The San Antonio Orthopaedic Group, San Antonio, Texas, USA.
Arthroscopy. 2011 Aug;27(8):1142-9. doi: 10.1016/j.arthro.2011.02.033. Epub 2011 Jun 24.
The recognition of and discussion of operative techniques for subscapularis tendon tears have lagged behind those for the posterosuperior rotator cuff. The advancement of shoulder arthroscopy has provided the opportunity to see the articular side of the rotator cuff and has led to increased recognition of subscapularis tears. Double-row fixation of the posterosuperior rotator cuff has become popular because of improved biomechanical strength, footprint restoration, and tendon healing compared with single-row fixation. Double-row fixation of the subscapularis, however, has been challenging because of the small anterior space overlying the subscapularis. Whereas the subacromial space allows freedom of movement, the limited subcoracoid space makes visualization, instrument manipulation, and knot tying more difficult. We describe a new technique for double-row fixation of the upper subscapularis footprint using a knotless technique without an additional anchor, which eases some of the aforementioned difficulties. The technique is indicated for partial- or full-thickness tears of the upper 50% of the subscapularis tendon and therefore applies to the majority of tears involving the subscapularis tendon.
肩胛下肌腱撕裂的认识和讨论一直落后于肩袖后上侧撕裂。肩关节镜技术的进步使我们有机会观察到肩袖的关节侧，从而提高了对肩胛下肌腱撕裂的认识。与单排固定相比，双排固定后上侧肩袖的生物力学强度、足印恢复和肌腱愈合都得到了改善，因此变得更加流行。然而，由于肩胛下肌前方空间小，双排固定肩胛下肌具有挑战性。虽然肩峰下间隙允许自由活动，但喙突下间隙有限，使得可视化、器械操作和打结更加困难。我们描述了一种使用无结技术和无需额外锚钉的新方法，用于修复肩胛下肌上止点的双排固定，可缓解上述部分困难。该技术适用于肩胛下肌腱上 50%的部分或全层撕裂，因此适用于大多数涉及肩胛下肌腱撕裂的情况。
