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Tears of the Subscapularis Tendon: Recognition and Treatment
The subscapularis muscle is the largest and strongest muscle of the rotator cuff, and plays a key role in shoulder stability and function. The management of subscapularis tears is aimed at restoring the integral role of this muscle in the shoulder. The indications for arthroscopic subscapularis tendon repair are essentially the same as the indications for arthroscopic rotator cuff repair. Although an open technique can be used, arthroscopic subscapularis tendon repair provides improved visualization of the anterior and posterior aspects of the subscapularis tendon, thus facilitating tendon identification, releases, and repair. Furthermore, arthroscopic management allows multiple portals of entry and angles of approach when repairing massive rotator cuff tears involving the subscapularis tendon combined with posterior extension. However, because of its relative complexity, arthroscopic subscapularis tendon repair should be attempted only after the surgeon is comfortable with standard arthroscopic rotator cuff repair techniques. This chapter reviews the indications, results, and surgical technique for arthroscopic repair of subscapularis tendon tears. Controversies, alternative treatments, and tips for limiting adverse events are also described.