Arthroscopic treatment of massive rotator cuff tears involving subscapularis

Introduction. Massive rotator cuff tears represent a major challenge in shoulder surgery. Contemporary arthroscopic techniques allow for repair in majority of cases. In the setting of a massive rotator cuff tear, engagement of subscapularis plays a significant role in function deterioration and is a risk factor for pseudoparalysis.
 Materials and methods. We present our experience and clinical results with arthroscopic repair of massive rotator cuff tears engaging subscapularis in 32 patients, followed for 12,5 months.
 Results. Complete repair was performed in 25 (78.1%) and partial repair in 7 (21,9%) of the cases with significant improvement in active forward flexion and good to excellent functional result in 68,8%, according to Constant score. Acute pseudoparalysis was successfully reversed in 8 out of 9 cases (88,8%). Transient neurologic complication was observed in 1 case (3%).
 Conclusion. Subscapularis plays an important role in massive rotator cuff tears and should always be repaired. Arthroscopic repair of massive rotator cuff tears engaging subscapularis is safe and efficient with good clinical results during one year follow up. While complete repair of all torn tendons with secure reattachment to the tuberosities is the preferred surgical treatment, repair of subscapularis and lower portion of infraspinatus is crucial for normal rotator cuff function. Careful patient selection and individually tailored surgery is important for successful treatment.