Illustrated Tips & Tricks CH16

124  Chapter 16 Arthroscopic Subscapularis Repair

• In the case of planned LHB tenodesis, most of the subscapularis repair can be completed up to placement of an inferolateral row anchor. Then the biceps tenodesis can be completed with the tenodesis anchor (BioComposite SwiveLock Tenodesis or Bio-Tenodesis, Arthrex, Inc., Naples, FL) serving as the superolateral row anchor. Postoperative Care Arthroscopic rotator cuff repair allows postoperative rehabilitation that prioritizes tendon-to-bone healing over early, aggressive shoulder range of motion, as the risk of stiffness is low. 9,10 ll 0-6 weeks: Sling immobilization • Three times daily passive external rotation of shoulder with the arm at the side (PVC cane) to 0 degrees (larger, full-thickness subscapularis tears) or 30 degrees (small, partial-thickness subscapularis tears). • Isolated subscapularis tears or other at-risk patients (calcific tendonitis, adhesive capsulitis, concomitant labral repair) perform early, closed chain, passive overhead motion (table slide) ll 6-12 weeks: Sling is discontinued and full passive range of motion (ROM) is added. • Full passive external rotation (ER) stretching is begun. • Rope and pulley overhead and behind back internal rotation stretches are begun. • Arm can be used for light activities of daily living below shoulder level. ll 3-6 months: Full active overhead ROM and strengthening • Rubber band strengthening is initiated. • No heavy overhead lifting and no acceleration of arm in sport is allowed. References 1. Brady PC, Narbona P, Adams CR, et al. Arthroscopic proximal biceps tenodesis at the articular margin: evaluation of out- comes, complications, and revision rate. Arthroscopy . 2015;31(3):470-476. 2. Sheean AJ, Hartzler RU, Denard PJ, Lädermann A, Hanypsiak BT, Burkhart SS. A 70° arthroscope significantly improves visualization of the bicipital groove in the lateral decubitus position. Arthroscopy . 2016;32(9):1745-1749. 3. Hartzler RU, Burkhart SS. Medial biceps sling takedown may be necessary to expose an occult subscapularis tendon tear. Arthrosc Tech . 2014;3(6):e719-e722. 4. Lo IK, Burkhart SS.The comma sign: an arthroscopic guide to the torn subscapularis tendon. Arthroscopy . 2003;19(3):334-337. 5. Denard PJ, Burkhart SS. Medialization of the subscapularis footprint does not affect functional outcome of arthroscopic repair. Arthroscopy . 2012;28(11):1608-1614. 6. Denard PJ, Burkhart SS. A new method for knotless fixation of an upper subscapularis tear. Arthroscopy . 2011;27(6):861-866. 7. Burkhart SS, Lo IK, Brady PC. Burkhart’s View of the Shoulder: A Cowboy’s Guide to Advanced Shoulder Arthroscopy . Philadelphia, PA: Lippincott Williams & Wilkins; 2006:48-52. 8. Denard PJ, Lädermann A, Burkhart SS. Double-row fixation of upper subscapularis tears with a single suture anchor. Arthroscopy . 2011;27(8):1142-1149. 9. Koo SS, Parsley BK, Burkhart SS, Schoolfield JD. Reduction of postoperative stiffness after arthroscopic rotator cuff repair: results of a customized physical therapy regimen based on risk factors for stiffness. Arthroscopy . 2011;27(2):155-160. 10. Huberty DP, Schoolfield JD, Brady PC, Vadala AP, Arrigoni P, Burkhart SS. Incidence and treatment of postoperative stiffness following arthroscopic rotator cuff repair. Arthroscopy . 2009;25(8):880-890.

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