Illustrated Tips & Tricks CH16

118  Chapter 16 Arthroscopic Subscapularis Repair

Figure 16-8 || Lesser tuberosity bone bed preparation (right shoulder) viewing with a 70-degree arthroscope and working from an ASL portal. The typical, “sharp angled” appearance of the superomedial border of the lesser tuberosity articular margin is outlined in dotted yellow . A. Electrocautery is used to remove soft tissue remnants. B. Ring curette (shown) or burr on reverse is used to remove the “charcoal” bone leaving a healthy bone bed with a sharp articular margin. H, humeral head; SSc, subscapularis.

Retracted Subscapularis Tears

ll Most retracted subscapularis tendon tears can be repaired primarily or to a slightly (~5 mm) medialized bone bed 5 ; however, a three-sided release may be necessary (Fig. 16-9). • The comma tissue is identified and protected. • A traction suture is placed at the junction of the comma and upper tendon border (Fig. 16-13A and B) through the ASL portal but maintained outside of the cannula. • Anterior (Fig. 16-9A) and superior (Fig. 16-9B) releases involve skeletonizing the coracoid from lateral (tip) along the neck to the base to release adhesions between the subscapularis tendon and the bone. nn A combination of electrocautery and shaver is used (Fig. 16-9A). nn The subscapularis is freed from the deep fascia and conjoint tendon, if necessary, respecting the proximity of the musculocutaneous nerve. nn A 30-degree elevator is used bluntly under the neck of the coracoid (Fig. 16-9B) to lyse adhesions in this area (it is unnecessary and risky to dissect medial to the neck). • Posterior release (Fig. 16-9C) involves freeing adhesions between the subscapularis and the scapula. nn Blunt dissection with a 15-degree elevator is used typically, as this is a relatively avascular plane.

Figure 16-9 || Left shoulder 70-degree arthroscopic views showing three-sided subscapularis releases. A. The anterior release involves lysis of adhesions between the coracoid ( C ) and the subscapularis tendon (SSc). A shaver from anterosuperior is used to resect adhesions in this area ( white arrow ). B. A 30-degree arthroscopic elevator bluntly releases adhesions between the tendon and the coracoid neck (CN). C. A 15-degree elevator is used to free the posterior subscapularis from the anterior scapula. H, humeral head; L, anterior labrum.