Summary

Arthroscopic subscapularis repair through anterolateral viewing portal using lasso-loop technique results in significant clinical and functional improvement and the technique is reproducible with equal success.

Abstract

Background

Our technique for arthroscopic subscapularis tendon repair through anterolateral viewing portal using Lasso-loop technique has already published in Journal of Arthroscopy (Arthroscopic techniques). We have undertaken this study to confirm whether excellent clinical results obtained with other techniques in arthroscopic subscapularis repair can be reproduced with equal success with our technique. Methods: The study included 40 patients aged between 48 and 80 years with isolated subscapularis or combined anterosuperior rotator cuff tear who underwent arthroscopic subscapularis repair using lasso-loop technique through anterolateral viewing portal. All the patients were clinically assessed pre-operatively. Clinical assessment included Range of motion of the shoulder and special test for subscapularis muscle which includes Lift off test and Belly press test. The functional outcome was assessed using the modified UCLA shoulder scoring system and the Oxford shoulder scoring systems. Clinical examination and shoulder scoring systems were done post-operatively at 6 weeks, 3 months, 6 months, 1 year and 2 years periods. The forward flexion, internal rotation and external rotation of the affected shoulder at the final follow up were compared with that of the opposite normal shoulder. Results: There was considerable improvement in the active range of motion of the shoulder post-operatively. It was noticed that with further motivation and regular physical therapy the active range of motion increased considerably and majority of the patients were satisfied with a painless range of motion. The belly press test was positive in half of the patients and the lift off test was positive in all the patients pre-operatively. Both the lift off test and belly press test was negative in majority of the patients during the final follow-up. Following arthroscopic repair, patients reported improvement in modified UCLA shoulder score from 10.15 ± 2.52 to 30.71 ± 4.3 at final follow-up and an improvement in the Oxford shoulder score from 15.6 ± 3.64 to 40.64 ± 6.87 at the final follow-up The modified UCLA shoulder score and the Oxford shoulder score improved considerably over subsequent follow up periods with 30 good and fair results and 4 excellent results out of 40 as reported by the patients. Conclusion: Arthroscopic subscapularis repair through anterolateral viewing portal using lasso-loop technique results in significant clinical and functional improvement and the technique is reproducible with equal success. There is a positive correlation of the range of motion of the shoulder with the opposite side indicating a satisfactory outcome following the arthroscopic subscapularis repair using our technique.