Table 1.

Pitfalls and Pearls

Pitfalls	Pearls
Poor visualization of the Hill-Sachs defect	The surgeon should use a high anterior viewing portal or a 70° arthroscope.
Limited working space posteriorly	The surgeon should apply slight traction to the arm and increase pump pressure temporarily.
Difficulty placing a cannula through the thick rotator cuff tendon and capsule	The Transtend system alleviates this problem.
Cannula slipping out once placed	The Transtend system alleviates this problem.
Poor placement of the anchor with possible penetration of the articular surface of the humeral head	The surgeon should establish an accessory posterolateral portal using a spinal needle to guide him or her.
Disorientation when viewing from the anterior portal, resulting in frustration	If operating with the patient in the beach-chair position, the surgeon should ensure that the screen is placed directly opposite himself or herself.
Difficulty accurately retrieving the separate limbs of the sutures intra-articularly if using the sharp tissue penetrator (technique described by Wolf and colleagues4)	Our technique does not require this step.
Difficulty locating the limbs of the suture from the subacromial space	Our technique does not require this step.
Encountering bleeding vessels in the subacromial space (because the sutures are place posteriorly, in an extra-bursal manner)	Our technique does not require this step.
Inadvertent damage to or debridement of the sutures limbs while attempting to locate the sutures in the subacromial space	Our technique does not require this step.