Single-Portal, Single-Anchor Repair of a Superior Third Subscapularis Tear Using a Self-Punching Knotless Soft Suture Anchor

Abstract

Numerous techniques exist for arthroscopic subscapularis repair with varying degrees of complexity based on tear morphology, all of which have established satisfactory outcomes in function and patient satisfaction. Arthroscopic subscapularis repair can require several working portals and suture anchors, increasing both technical complexity and operative time. This Technical Note describes an arthroscopic repair of a superior one-third subscapularis tear using a self-punching knotless soft suture anchor through a single anterior working portal. Thus, we offer a unique approach to arthroscopic repair of superior one-third subscapularis tears that is time-saving, reproducible, and highly efficient while minimizing iatrogenic damage and postoperative complications.

Combined, Single-Anchor Subscapularis Tendon Repair and Proximal Biceps Tenodesis Leads to Improved Function and Decreased Pain at 1 Year

“…Although arthroscopic SST repair is generally supported, 25 , 26 , 27 the clinical evaluation of specific or isolated tear patterns has become more relevant. 4 , 5 , 6 , 11 , 12 , 17 , 18 , 28 Injuries to the upper-third SST are of particular interest given its biomechanical importance and role in difficult-to-treat anterior shoulder dysfunction. 4 , 5 , 17 , 18 The use of single-anchor fixation is supported for isolated, complete SST tears containing up to 50% footprint disruption (Lafosse II-III).…”

“… 4 , 5 , 6 , 11 , 12 , 17 , 18 , 28 Injuries to the upper-third SST are of particular interest given its biomechanical importance and role in difficult-to-treat anterior shoulder dysfunction. 4 , 5 , 17 , 18 The use of single-anchor fixation is supported for isolated, complete SST tears containing up to 50% footprint disruption (Lafosse II-III). 12 , 29 Biomechanical studies have recommended that upper-third SST tears should be anchored superolateral from the native footprint, near the entrance of the bicipital groove, to preserve the “leading edge” and function of the superior aspect of the subscapularis.…”

“… 2 , 3 , 4 , 5 However, the utility of single-anchor constructs for combined SST repair and proximal biceps tenodesis is limited to a few technical reports that lack any clinical evaluation. 4 , 17 , 18 …”

“… 13 , 14 , 15 , 16 Currently, there are few combined single-anchor techniques reported in literature to address both pathologies. 4 , 5 , 17 , 18 The Loop ‘N’ Tack (LNT) tenodesis has been reported as an effective treatment for isolated proximal biceps disease across recent biomechanical and clinical studies. 19 , 20 , 21 , 22 Additionally, as outlined by Kim et al., 17 this simple, knotless, all-arthroscopic procedure can also accommodate repairs of the anterior RCT.…”