Illustrated Tips & Tricks CH16

122  Chapter 16 Arthroscopic Subscapularis Repair

Multiple Anchor and Double-Row Repairs Larger subscapularis tears may require additional anchors and/or linked, double-row fixation. ll Two medial suture anchors are used for tears larger than 50% of the superoinferior length of the lesser tuberosity (rule of thumb: one double-loaded suture anchor [5.5 or 4.5 mm BioComposite FT CorkScrew (Arthrex, Inc., Naples, FL)] is used for each linear centimeter of tear). • The inferior medial anchor can be placed transtendon for nonretracted tears (Fig. 16-13A and B), from lateral to the retracted edge (ensure a good angle of approach using spinal needle), or by coming “over the top” of the superior border of the subscapularis (Fig. 16-14C). • In the case of two medial anchors, sutures can be passed and tied using a double-pulley construct (Fig. 16-14F and J), in a horizontal mattress fashion (Fig. 16-13C and D) or as simple sutures. ll Linked, double-row repairs of the subscapularis may require novel constructs, as the “real estate” for lateral row anchors can be limited. • Double-row repair should be attempted for large (50%-100% bare lesser tuberosity) tears (Fig. 16-14B), particularly those that are full thickness from medial to lateral and retracted.

Figure 16-13 || Left shoulder single-row subscapularis (SSc) repair with two medial anchors. A. 70-degree view showing a bone socket being punched transtendon with the lower medial anchor (B) also being inserted in this fashion. The sutures from both medial anchors have been passed (C) in mattress fashion and then tied using a double-diameter knot pusher. The final construct (D) shows an anatomic repair. H, humeral head; LT, lesser tuberosity.