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Purpose: To investigate the accuracy of preoperative 1.5 T magnetic resonance imaging (MRI) interpreted with standardized procedure for diagnosing subscapularis (SSC) tears identified by arthroscopy. The diagnostic accuracy of MRI for different types of SSC lesions was also evaluated., Methods: Two-hundred and seventy-two consecutive patients with rotator cuff tears identified by arthroscopy were included into this study. All patients had preoperative MRI scans with 1.5 T strength. Totally, seven different signs of SSC tears were evaluated on MRI scans. The diagnostic value of MRI was evaluated, respectively, according to two classifications of SSC lesions. The definitive diagnosis for SSC lesions was based on the arthroscopic findings., Results: Among the 272 patients in this study, 107 (39 %) had SSC tears confirmed by arthroscopy. The surgeons correctly diagnosed 88 of 107 patients with SSC tears. The overall sensitivity was 82.2 %. The sensitivity of MRI for types I, II, III, IV and V was 70, 82.4, 96, 100 and 100 %, respectively, based on the classification by Lafosse. The sensitivity of MRI for partial-thickness and partial-width, full-thickness and partial-width, full-thickness and full-width tear was 75.3, 96.2, 100 %, respectively, according to the classification by Kim., Conclusions: The sensitivity of MRI in predicting SSC tears preoperatively was improved with the current procedure. Understanding of certain MRI characteristics of SSC tears could increase the accuracy for diagnosing SSC lesions. 1.5 T MRI of the SSC was not reliable for predicting partial thickness and especially less than 1/3 width tears., Level of Evidence: III.

Background: There have been few studies using magnetic resonance imaging (MRI) to evaluate the clinical outcomes and structural results after arthroscopic repair of bursal-side partial-thickness rotator cuff tears (PTRCTs)., Methods: From 2009 to 2012, 73 consecutive patients with bursal-side PTRCTs underwent arthroscopic repair. Fifty-nine of them were retrospectively evaluated as Ellman classification grade 2 (group A, n = 11) or grade 3 (group B, n = 48). All repairs were performed with a technique that preserved the intact articular fibers and repaired the avulsed bursal flap. The University of California-Los Angeles (UCLA) score and Constant score were assessed before the operation and at the final follow-up. Postoperative cuff integrity was determined with MRI following Sugaya's classification., Results: At the 2-year follow-up, the average UCLA score increased from 17.3 ± 3.7 to 33.3 ± 2.2, and the Constant score increased from 65.3 ± 12.9 to 93.9 ± 5.1 (P < .001). Forty-nine patients received follow-up MRI examinations at an average of 10.3 months after surgery. Of these 49 patients, 41 patients (83.7%) had a healed tendon and 8 patients had partial tears. Neither the clinical scores nor the retear rates on follow-up MRI were significantly different between the 2 groups., Conclusions: Arthroscopic repair of bursal-side PTRCTs achieved good functional and structural outcomes at a minimum of 2 years after surgery., (Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate the clinical characteristics of intratendinous subscapularis (inSSC) tears. Methods: Retrospectively, 69 patients with arthroscopically confirmed inSSC tears were identified from 2018 to 2019. Preoperatively and at final follow-up, thorough physical examination was performed and clinical outcomes (American Shoulder and Elbow Surgeons [ASES] score; University of California, Los Angeles [UCLA] score; visual analogue scale [VAS] for pain; and Simple Shoulder Test [SST]) were recorded. Features of pre-operative magnetic resonance image (MRI) such as high signalling within the tendon substance, communication to the bicipital groove and long head of biceps tendon (LHBT) lesions were investigated. Characteristics of arthroscopic view were investigated. Bear-hug and internal rotation resistance test at 90° abduction and external rotation (IRRT90°) test were used to assess the SSC strength. Results: The mean follow-up was 2.4 (2–3) years. The prevalence of arthroscopically confirmed inSSC tears was 69/675 (10.2%) among arthroscopic rotator cuff repairs. Pre-operative physical examination found positive IRRT90° and bear-hug test in 41/60 (68.3%) and 42/69 (60.8%) patients, respectively. The Cohen kappa coefficient was interpreted to be substantial for the evaluation of all MRI parameters. According to the conditions of LHBT, inSSC tears were classified into 3 types: type I: without LHBT subluxation and tear; type II: with LHBT subluxation or tears and type III: with LHBT dislocation. At final follow-up, mean ASES, UCLA, VAS, and SST scores improved significantly from mean of 50.6 ± 14.7, 19.4 ± 3.07, 6.2 ± 2.0, and 6.1 ± 2.5 to mean of 90.7 ± 9.5, 32.2 ± 1.8, 1.4 ± 1.2 and 9.8 ± 2.2, respectively (P < 0.001). Bilateral symmetric strength was found by bear-hug and IRRT90° test in all patients postoperatively. Conclusion: Understanding features of pre-operative MRI, physical examination and arthroscopic view is helpful to identify inSSC tears. Arthroscopic repair yielded satisfactory clinical outcomes in patients with inSSC tears. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

Background: Avulsion fracture of the lesser tuberosity (AFLT) of the humerus has traditionally been treated with open reduction internal fixation using screw fixation. The clinical outcomes of arthroscopic repair with suture anchors remains unknown. Hypothesis: It was hypothesized that arthroscopic fixation with suture anchors would result in good clinical outcomes for the treatment of AFLT. Study Design: Case series; Level of evidence, 4. Methods: This study included 15 patients who underwent arthroscopic repair of AFLT of the humerus between January 2014 and October 2017. All patients had 3-dimensional computed tomography scans and magnetic resonance imaging to evaluate the avulsed fracture and concomitant injuries before surgery. The arthroscopic double-row and suture-bridge techniques were used based on the morphology of the avulsion fractures. Functional outcomes were assessed with range of motion, the visual analog scale (VAS) for pain, the Subjective Shoulder Value (SSV), the American Shoulder and Elbow Surgeons (ASES) score, and the University of California, Los Angeles (UCLA) shoulder score. The bear-hug test, liftoff test, and internal rotation resistance test at 90° abduction and external rotation (IRRT 90°) were used to evaluate subscapularis tendon integrity. Results: The mean follow-up time was 3.5 years (range, 3-5 years). Comminuted fractures with 1 large part and ≥1 small pieces were seen in 12 cases, partial tear of the supraspinatus in 2 cases, Bankart lesion in 2 cases, and superior labrum anterior to posterior injury in 2 cases. There was a statistically significant improvement from the baseline to the final follow-up in the VAS (from 6.9 ± 1.5 to 1.1 ± 1), SSV (from 30.7 ± 5.1 to 90.5 ± 11.6), ASES (from 28.5 ± 7.7 to 92.3 ± 4.5), and UCLA (from 29.5 ± 6.3 to 94.2 ± 8.3) scores (P <.001 for all). All patients showed full range of shoulder motion and bilateral symmetric strength on physical examination with the bear-hug test, liftoff test, and IRRT 90° test. Conclusion: The arthroscopic repair of AFLT resulted in excellent reduction and healing of the displaced fragment. At the final follow-up, clinical and functional results were good. Associated injuries occurred in 40% of patients but did not affect outcomes. [ABSTRACT FROM AUTHOR]

Purpose: A new clinical test for evaluating subscapularis (SSC) integrity was described, and its diagnostic value was compared with the present SSC tests (the lift-off, belly-press, IRLS and bear-hug tests). The new test is called internal rotation resistance test at abduction and external rotation (IRRT). The test is performed at maximal 90° of abduction and maximal external rotation. Methods: Two hundred and thirty-five consecutive patients suffering from rotator cuff injury were evaluated preoperatively. Six tests were performed to assess the function of the SSC: the lift-off, belly-press, IRLS, the bear-hug, IRRT at 0° abduction and 0° external rotation (IRRT0°) and IRRT at maximal 90° abduction and maximal external rotation (IRRTM). Arthroscopic findings were the reference for diagnosing of SSC lesions. Results: The IRRTM test showed the greatest sensitivity (76.5 %), and IRLS (31.6 %) test had the lowest sensitivity. The IRRTM had the highest accuracy (79.0 %), and lift-off had the lowest accuracy (65.3 %). Positive IRRTM, bear-hug, belly-press, IRRT0° tests indicate that about one-third of the SSC is torn, and a positive lift-off and IRLS tests predict a severe tear at least two-thirds of the SSC. Conclusions: The IRRTM represents a sensitive diagnostic test for SSC lesions and improves the chance of finding the upper part of the SSC tears. When the IRRTM is positive, the surgeon should pay particular attention to detecting the SSC tendon during arthroscopy. Level of evidence: Diagnostic study, Level I. [ABSTRACT FROM AUTHOR]