). 2016 and 2020. A hidden lesion was defined as a subscapularis tendon tear requiring repair that preoperative internal rotation weakness was assessed using the modified belly-press test. Preoperative MR images were reviewed using a systemic approach. RESULTS The prevalence of hidden lesions was 19.1% (82/430). No significant difference was found in preoperative internal rotation weakness between the groups. Preoperative MRI showed a significantly lower detection rate in the hidden lesion group than in the non-hidden group (69.5% vs. 84.8%; P = 0.001). The hidden lesions were at a significantly earlier stage of subscapularis tendon tears than the non-hidden lesions, as revealed by the arthroscopic findings (Lafosse classification, degree of retraction; P = 0.003 for both) and MR findings (muscle atrophy, fatty infiltration; P = 0.001, P = 0.005, respectively). CONCLUSIONS Among the subscapularis tears requiring repair, 19.1% could be identified by a 70° arthroscope, but not by a 30° arthroscope, through the posterior portal. The hidden lesions showed a significantly lower detection rate on preoperative MRI than the non-hidden lesions. Thus, for subscapularis tears suspected on preoperative physical examination, the 70° arthroscope would be helpful to avoid a misdiagnosis.
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Affiliation(s)
- Joo-Hyung Kim
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, 134, Shinchon-Dong, Seodaemun-Gu, CPO Box 8044, Seoul, 120-752, Republic of Korea
| | - Woo-Sung Do
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, 134, Shinchon-Dong, Seodaemun-Gu, CPO Box 8044, Seoul, 120-752, Republic of Korea
| | - Joon-Ryul Lim
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, 134, Shinchon-Dong, Seodaemun-Gu, CPO Box 8044, Seoul, 120-752, Republic of Korea
| | - Tae-Hwan Yoon
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, 134, Shinchon-Dong, Seodaemun-Gu, CPO Box 8044, Seoul, 120-752, Republic of Korea
| | - Yong-Min Chun
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, 134, Shinchon-Dong, Seodaemun-Gu, CPO Box 8044, Seoul, 120-752, Republic of Korea.
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Endell D, Child C, Freislederer F, Moroder P, Scheibel M. [Treatment of subscapularis tendon lesions]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:731-740. [PMID: 35943549 DOI: 10.1007/s00113-022-01221-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
The further development of minimally invasive techniques in recent years, enables adequate intraoperative visualization, mobilization and stable reconstruction even of larger subscapularis tears resulting in good to excellent clinical and structural results. Chronic tears of the subscapularis tendon with high grade muscle atrophy and advanced fatty infiltration can be treated with a muscle tendon transfer (e.g. pectoralis major or latissimus dorsi transfer). If pseudoparalysis and/or signs of anterosuperior decentration of the humeral head or defect arthropathy are present, in most cases a reverse shoulder arthroplasty represents the only surgical option.
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Affiliation(s)
- David Endell
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz.
| | - Christopher Child
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz
| | - Florian Freislederer
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz
| | - Philipp Moroder
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz
| | - Markus Scheibel
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz
- Centrum für Muskuloskeletale Chirurgie (CMSC), Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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Nigues A, Salentiny Y, Nabergoj M, Lädermann A, Neyton L. The Digitation Sign Facilitates Diagnosis of Shoulder Subscapularis Lesions on Preoperative Magnetic Resonance Imaging. Arthrosc Sports Med Rehabil 2022; 4:e883-e889. [PMID: 35747646 PMCID: PMC9210382 DOI: 10.1016/j.asmr.2021.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/28/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose The purposes of this study were to investigate a radiographic sign found on coronal magnetic resonance imaging (MRI) sequences in subscapularis (SSC) pathology, reporting interobserver reliability data and sensitivity and specificity; and to correlate the preoperative assessment of SSC pathology with intraoperative assessment of the SSc during shoulder arthroscopy. Methods A consecutive series of patients undergoing arthroscopic rotator cuff repair from January 2020 to December 2020 were examined. The positive diagnosis of a subscapularis tendon tear was prospectively determined and confirmed by arthroscopy. The “digitation sign” was assessed by 3 independent shoulder-trained fellows when evaluating the SSC in the coronal plane on T2-weighted images. Results Of the 132 patients included, 74 (56%) had SSC tendon tears confirmed during arthroscopy. Interobserver agreement for digitation sign was substantial (k= 0.640). Sensitivity for digitation sign only was 74.3%; for criteria of Adams et al. (Accuracy of preoperative magnetic resonance imaging in predicting a subscapularis tendon tear based on arthroscopy; Arthroscopy 2010;26:1427-1433) only, 83.8%; and for the combination of the 2 methods, 89.2%. Specificity was 84.5% for digitation sign only, 77.6% for Adams et al. criteria only, and 67.2% for the combination of the 2 methods. Sensitivity is statistically better when the digitation sign is added to the Adams et al. criteria for detection of SSC lesions. As expected, specificity is statistically lower. SSC tears are significantly associated with biceps lesions. Conclusion Preoperative systematic MRI evaluation by shoulder surgeons can diagnose subscapularis lesions by using the digitation sign in the coronal plane along with Adams et al. criteria, leading to good sensitivity. This easy-to-apply sign can be helpful in the initial MRI evaluation in the coronal plane, with improved sensitivity when combined with a systematic approach. Level of Evidence II, study of diagnostic test.
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Kao JT, Chiu CH, Hsu KY, Chang SS, Chan YS, Chen ACY. Arthroscopic diagnosis of long head of biceps tendon instability in refractory anterior shoulder pain: A comparison study between pulley tear and non-tear lesions. Biomed J 2022; 46:163-169. [PMID: 35065282 PMCID: PMC10104962 DOI: 10.1016/j.bj.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/23/2021] [Accepted: 01/10/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Long head of the biceps tendon (LHBT) instability and biceps reflection pulley (BRP) lesions are common cause of refractory anterior shoulder pain. We described a technique using dynamic arthroscopy to determine associated intraarticular pathologies. METHODS Patients with refractory anterior shoulder pain and arthroscopically-diagnosed LHBT instability were enrolled. LHBT instability and the integrity of BRP and concomitant intra-articular lesions were investigated by ramp test. Demographics and arthroscopic findings were compared between patients with and without BRP tear. RESULTS Forty patients were enrolled. BRP tear was noted in 25 patients (group A) and superior glenohumeral ligament (SGHL) insufficiency through ramp test in 15 patients (group B). Concomitant intraarticular pathologies were noted in 27 patients, including 19 in group A (76%) and eight in group B (53%), without significant group-wise difference (p = 0.138). The incidence of articular-side subscapularis tear was significantly higher in group A (p = 0.021), and those of the other intraarticular pathologies were similar between groups A and B. Fraying at the articular side of the subscapularis and supraspinatus tendons was frequent in group B, without difference of incidence as compared to group A (p = 0.5 and p = 0.084, respectively). CONCLUSIONS LHBT instability was a common disorder in patients with refractory shoulder pain. In those patients, dynamic assessment of BRP lesions and SGHL insufficiency and meticulous survey of associated intra-articular pathologies, including subscapularis tear are necessary for making accurate diagnosis and treatment decision.
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Gröger F, Hackl M, Buess E. Arthroscopic Suture-Bridge Repair of the Subscapularis Tendon-"Inside and Outside the Box" With Preservation of the Comma Sign. Arthrosc Tech 2021; 11:e31-e36. [PMID: 35127426 PMCID: PMC8807881 DOI: 10.1016/j.eats.2021.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/27/2021] [Indexed: 02/03/2023] Open
Abstract
The subscapularis muscle and its tendon are of major importance in the kinematics of the glenohumeral joint. Therefore, a diligent repair of subscapularis tears is essential. We describe our reliable standardized arthroscopic suture bridge technique to repair subscapularis tears under intra- and extraarticular visualization and with preservation of the "comma sign." This technique provides excellent exposure of the subscapularis tendon, allows its complete release in the subcoracoid space and ensures a safe and stable repair.
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Affiliation(s)
- Falk Gröger
- Shoulder Care Bern, Bern, Switzerland,Address correspondence to Dr. med. Falk Gröger, Shoulder Care Bern, Riedweg 5, 3012 Bern, Switzerland.
| | - Michael Hackl
- Schwerpunkt für Unfall-, Hand und Ellenbogenchirurgie, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln (AöR), Köln, Germany
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Lee JH, Rhyou IH, Ahn KB. Prediction of the anterior shoulder pain source by detecting indirect signs for partial articular subscapularis tendon tears through conventional magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc 2021; 29:2297-2304. [PMID: 32897409 DOI: 10.1007/s00167-020-06259-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the diagnostic efficacy of indirect signs for proximal articular-positioned, partial (< 50%), subscapularis tendon tears (facet 1 tears) via conventional magnetic resonance imaging (MRI). METHODS A retrospective study was conducted on 67 patients of Yoo's type 1 or 2A tears. Forty-five arthroscopic subacromial decompression and acromioclavicular resection cases served as controls. Indirect signs indicating a facet 1 tear included small defects, superior subscapularis recess (SSR), long head of the biceps (LHBT) configurations, bone edema or cyst formation on lesser tuberosity (LTBEC), and fatty infiltration of subscapularis muscle. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were checked. RESULTS SSR was the most sensitive sign (90%). The sensitivities and NPV of LHBT configurations and LTBEC were low (sensitivity: 42.9% and 17.9%, NPV: 56.4% and 44.4%, respectively). The specificities of all indirect signs were relatively high (> 90%). The Chi-squared test and multinomial logistic regression confirmed the significance of small defects, SSRs, and fatty infiltrations for facet 1 tears (p ≤ 0.014). The combined sensitivity and specificity were up to 97.7% and 92.3%, respectively, in the presence of either a small defect or an SSR. CONCLUSIONS Conventional MRI alone can detect facet 1 tears through indirect signs (small defects, SSR, and fatty infiltrations of the subscapularis muscle), predicting unspecified anterior shoulder pain due to concealed biceps instability, and facilitating preoperative diagnosis for a facet 1 tear. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ji Ho Lee
- Department of Orthopedic Surgery, Pohang Semyeong Christianity Hospital, 351, Poscodaero, NamKu, Pohang, Gyungbuk, South Korea
| | - In Hyeok Rhyou
- Department of Orthopedic Surgery, Pohang Semyeong Christianity Hospital, 351, Poscodaero, NamKu, Pohang, Gyungbuk, South Korea.
| | - Kee Baek Ahn
- Department of Orthopedic Surgery, Pohang Semyeong Christianity Hospital, 351, Poscodaero, NamKu, Pohang, Gyungbuk, South Korea
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Chae SH, Jung TW, Lee SH, Kim MJ, Park SM, Jung JY, Yoo JC. Hidden Long Head of the Biceps Tendon Instability and Concealed Intratendinous Subscapularis Tears. Orthop J Sports Med 2020; 8:2325967119898123. [PMID: 32656285 PMCID: PMC7333499 DOI: 10.1177/2325967119898123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 09/03/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Few studies have described the characteristics of a concealed intratendinous subscapularis tear (CIST), and there is a lack of research on the preoperative predictability of such lesions. Purpose: To describe the characteristics of a CIST as seen on magnetic resonance imaging (MRI) and intraoperatively and to develop a scoring system for predicting such lesions. Study Design: Case series; Level of evidence, 4. Methods: Retrospectively, we identified 43 patients with CISTs among 442 consecutive patients who had undergone rotator cuff repair from July 2014 to June 2016. Range of motion, visual analog scale results for pain and function, and patient-reported outcome scores were evaluated preoperatively and at 1 and 2 years postoperatively. CISTs were classified arthroscopically as small (<5 mm), medium (5-10 mm), and large (>10 mm). We performed repair (≥50%) or debridement (<50%) depending on the total subscapularis tendon tear size including the CIST. Preoperative MRI findings were analyzed by 2 observers and were correlated with the arthroscopic findings. A 10-point scoring system was developed based on characteristics during the physical examination (anterior tenderness, bear hug sign), MRI (biceps tendon displacement and subluxation, subscapularis signal change just lateral to the lesser tuberosity), and arthroscopic surgery (medial biceps tendon lesion, combined subscapularis tendon tear), with a cutoff value of ≥7 predicting a CIST. After the retrospective study, we prospectively enrolled 95 patients to validate the 10-point CIST scoring system. Results: All 43 patients diagnosed with a CIST during the retrospective study improved both range of motion and functional scores at 1 year postoperatively. The interrater agreement of the 2 observers was substantial for the evaluation of all parameters except for subscapularis tear classification, which was moderate. On arthroscopic surgery, 11 small, 19 medium, and 13 large CISTs were detected. The preliminary prospective study showed a sensitivity of 61.9%, specificity of 94.3%, positive predictive value of 89.0%, negative predictive value of 75.7%, and accuracy of 80.0% when the cutoff value was set at ≥7 on the CIST scoring system. Conclusion: A CIST can be suspected using a combination of preoperative MRI and intra-articular diagnostic arthroscopic findings, but a definitive diagnosis requires an arthroscopic view. On the 10-point CIST scoring system, a score of ≥5 can be suggestive of a CIST, and a score of ≥7 is most likely to predict a CIST.
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Affiliation(s)
- Sang Hoon Chae
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Wan Jung
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Hyeon Lee
- Department of Orthopaedics, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Myo Jong Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung Min Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeung Yeol Jung
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Chul Yoo
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Chauvet T, Haritinian E, Baudin F, Collotte P, Nové-Josserand L. The Invisible MGHL Test: Diagnostic Value and Benefits for the Repair of Retracted Subscapularis Tears. Am J Sports Med 2020; 48:2144-2150. [PMID: 32551821 DOI: 10.1177/0363546520929695] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Some full-thickness subscapularis tendon tears and partial tears of the deep layer are difficult to characterize, leading to misdiagnosis. PURPOSE To evaluate the association between displacement of the middle glenohumeral ligament (MGHL) and retracted tears of the subscapularis tendon as a possible test to improve diagnosis. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Videos (N = 100) recorded during arthroscopic rotator cuff repair involving a torn subscapularis tendon were analyzed retrospectively to assess the association between the MGHL test (nonvisibility of the MGHL) and other objective anatomic criteria. The invisible MGHL test was defined as positive if the MGHL was initially nonvisible in the beach-chair position and appeared only when the subscapularis tendon was pulled back into position by using a 30° arthroscope from the standard posterior portal. The parameters considered during the initial exploration were (1) visibility of the horizontal part of the subscapularis tendon; (2) visibility of the MGHL in its usual position, crossing the superior border of the subscapularis tendon; (3) exposure of the lateral border of the subscapularis tendon (full-thickness retracted tear); and (4) complete or partial exposure of the lesser tuberosity of the humerus. Tendon retraction was evaluated in 3 stages according to the Patte classification. RESULTS The invisible MGHL test result was positive in 45% of cases. It was positive in 6% of cases (2 of 31) when there was no subscapularis tendon retraction and in 62% of cases (43 of 69) when there was partial or complete retraction (P < .001). The invisible MGHL test was significantly associated with the width of the tear (P < .001) and exposure of the lateral border of the subscapularis tendon (full-thickness retracted tear, P = .0002). After repair, the MGHL was visible in its anatomic position in 96% of cases. CONCLUSION A positive invisible MGHL test is an alternative indication of subscapularis tendon retraction, and the relocation of the MGHL can also be used after repair to assess the proper anatomic repositioning of the subscapularis tendon.
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Affiliation(s)
- Thomas Chauvet
- Ramsay Générale de Santé, Jean Mermoz Private Hospital, Centre Orthopédique Santy, Lyon, France
| | - Emil Haritinian
- Carol Davila University of Medicine and Pharmacy, Foişor Orthopaedic Hospital, Bucharest, Romania
| | | | - Philippe Collotte
- Ramsay Générale de Santé, Jean Mermoz Private Hospital, Centre Orthopédique Santy, Lyon, France
| | - Laurent Nové-Josserand
- Ramsay Générale de Santé, Jean Mermoz Private Hospital, Centre Orthopédique Santy, Lyon, France
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Yamakado K. Floating Subscapularis Tear: A Variation of the Partial Subscapularis Tear. J Funct Morphol Kinesiol 2020; 5:jfmk5010011. [PMID: 33467227 PMCID: PMC7739246 DOI: 10.3390/jfmk5010011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 11/25/2022] Open
Abstract
A variation of subscapularis tear has been identified, named floating subscapularis, where the tendon is completely detached from the lesser tuberosity but is continuous with the tissue covering the bicipital groove. An accurate diagnosis can be made using arthroscopic observation with passive external and internal rotation of the affected shoulder, which shows mismatched movement between the humerus and the subscapularis tendon. The purpose of this study is to examine the prevalence of this particular tear pattern. Clinical records during the study period (from January 2011 to December 2017) were retrospectively examined. Overall, 1295 arthroscopic rotator cuff repair procedures were performed. Among these, the subscapularis tendon was repaired in 448 cases, and 27 cases were diagnosed as floating subscapularis. The prevalence of floating subscapularis was 6% in the subscapularis repair population. This particular tear pattern has not previously been described and it seems to be ignored. The floating subscapularis is thought to be the tear of the deep layer preserving the superficial layer connected to the greater tuberosity by fibrous extension of the soft tissue covering the bicipital groove.
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Affiliation(s)
- Kotaro Yamakado
- Department of Orthopaedics/Sposrts medicine, Fukui General Hospital, Fukui 9108561, Japan
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Editorial Commentary: You May Not Have Seen It, but It Has Seen You: Diagnosis of Long Head Biceps Tendon and Subscapularis Pathology in Association With Shoulder Rotator Cuff Pathology Can Be Challenging. Arthroscopy 2017; 33:1977-1980. [PMID: 29102012 DOI: 10.1016/j.arthro.2017.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/06/2017] [Accepted: 09/08/2017] [Indexed: 02/02/2023]
Abstract
The shoulder can humble you. It is often challenging in determining the extent of pathology even when there is an adequate magnetic resonance imaging performed preoperatively and even during the so-called diagnostic portion of the arthroscopy. Abnormalities of the long head of the biceps tendon and the rotator cuff especially the subscapularis can be difficult to diagnose definitively. Experience can be very helpful in predicting pathology based on patterns seen before and knowing certain pearls that can make diagnosis and ultimately treatment more accurate.
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