Illustrated Tips & Tricks CH16

Chapter 16 Arthroscopic Subscapularis Repair  123

Figure 16-14 || Left shoulder showing a linked, double-row subscapularis repair (SpeedBridge). A. In this case, even with a posterior lever push, there was limited working space ( red double arrow ) anteriorly. A traction suture placed at the junction of the comma tissue ( black comma symbol  ) and the upper subscapularis (SSc) is being retrieved out of an accessory anterior portal. B. The working space ( green double arrow ) has been dramatically improved with anteriorly directed traction ( black arrow ) from the traction suture. Nearly the entire lesser tuberosity (LT) has bare bone. C. The punch for the lower medial anchor is being brought in superior to the subscapularis tendon. This anchor also can be placed transtendon. D. The superomedial anchor is inserted at the superomedial aspect of the LT. E. Antegrade lower medial anchor suture passage using a Scorpion from the ASL portal. F. The final six-throw surgeon’s knot is tied in the subcoracoid space completing a medial double-pulley construct ( white sutures from each anchor tied together as a double mattress). G. The blue sutures from each anchor passed and tied as standard horizontal mattresses. Half of the suture limbs were retrieved and fixed laterally to SwiveLock anchors (H) . The final 70-degree intra-articular (I) and subacromial (J) views of the repair show anatomic restoration of the footprint. In this case, because the biceps tendon had been chronically torn, the bicipital groove was unobstructed for placement of inferior ( orange arrow ) and superior ( blue arrow ) lateral row anchors. H, humeral head.

• If a SpeedFix upper tendon repair has not fully restored the footprint, the FiberTape suture can be left long and secured laterally into a biceps tenodesis construct or another SwiveLock anchor as a linked, double-row construct. 8 • If the LHB tendon has been chronically torn and retracted (or with tenotomy), there may be ade- quate room for a true SutureBridge or SpeedBridge (Arthrex, Inc., Naples, FL) repair with two lateral row knotless anchors (Fig. 16-14).