In diagnosis and repair of partial subscapularis tendon tears, we used a simplified arthroscopic direct technique.

We used the anterosuperior arthroscopic portal to visualise the subscapularis tendon insertion, while probing and repairing from the adjacent anterior portal. Three anatomical dissections were done to define the insertion of the subscapularis tendon at the lesser tuberosity. While viewing from the anterosuperior portal, we repaired the subscapularis tendon with one or two suture anchors, inserted into the lesser tuberosity from the anterior portal. Suture management was via the standard posterior portal. From the anterior portal, a tendon-penetrating grasping device passed the sutures through the displaced subscapularis tendon. The arthroscopic knots were tied from the anterior portal.

Associated with the first 10 subscapularis repairs were six complete and four partial thickness supraspinatus/infraspinatus tears. There were no isolated subscapularis tears. Three patients had associated biceps lesions.

Subscapularis tears are often associated with supraspinatus and infraspinatus tendon tears. Direct anterosuperior viewing and anterior probing enables the surgeon to see and repair ‘hidden’ tears.