دانلود رایگان مقاله آرتروسکوپی مرور شده ساب اسکاپولاریس ضایعه پنهان

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. The authors report the following potential conflict of interest or source of funding: L.N. receives support from Tornier and Arthrex. G.W. receives royalties from Tornier/Wright Company and equity from Imascap. Their immediate family and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.

Discussion

The hidden lesion, as described by Walch et al.2 in open repairs of the supraspinatus, is still pertinent in the age of arthroscopy. Both Bennett3 and Koo and Burkhart4 have documented techniques to aid in the arthroscopic identification of subscapularis tears. However, visualization of the entire subscapularis attachment is not possible arthroscopically, given the anatomic relations with the coracohumeral ligament and medial pulley.5 By removing the rotator interval and medial pulley, complete visualization of the subscapularis attachment is obtained, thus allowing for identification of a hidden lesion. When clinical suspicion of a subscapularis lesion is present, we believe this technique allows for adequate visualization of the subscapularis attachment and reduces the risk of missing a lesion during arthroscopy. There are some risks and limitations with the described technique (Table 2). Most important, clinical suspicion of a hidden lesion must exist to use this technique because the additional dissection and operative time required may result in inferior surgical outcomes. Meticulous dissection of the rotator interval and medial pulley is paramount because aggressive or misplaced dissection can damage the supraspinatus or subscapularis tendon.