Saadat Waqar, Taylor Fraser, Kakkar Rahul, Monga Puneet
Department of Trauma and Orthopaedic, Furness General Hospital, Barrow-in-Furness, UK.
Department of Trauma and Orthopaedic, John Flynn Medical Centre, John Flynn Private Hospital, Brisbane, Queensland, Australia.
J Orthop Case Rep. 2018 Mar-Apr;8(2):51-53. doi: 10.13107/jocr.2250-0685.1046.
Subscapularis tendon plays an important role in shoulder stability and functions. There has been much interest recently in the prevalence of subscapularis tears and outcomes following repair of subscapularis tears. We aimed to assess whether there is an increase in pick up rate of subscapularis tears in patients who underwent arthroscopic rotator cuff repair following routine additional use of a 70° arthroscope during shoulder arthroscopy.
A retrospective review of a single surgeons practice was performed to assess the frequency of identifying and repairing subscapularis tears among a cohort of 58 consecutive arthroscopic rotator cuff tears performed over a 12 months period. The patients' had an age ranged between 42 and 71 years (mean 54.4). The case mix was a combination of degenerative and traumatic tears. All-arthroscopic procedures had an additional assessment with a 70° arthroscope, in addition to routine assessment with a 30° arthroscope. The follow-up ranged from 30 to 120 days. The prevalence of subscapularis tendon tears was noted intraoperatively. This was compared to the pre-operative incidence as determined by the various clinical examination and radiological techniques.
Of the 58 arthroscopic rotator cuff repairs, subscapularis tear was identified in 25 patients (43.1%). Among the imaging modalities used pre-operative magnetic resonance imaging scanning reported a subscapularis tear in 71.4% and pre-operative ultrasound scanning reported a tear in 78.6.
The use of a 70° arthroscope can facilitate the recognition and management of subscapularis tears which may not be recognized with a routine 30° shoulder arthroscope. A combination of high index of suspicion, judicious use of pre-operative imaging and careful arthroscopic assessment aids identification of subscapularis tendon tears.
肩胛下肌腱在肩部稳定性和功能中起着重要作用。近年来，肩胛下肌撕裂的患病率以及肩胛下肌撕裂修复后的疗效受到了广泛关注。我们旨在评估在肩关节镜检查期间常规额外使用70°关节镜进行关节镜下肩袖修复的患者中，肩胛下肌撕裂的检出率是否有所增加。
对一位外科医生的手术记录进行回顾性分析，以评估在12个月内连续进行的58例关节镜下肩袖撕裂修复病例中，肩胛下肌撕裂的识别和修复频率。患者年龄在42岁至71岁之间（平均54.4岁）。病例组合包括退行性和创伤性撕裂。所有关节镜手术除了使用30°关节镜进行常规评估外，还额外使用70°关节镜进行评估。随访时间为30至120天。术中记录肩胛下肌腱撕裂的患病率，并与通过各种临床检查和放射学技术确定的术前发病率进行比较。
在58例关节镜下肩袖修复病例中，25例（43.1%）发现肩胛下肌撕裂。在术前使用的影像学检查中，磁共振成像扫描报告肩胛下肌撕裂的比例为71.4%，术前超声扫描报告撕裂的比例为78.6%。
使用70°关节镜有助于识别和处理常规30°肩关节镜可能无法识别的肩胛下肌撕裂。高度怀疑、合理使用术前影像学检查和仔细的关节镜评估相结合，有助于识别肩胛下肌腱撕裂。
