Table 1.

Pearls and Pitfalls of Modified Single–Working Portal Technique Using Percutaneous Spinal Needle Suture Passing

Pearls

The spinal needle selected should be as small as possible to reduce iatrogenic injury to tendon tissue. At the same time, the spinal needle must not be easy to bend, and its diameter should be able to pass through the traction suture.

The establishment of the anterior portal is mainly based on the need to implant the suture anchor.

The percutaneous position of the spinal needle is usually below the anterior portal, mainly to facilitate reaching the subscapularis. If the puncture angle is not good, the spinal needle can be pulled out and the appropriate percutaneous puncture point can be selected again.

The rotator cuff interval should be cleared with a radiofrequency device prior to puncture, especially around the subscapularis, so as to better reveal the puncture point of the spinal needle in front of the subscapularis.

Suture passing is performed through a loop formed by a spinal needle loaded with traction suture. There are 2 types of suture passing: intra-joint suture passing and out-of-joint suture passing. We believe that intra-joint suture passing is more simple, convenient, and safe and can be completed independently without relying on assistants.

Once the suturing is finished, the suture that has gone through the tissue and the suture that has not gone through the tissue should be pulled out through the anterior operation portal with a grasper before tying. We recommend that the suture located on the lower subscapularis be knotted first.

Pitfalls

The spinal needle should not be too medial during percutaneous puncture to avoid damage to blood vessels and nerves.

The rotator cuff interval should be cleaned as much as possible to avoid problems with suture management.