Illustrated Tips & Tricks CH16

Chapter 16 Arthroscopic Subscapularis Repair  119 Partial-Thickness and Full-Thickness Upper Subscapularis Tears ll Tears of the upper 50% of the subscapularis tendon (Fig. 16-10A) fixed with a single anchor (Fig. 16-10B) represent the majority of repairs in our practice. • A tape suture secured with a knotless, threaded suture anchor (eg, FiberTape and SwiveLock, Arthrex, Inc., Naples, FL) is a very efficient construct (SpeedFix, Arthrex, Inc., Naples, FL). 6 nn Usually the tape suture is passed antegrade (Fig. 16-10C and D) (eg, Scorpion suture passer, Arthrex, Inc., Naples, FL) through the ASL portal. nn The anchor (Fig. 16-11) is placed through the ASL portal or through an accessory anterior portal, depending on the best angle of approach (Fig. 16-11). • Sutures (no. 2 FiberWire, Arthrex, Inc., Naples, FL) from a high biceps tenodesis construct can be used to suture the upper subscapularis tendon (Fig. 16-12). nn The tenodesis socket is placed slightly medial at the top of the groove (Fig. 16-12D) so that the tendon is compressed against the lesser tuberosity (Fig. 16-12F). nn One FiberWire limb from each suture pair is passed antegrade using a Scorpion through the ASL portal. nn The sutures are tied with a six-throw surgeon’s knot 7 with a double-diameter knot pusher (6th Finger, Arthrex, Inc., Naples, FL). nn This is most commonly done as a single-portal technique.

Figure 16-10 || SpeedFix upper subscapularis repair (right shoulder). A. 70-degree view demonstrates the subscapularis (SSc) tear and (B) final anatomic repair (30-degree view) with preserved comma tissue ( black comma symbol ). (C) A FiberTape suture is passed through the ASL working portal with a Scorpion suture passer (D) . Care must be taken to not fire the Scorpion needle against the coracoid (C) or into the conjoint tendon (CT). The suture tails are retrieved out of the anterior portal, threaded through the eyelet of the anchor, and secured using a SwiveLock anchor (E) . After the FiberTape has been cut (F) , the final construct is very low profile (70 degrees view). C, coracoid; CT, conjoint tendon; H, humeral head; LT, lesser tuberosity.