Purpose Based on its close anatomic features and nearly-collinear force vector to those of supraspinatus muscle, the current article describes a technique of middle trapezius tendon transfer for reproduction of supraspinatus function in the context of rotator cuff irreparability/re-tear management. Methods While seating the patient in beach-chair position, arthroscopic gleno-humeral examination and sub-acromial decompression are initially performed. Hamstring tendons are harvested and fashioned as flattened quadruple sheet. Through McKenzie approach, infraspinatus and subscapularis tendons are repaired. Then, medial half of middle trapezius insertion tendon is harvested from most medial 5-6 cm of the scapular spine. Through McKenzie approach, hamstring sheet is retrieved via a sub-trapezius/sub-acromial corridor from the scapular wound. Hamstring sheet is re-attached to cuff footprint by double row/suture bridge repair configuration. While retracting the scapula and placing gleno-humeral joint in 45O-abduction/45O-external rotation, hamstring sheet is re-attached to released middle trapezius tendon by non-absorbable sutures. Finally, tendon reconstruct is dynamically-tested in different positions of range of motion. Results Transfer of medial portion of middle trapezius insertion tendon (lengthened by interposition hamstring tendon sheet) to cuff footprint was technically feasible. Dynamic testing showed smooth sub-acromial gliding motion of the tendon reconstruct. Conclusion For reproduction of supraspinatus function, hamstring tendon augmented-middle trapezius tendon transfer to cuff footprint heralds a number of technical and biomechanical advantages; thus offering a potential effective modality of cuff irreparability/re-tear management in relatively young patients of high functional demands. However, current description should be investigated in further biomechanical and clinical studies to validate its long-term outcomes.

As an alternate to sling glenohumeral restabilization mechanism of Latarjet procedure, recent different arthroscopic soft-tissue reconstructive techniques have been described for the management of glenohumeral instability. One of these techniques is trans-subscapularis bony tenodesis of long head of biceps (instead of coracoid graft transfer) to the anteroinferior glenoid. For simplification of the latter technique, the current article reports an alternative arthroscopic technique for management of glenohumeral instability in patients with type V SLAP lesion or poor soft-tissue quality of the anterior capsulolabral complex. In this technique, Bankart repair is followed by soft-tissue tenodesis of long head of biceps to upper border of subscapularis tendon by 2 simple stitches of non-absorbable sutures. Compared with previous ones, the currently reported technique is versatile, quick, technically simple, entirely intra-articular, and cost-saving; however, it is nonanatomic and should be investigated in biomechanical and cohort clinical studies to clarify its longterm validity.

Background: This study was conducted to investigate three questions; Does biceps tenodesis without tenotomy reduce short-term tenodesis failure and revision rate? Does preserved biceps origin increase the prevalence of postoperative bicipital pain and tenderness? Does this technical modification limit postoperative range of motion? Methods: Between October 2014 and December 2018, a case series of 24 patients with different isolated biceps tendon lesions were prospectively managed by arthroscopic intraarticular suture-anchor biceps tenodesis without tenotomizing the biceps intraarticular origin. Patients were evaluated for demographics and for preoperative and 2-year postoperative range of motion, University of California Los Angeles (UCLA) scoring system, return to work, persistent bicipital pain or tenderness, and Popeye sign (tenodesis failure). Results: Mean age of the group was 46.7 yr. Statistical analysis revealed highly significant postoperative improvement in UCLA score parameters (P<0.001) and in active range of motion (P<0.001). However, when compared with its sound counterpart, the operated shoulder had 12.5-degree range deficits of external rotation at 0-degree abduction. Five (20.8%) patients reported persistent or recurrent bicipital pain or tenderness; four (80%) of those five patients responded well to local steroid injection. A Popeye sign was not reported subjectively or objectively, and there was no reported tenodesis revision. Conclusions: Providing potential biological, biomechanical, and technical advantages and rendering low rates of short-term tenodesis failure and revision, this technique of modified (without-tenotomy) arthroscopic biceps tenodesis can achieve satisfactory outcomes. However, this technique could have the disadvantages of external rotational range deficits, relatively high prevalence of postoperative bicipital pain and tenderness, and technical irreproducibility in extensive biceps lesions that involve the tendon segment proposed for tenodesis. Level of Evidence: Level IV.

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The recent innovative concept of dynamic anterior stabilization of the shoulder by long head of biceps tendon for anterior gleno-humeral instability management has gained growing popularity among shoulder surgeons. Different techniques using this concept have been reported. Nevertheless, these techniques share common steps of tenotomy, re-routing, trans-subscapularis transfer and bony glenoid fixation of long head of biceps. Lately, a simplified procedure of intra-articular soft arthroscopic Latarjet technique has been introduced to refer to soft tissue tenodesis of long head of biceps to subscapularis tendon by 2 simple stitches of nonabsorbable sutures following Bankart repair. For more technical simplicity and closer reproducibility of gleno-humeral restabilization mechanisms of Latarjet procedure; the current Technical Note describes the extra-articular soft arthroscopic Latarjet technique, whereby long head of biceps is retrieved to the subpectoral region following intra-articular tenotomy; whip-stitched; rerouted deep to pectoralis major; and passed within subscapularis window into the gleno-humeral joint, where it is sutured over itself around upper subscapularis tendon. The currently reported technique offers potential advantages of versatility, steep learning curve, low cost (no hardware), feasibility of concurrent gleno-humeral restabilization procedures, and technical easiness of revision management; however; it is nonanatomic and should be biomechanically and clinically investigated to validate its long-term versatile utility.

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