Orthopedic surgery Department, Alps Surgery Institute, 4, chemin Tour-La-Reine, 74000 Annecy, France.
Orthop Traumatol Surg Res. 2010 Dec;96(8 Suppl):S99-108. doi: 10.1016/j.otsr.2010.09.009. Epub 2010 Nov 9.
Arthroscopic management of extensive subscapularis tendon lesions was reported more recently than for the supra- and infra-spinatus tendons. Extensive tears create technical problems requiring an extra-articular approach. The few results so far reported have been encouraging.
Surgical techniques adapted to each type of tear according to our subscapularis lesion classification are described, with the preliminary results from our cohort.
Between January 2006 and December 2008, 74 patients were operated on for extensive subscapularis tear. Twenty-three were assessed over a minimum 2 years' follow-up (mean, 32 months) on UCLA, ASES and Constant scores, comparative dynamometric Bear-Hug test, visual analog pain scale and self-assessed shoulder function.
Postoperative clinical results for the 23 patients followed up showed an improvement in shoulder function from 58 to 86%, in UCLA score from 16.4 to 30.9 points and in weighted Constant score from 48.6 to 75.2%.
In case of severe tear, we recommend visualizing the subscapularis tendon along its main axis from above, on a lateral approach allowing the intra- and extra-articular parts to be controlled, so as to check the reduction achieved by traction wire and anatomic fixation by anchors and sutures via an anterior access of varying height but systematically kept under tension. Biceps tenodesis is often required. Results show a clear improvement on all scores: pain, strength and function. The failure rate was 9% (two cases). There were no complications.
关节镜下治疗广泛的肩胛下肌腱病变的报道比治疗冈上肌和冈下肌肌腱病变的报道要晚。广泛的撕裂会产生技术问题，需要关节外入路。目前为止，为数不多的报道结果是令人鼓舞的。
根据我们的肩胛下肌损伤分类，描述了适用于每种撕裂类型的手术技术，并介绍了我们队列的初步结果。
2006 年 1 月至 2008 年 12 月，74 例广泛肩胛下肌腱撕裂患者接受了手术治疗。其中 23 例患者在至少 2 年的随访（平均 32 个月）中接受了 UCLA、ASES 和 Constant 评分、对比动力 Bear-Hug 试验、视觉模拟疼痛评分和自我评估肩部功能的评估。
23 例随访患者的术后临床结果显示，肩部功能从 58%提高到 86%，UCLA 评分从 16.4 分提高到 30.9 分，加权 Constant 评分从 48.6 分提高到 75.2%。
在严重撕裂的情况下，我们建议从上方沿着肩胛下肌腱的主轴线进行可视化，采用外侧入路可以控制关节内和关节外部分，以检查牵引线实现的复位，并通过前入路进行解剖固定，前入路的高度不同，但始终保持张力。通常需要进行二头肌肌腱转位。所有评分的结果都显示出明显的改善：疼痛、力量和功能。失败率为 9%（2 例）。没有并发症。
