The Double-Pulley Anatomic Technique for Type II SLAP Lesion Repair Nata Parnes, M.D., Mario Ciani, D.C., Brian Carr, M.D., Paul Carey, M.D.  Arthroscopy Techniques  Volume 4, Issue 5, Pages e545-e550 (October 2015) DOI: 10.1016/j.eats.2015.05.009 Copyright © 2015 Terms and Conditions

Fig 1 With viewing through the posterior portal, the type II SLAP lesion is confirmed by the existence of a complete detachment of the biceps anchor from the supraglenoid tubercle using a probe. This image and Figures 2-9 show the same left shoulder with the patient in the beach-chair position. Arthroscopy Techniques 2015 4, e545-e550DOI: (10.1016/j.eats.2015.05.009) Copyright © 2015 Terms and Conditions

Fig 2 With viewing through the posterior portal, a 4.5-mm shaver is used through the anterosuperior portal to debride the superior glenoid neck to bleeding bone and the edge of the superior labrum as indicated. Arthroscopy Techniques 2015 4, e545-e550DOI: (10.1016/j.eats.2015.05.009) Copyright © 2015 Terms and Conditions

Fig 3 With viewing through the posterior portal, a Suturefix 1.9-mm double-loaded anchor is placed at the 10-o'clock position through a trans–rotator cuff portal. Arthroscopy Techniques 2015 4, e545-e550DOI: (10.1016/j.eats.2015.05.009) Copyright © 2015 Terms and Conditions

Fig 4 An arthroscopic simple vertical knot is used to fix the posterior portion of the tear where the appearance of the articular edge of the labrum does not change with shoulder motion. Arthroscopy Techniques 2015 4, e545-e550DOI: (10.1016/j.eats.2015.05.009) Copyright © 2015 Terms and Conditions

Fig 5 The 2 arms of the second suture on the anchor are shuttled through the superior-posterior labrum. By use of the anterosuperior portal, a Suturefix 1.7-mm single-loaded anchor is placed on the glenoid neck in line with the anterior edge of the long head of the biceps tendon. Arthroscopy Techniques 2015 4, e545-e550DOI: (10.1016/j.eats.2015.05.009) Copyright © 2015 Terms and Conditions

Fig 6 A shuttling device is used to retrieve the 2 arms of the suture on the anterior anchor through the superior-anterior labrum. The surgeon retrieves the 4 limbs of the 2 sutures through the trans–rotator cuff portal, paying attention to retrieve the suture limbs from the anterior anchor superior to the biceps tendon to prevent entanglement. Arthroscopy Techniques 2015 4, e545-e550DOI: (10.1016/j.eats.2015.05.009) Copyright © 2015 Terms and Conditions

Fig 7 One suture limb for each anchor is chosen to be coupled in a double-pulley configuration. Arthroscopy Techniques 2015 4, e545-e550DOI: (10.1016/j.eats.2015.05.009) Copyright © 2015 Terms and Conditions

Fig 8 Fixation of the long head of the biceps tendon anchor is completed with tightening of non-sliding knots on the remaining suture limbs of each anchor. As viewed from above, the completed double-pulley construct secures the biceps anchor fibers medially between 2 suture anchors. Arthroscopy Techniques 2015 4, e545-e550DOI: (10.1016/j.eats.2015.05.009) Copyright © 2015 Terms and Conditions

Fig 9 At the end of the procedure, the adequacy of the repair is confirmed using a probe. Arthroscopy Techniques 2015 4, e545-e550DOI: (10.1016/j.eats.2015.05.009) Copyright © 2015 Terms and Conditions