After mobilizing anteroinferior osseous Bankart lesion from the glenoid neck, a suture anchor loaded with differently colored non-absorbable braided sutures is placed on the medial edge in the glenoid neck along the rim fracture through the anterior-inferior trans-subscapularis tendon portal. Two same-colored suture limbs on the anchor are then pulled through the labrum using PDS suture shuttling simultaneously. These steps are repeated for the others suture limbs. The two same-color suture limbs located inferiorly are retrieved using the trans-subscapularis tendon portal. Both suture strands are threaded through the eyelet of a PushLock anchor on the distal end of the driver. The anchor is advanced into the pilot hole completely. These steps are repeated for a second anchor at the upper edge of the fracture in the glenoid rim using the anterior portal. This technique confers effective, firm fixation of the bony Bankart lesion by three-point fixation without the suture material crossing the glenoid cavity.
After preparation of the bone bed, two doubly loaded suture anchors with suture eyelets are inserted at the articular margin of the greater tuberosity. A retrograde suture-passing instrument penetrates the rotator cuff to retrieve the sutures through the modified Neviaser or subclavian portal. An ipsilateral pair of suture eyelets in the suture anchor is passed through the margins of the rotator cuff tear. The blue suture of the second and third pair is pulled out of the lateral cannula, and the threaded blue suture of the third pair in the needle is passed through the blue suture of the second pair. After retrieving the blue suture of the first pair through the anterior portal, it is pulled out to pass the blue suture of the third pair through the eyelet of the anteromedial anchor. The blue suture is linked between two anchors. The medial row of suture-bridge is repaired with a sliding knot, and the sutures are not cut. Once the rotator cuff repair using the suture-bridge technique has been performed, the two blue strands in the anterior portal are tied. We describe our technique that possesses the advantages of both the double-pulley and suture-bridge techniques, which improves the pressurized contact area and maximizes compression along the medial row.
Many anomalous origins of the long head of the biceps tendon (LHBT) have been reported. However, developmental anomalies of the LHBT are rarely encountered in daily practice. We report a patient with an anomalous LHBT that was adherent to and confluent with the rotator cuff throughout its intra-articular course and present the clinical, magnetic resonance arthrography, and arthroscopic findings.
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