| Popis: |
The subscapularis muscle is the largest and most powerful rotator cuff muscle and therefore it plays a fundamental role in shoulder function. Most tears of the subscapularis tendon are suitable for arthroscopic repair. The advantage of arthroscopic repair in comparison with the open procedure is that it allows better diagnosis and treatment of partial articular sided lesions and makes it possible to address pathology of the biceps tendon, its pulley, and the labrum at the same time. The main technical difficulty with arthroscopic repair is from limited visibility and working space in the anterior glenohumeral joint, between the coracoid and the humeral head. In addition, mobilization of the tendon is more difficult when there is severe retraction of the tendon because there is more swelling of the tissue with the arthroscopic procedure. So repair of the subscapularis tendon should be the first arthroscopic procedure before any other procedures (Burkhart and Brady, Arthroscopy 22:1014–1027, 2006). This requires precise assessment of the size of the lesion and identification of all other pathological findings followed by mobilization and anatomic repair with suture anchors in a single row or double row in the area of the SSC footprint. The aims with repair of the subscapularis tendon are to restore the original function of the glenohumeral joint and to recenter the humeral head. If there is complete rupture of the SSC tendon, the tendon retracts and its inferior edge is often no longer visible intra-articularly. It may be hidden by the middle glenohumeral ligament (MGHL), the inferior glenohumeral ligament (IGHL), or adhesions. If the inferior edge of the rupture cannot be seen with the arthroscopic, or there is a complete traumatic rupture that is difficult to mobilize, we recommend subscapularis repair with an open procedure following the arthroscopy. |
