Subcapularis tendon tear: A structure-based arthroscopic description

Introduction: Subscapularis (SSC) tendons differ from supraspinatus tendons, although both have similar histologic structure comprising two layers with distinct collagen fiber organization. Hypothesis: The partial/full-thickness tear classification for the supraspinatus based on tendon structure can be applied to the subscapularis tendon on objective criteria. Material and methods: The present study used 100 films of arthroscopic rotator cuff repair involving SSC lesion. Lesions were reported on 3 objective criteria: horizontal superior tendon edge visibility, lesser tuberosity bone exposure, and lateral tendon edge visibility. Combining the three distinguishes deep, superficial or interstitial partial tear versus full-thickness tear. Degree of retraction was also noted. Results: Forty-six of the 73 partial lesions involved the deep articular layer, which was often retracted, but conserving the horizontal superior tendon edge and thus misleadingly suggesting SSC integrity; 23 were interstitial, without detachment from the lesser tuberosity; 4 involved only the superficial layer. Full thickness tears were always retracted, with loss of horizontal superior tendon edge, visibility of the lateral tendon edge and presence of comma sign. Interand intra-observer reproducibility was satisfactory. Discussion - conclusion: Like in superior cuff tear, a structure-based classification can be made of SSC lesions on objective criteria. (C) 2020 Elsevier Masson SAS. All rights reserved.