The document describes the steps for performing a subscapularis repair surgery. It begins with positioning the patient in lateral decubitus and establishing arthroscopic portals. It then details classifying subscapularis tears, mobilizing the torn tendon, preparing the footprint with debridement, inserting anchors and sutures, and tying knots to reattach the tendon. Proper management of sutures and evaluation of the final repair are emphasized.
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S sc repair final
1. www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
How to do a subscapularis
repair
Manos Antonogiannakis
Orthopaedic Surgeon
Director of 3rd Orthopaedic Department
Centre for Arthroscopy & Shoulder Surgery
Hygeia General Hospital
ESSKA Advanced Shoulder Arthroscopy Course
All About Rotator Cuff & Other Subacromial Disorders
Verona, 13-14 June 2017 .
3. www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Subscapularis repair
• Dorsal portal
• Anteroinferior portal
• Anterosuperior portal
30° or 70° arthroscope
4. www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Classification of SSC-tears (Fox and Romeo)
Type I Partial thickness tear
Type II Complete tear of the upper 25% of the tendon
Type III Complete tear of the upper 50% of the tendon
Type IV Complete rupture of the tendon
5. www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Subscapularis repair
Instability or tear of LBT : tenotomy
or tenodesis
Repair of SSC
then
9. www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Coracoid Impingement
Roller-wringer effect
Normal coracohumeral space: 8-10mm
Burkart St. Cowboy´s guide to advanced shoulder arthroscopy
15. www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Subscapularis repair
Mobilization of SSC tendon
• anterior (open the rotator
interval, free from coracoid
process )
• posterior (from glenoid neck)
• Superior from coracoid
18. www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Subscapularis repair
Debridement of the footprint
Lichtenberg, Habermeyer, Magosch
19. www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Subscapularis repair
Anchor / sutures
1 anchor (partial tear)
2 anchors (complete tear)
Lichtenberg, Habermeyer, Magosch
21. www.shoulder.gr
E. Antonogiannakis How to do a subscapularis repair
Verona 13.06.2017
Subscapularis repair
Knot tying
Lichtenberg, Habermeyer, Magosch