PMC9826548_01
Arrow showing retracted subscapularis tear.
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F1
Magnetic resonance imaging MRI is showing subscapularis tear retracted medial to glenoid as in (Fig. 1) and anterior supraspinatus tear with minimal retraction.
Portals.
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F2
After establishing a standard posterior viewing portal which is 2 cm inferior and 1 cm medial from the posterolateral corner of acromion and a standard anteroinferior working portal through the rotator interval which is is inferolateral to the the tip of coracoid process as in (Fig. 2) using outside in technique with 18- guage Guage spinal needle.
Retracted subscapularis.
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F3
The rotator cuff is carefully examined which showed a retracted subscapularis tear, as shown in (Fig. 3).
Glenoid decorticated.
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F4
With anterolateral portal as viewing portal and anteroinferior portal as working portal, glenoid anterior surface is decorticated with a burr, as shown in (Fig. 4) and curetted for bleeding bony surface preserving the anterior labrum.
Two knotless anchors on glenoid.
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F5
Two knotless all suture anchors (arthrex - fibereTak 1.8mm) were drilled on anterior glenoid, one at 2.30' o clock and other at 4.30 ' o clock positions as in (Fig. 5).
Lesser tuberosity Anchor 1.
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F6
Two all suture anchors (conmed - Y Knot RC 2.8 mm) are deployed on the superior and inferior aspect, in the middle of subscapularis footprint as in (Fig. 6, 7).
Lesser tuberosity Anchor 2.
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F7
Two all suture anchors (conmed - Y Knot RC 2.8 mm) are deployed on the superior and inferior aspect, in the middle of subscapularis footprint as in (Fig. 6, 7).
Distance between glenoid anchors.
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F8
With anterolateral portal as viewing portal and anteroinferior portal as working portal, the distance between glenoid anchors is measured to be 10 mm, as shown in (Fig. 8) and between lesser tuberosity anchors is 15 mm.
Distance from glenoid to humerus.
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F9
The distance between superior anchors of glenoid & and humerus is 30 mm, as shown in (Fig. 9).
Graft harvest incision.
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F10
From ipsilateral thigh an S- shaped incision is given, as shown in (Fig. 10) and fascia lata graft (3x18 cm) is harvested, as shown in (Fig. 11).
Graft after preparation - arrow indicates glenoid side.
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F12
Traction sutures with 2--0 vicryl are passed at lateral corners of the graft to keep graft in tension during graft passage, as shwon in (Fig. 12).
10 mL syringe as cannula.
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F13
A 10 ml syringe is cut at the tip and used as cannula in the anteroinferior portal (interval portal) for the graft to pass, as shown in (Fig. 13).
Final repair with remaining subscapularis (shown with white arrow) sutured along with upper border of graft (black arrow).
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F14
Final repair was checked as in (Fig. 14).
One year post-operative shoulder elevation.
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F15
At 1 year follow -up, the patient is having full range of forward and lateral elevation and active external rotation sideways (ERS) is 0-70, as shown in Figs.15 & and 16.