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The Hidden Lesion of the Subscapularis: Arthroscopically Revisited.

ABSTRACT: The "hidden lesion" refers to a tear of the subscapularis in the presence of an intact biceps pulley or rotator interval. Visualization of these tears during open surgery is difficult, yet even with the advancement of arthroscopy, visualization can still be challenging. Incomplete visualization of the subscapularis could lead to failure to diagnose a tear of the tendon and subsequently hinder results after shoulder surgery. With the advancement of arthroscopy, a technique to identify these hidden lesions is needed to avoid inferior results. We describe an arthroscopic technique to visualize, diagnosis, and repair these tears when clinically indicated. Implementing this technique in the setting of suspected subscapularis tendon injury can provide complete visualization of the tendon insertion.

SUBMITTER: Neyton L

PROVIDER: S-EPMC5040480 | biostudies-literature | 2016 Aug

REPOSITORIES: biostudies-literature

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The Hidden Lesion of the Subscapularis: Arthroscopically Revisited.

Neyton Lionel L Daggett Matthew M Kruse Kevin K Walch Gilles G

Arthroscopy techniques 20160815 4

The "hidden lesion" refers to a tear of the subscapularis in the presence of an intact biceps pulley or rotator interval. Visualization of these tears during open surgery is difficult, yet even with the advancement of arthroscopy, visualization can still be challenging. Incomplete visualization of the subscapularis could lead to failure to diagnose a tear of the tendon and subsequently hinder results after shoulder surgery. With the advancement of arthroscopy, a technique to identify these hidde ...[more]

PMID: 27709052

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Project description:PurposeThe purpose of this study was to describe the surgical findings and clinical outcomes in a series of patients with occult posterolateral meniscocapsular separations diagnosed arthroscopically after a negative magnetic resonance imaging (MRI) scan.MethodsA retrospective analysis of prospectively collected data of consecutive patients who underwent surgical arthroscopy with repair of an occult posterolateral meniscocapsular separation by 2 fellowship-trained orthopaedic sports medicine surgeons at a single institution was performed. All lesions were identified arthroscopically in the posterolateral aspect of the lateral compartment as a distinct pathologic separation between the posterolateral capsule and adjacent meniscal tissue with increased excursion on probing. Clinical examination notes, MRI scans, and operative reports were reviewed. Patient-reported outcome measures were assessed via patient questionnaire.ResultsA total of 6 patients were included for analysis. MRI evaluation of the lateral meniscus was unrevealing in 4 patients, suggesting a possible tear of the body of the lateral meniscus in one patient and demonstrating a parameniscal cyst abutting the anterior root of the lateral meniscus in another patient. Arthroscopic examination revealed meniscocapsular separations of the posterolateral meniscus in all 6 knees, with 2 knees demonstrating concomitant bucket-handle meniscus tears. Patient-reported outcomes were determined for 67% of study patients. The average reported International Knee Documentation Committee score was 63.8, the average Knee Outcome Survey Activities of Daily Living Scale score was reported as 63, the 12-Item Short Form Survey (SF-12) Physical score averaged 46.8 with an average SF-12 Mental score of 59.9.ConclusionsThe diagnosis of occult posterolateral meniscocapsular separations (MCS) could be missed on advanced imaging, such as MRI, so arthroscopic diagnosis may be required. This study indicates that arthroscopic diagnosis and repair of occult posterolateral MCS results in good functional and clinical outcomes.Level of evidenceIV, therapeutic case series.

Dataset Information

The Hidden Lesion of the Subscapularis: Arthroscopically Revisited.

Publications

The Hidden Lesion of the Subscapularis: Arthroscopically Revisited.

Similar Datasets

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