Arthroscopic Upper Third Subscapularis Tendon Repair Using H-Loop Technique: A Case Series

Abstract

Objective: Arthroscopic repair of upper one-third subscapularis tendon tears remains challenging due to suture management difficulties and repair quality limitations. We proposed a simpler knotless technique—the H-Loop technique. This study evaluates its early clinical and imaging outcomes.

Method: This is a case series of 38 patients (9 males and 29 females), who underwent arthroscopic H-Loop technique repair for upper one-third subscapularis tendon tears between January 2021 and August 2023. Postoperative assessments include the American Shoulder and Elbow Surgeons (ASES) score, the University of California, Los Angeles (UCLA) shoulder score, the Constant-Murley score, the visual analog scale (VAS), range of motion (ROM) (internal and external rotation), and internal rotation strength. In addition, MRI (30 patients) evaluated fatty infiltration, re-tears, and subscapularis integrity, comparing tendon dimensions and signal-to-signal ratios with a control group of patients with normal subscapularis tendons.

Result: Preoperative symptom duration ranged from 3 to 36 months, with an average of 9 months. Follow-up ranged from 12 to 14 months, with an average duration of 12.6 months. No complications were observed in any patient. Postoperative ASES scores increased significantly compared to preoperative scores (55.63 ± 15.85 vs. 88.92 ± 8.24), as did UCLA scores (21.82 ± 4.44 vs. 29.74 ± 3.55) and Constant-Murley scores (69.76 ± 15.30 vs. 86.34 ± 14.48). VAS scores decreased significantly (5.16 ± 1.84 vs. 0.89 ± 0.76). Postoperative ROM showed significant improvement in internal rotation (7.79 ± 2.07 vs. 8.45 ± 1.33) and external rotation (57.63° ± 15.84° vs. 66.58° ± 9.08°) (p < 0.05). Internal rotation strength ratios increased markedly (78.00% ± 15.86% vs. 91.97% ± 6.62%). MRI indicated no re-tears or fatty infiltration in the 30 patients, and compared to the control group, there were no statistically significant differences in the vertical diameter of the subscapularis muscle (62.89 mm ± 9.30 mm vs. 59.41 mm ± 7.55 mm; p = 0.153), transverse diameter of the upper subscapularis muscle (17.82 mm ± 3.79 mm vs. 19.43 mm ± 4.76 mm; p = 0.395), transverse diameter of the lower subscapularis muscle (24.09 mm ± 5.84 mm vs. 25.23 mm ± 5.41 mm; p = 0.870), cross-sectional area of the subscapularis muscle (1338.54 mm² ± 277.26 mm² vs. 1247.94 mm² ± 210.55 mm²; p = 0.098), signal-to-signal ratio of the upper subscapularis muscle (1.18 ± 0.28 vs. 1.24 ± 0.28; p = 0.792), or the signal-to-signal ratio of the lower subscapularis muscle (1.02 ± 0.24 vs. 1.03 ± 0.16; p = 0.128).

Conclusion: The arthroscopic H-Loop technique significantly restores function, improves range of motion, and enhances internal rotation strength, maintaining good tendon integrity in the early postoperative period.

Keywords

knotless / rotator cuff injuries / rotator cuff repair / subscapularis

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