The Combined “Double-Pulley” Simple Knot Technique for Arthroscopic Transtendon Fixation of Partial Articular-Sided Tear of the Subscapularis Tendon  Nata Parnes, M.D., Paul Carey, M.D., Mario Ciani, D.C., Monica Morman, M.D.  Arthroscopy Techniques  Volume 5, Issue 1, Pages e177-e183 (February 2016) DOI: 10.1016/j.eats.2015.10.018 Copyright © 2016 Terms and Conditions

Fig 1 By use of a probe through the anterior portal, the partial articular-sided subscapularis tendon tear is confirmed according to the existence of a partial detachment of the subscapularis tendon (SST) from the lesser tuberosity (left shoulder, viewing from posterior). (HH, humeral head.) Arthroscopy Techniques 2016 5, e177-e183DOI: (10.1016/j.eats.2015.10.018) Copyright © 2016 Terms and Conditions

Fig 2 Debridement of tissue along the anterior aspect of the tendon is performed under direct visualization, with avoidance of dissection medial or distal to the coracoid base to avoid injury to the neurovascular structures (same left shoulder shown in Fig 1, viewing from posterior). Arthroscopy Techniques 2016 5, e177-e183DOI: (10.1016/j.eats.2015.10.018) Copyright © 2016 Terms and Conditions

Fig 3 By use of a motorized shaver through the anterior portal while the arm is in internal rotation, the exposed bone of the lesser tuberosity is debrided and all the remnant soft tissue is removed from the bone (same left shoulder shown in Fig 1, viewing from posterior). Arthroscopy Techniques 2016 5, e177-e183DOI: (10.1016/j.eats.2015.10.018) Copyright © 2016 Terms and Conditions

Fig 4 The straight Acupass device (Smith & Nephew) is used through the anterior portal to shuttle both limbs of the suture through the inferomedial aspect of good-quality tendon (same left shoulder shown in Fig 1, viewing from posterior). Arthroscopy Techniques 2016 5, e177-e183DOI: (10.1016/j.eats.2015.10.018) Copyright © 2016 Terms and Conditions

Fig 5 The Healicoil Regenesorb 4.75-mm double-loaded anchor (Smith & Nephew) is placed at the proximal portion of the exposed lesser tuberosity footprint (same left shoulder shown in Fig 1, viewing from posterior). Arthroscopy Techniques 2016 5, e177-e183DOI: (10.1016/j.eats.2015.10.018) Copyright © 2016 Terms and Conditions

Fig 6 The straight Acupass device (Smith & Nephew) is used through the anterior portal to shuttle three suture limbs through the upper portion of the tendon in line with the sutures from the first anchor (same left shoulder shown in Fig 1, viewing from posterior). Arthroscopy Techniques 2016 5, e177-e183DOI: (10.1016/j.eats.2015.10.018) Copyright © 2016 Terms and Conditions

Fig 7 The matching limb of the suture that was previously retained in the cannula is retrieved through the anterolateral portal (same left shoulder shown in Fig 1, viewing from posterior). Arthroscopy Techniques 2016 5, e177-e183DOI: (10.1016/j.eats.2015.10.018) Copyright © 2016 Terms and Conditions

Fig 8 Through the anterior cannula, the sutures from the two anchors are tied by a double-pulley technique (same left shoulder shown in Fig 1, viewing from posterior). Arthroscopy Techniques 2016 5, e177-e183DOI: (10.1016/j.eats.2015.10.018) Copyright © 2016 Terms and Conditions

Fig 9 At the end of the procedure, the adequacy of the repair is confirmed with a probe (same left shoulder shown in Fig 1, viewing from posterior). Arthroscopy Techniques 2016 5, e177-e183DOI: (10.1016/j.eats.2015.10.018) Copyright © 2016 Terms and Conditions

Fig 10 Final view through anterolateral portal after combined double-pulley simple knot repair technique (same left shoulder shown in Fig 1, viewing from posterior). Arthroscopy Techniques 2016 5, e177-e183DOI: (10.1016/j.eats.2015.10.018) Copyright © 2016 Terms and Conditions