PMC6512045_01
Noncontrast MRI of (a) axial, (b) coronal, and (c) sagittal views of the right shoulder; (d) axial, (e) coronal, and (f) sagittal views of the left shoulder. * denotes a torn subscapularis tendon. Delta denotes an intact supraspinatus tendon.   denotes a type 4 SLAP tear. Sagittal views demonstrate edematous changes and retraction, without significant fatty infiltration.
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fig1
A noncontrasted MRI (Figure 1) obtained two days later demonstrated complete rupture of the right subscapularis tendon, just distal to the musculotendinous junction; complete rupture of the left subscapularis tendon, just distal to the musculotendinous junction; and bilateral type 4 SLAP lesions.
Intraoperative arthroscopic photographs of the right shoulder; left shoulder images were symmetric. All captured from standard posterior portal. (a) * denotes torn subscapularis tendon. (b) ** denotes repaired subscapularis tendon. (c) Delta and   denote a torn long head of the biceps tendon. Delta denotes a type 4 SLAP tear. (d)    denotes an arthroscopic long head of the biceps tenodesis.
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fig2
Intraoperative findings (Figure 2) included complete subscapularis rupture on both sides, with type 4 SLAP lesions and associated partial tear of the long head of the biceps at its labral origin. Within the joints of both shoulders, we visualized similar pathologies related to the superior glenohumeral ligaments, superior labrum (Figure 2(c)), and subscapularis tendons (Figure 2(a)):where all these structures were torn and retracted from their origins and the biceps tendon was in its anatomic groove. Two 4.75 mm biocomposite suture anchors were then placed within the proximal and distal aspects of the medial ridge of the bicipital groove, which allowed the subscapularis footprint to be completely covered with the repaired tendon, without tension (Figure 2(b)). This completed the biceps tenodesis (Figure 2(d)).