Fig. 2.

(A) The semitendinosus and gracilis grafts are passed through the PMM, leaving the graft stumps at the posterior face of the muscle, which will be in contact with the humeral cortex, and the graft loop passing through the pectoral muscle on its anterior face; (B) Krackow sutures from one end of the graft with non-absorbable sutures passing through the adjustable cortical button loop. After passing through the muscle, 1.5 cm of graft is preserved; this part will remain inside the humeral cortex for biological integration of the reconstruction; (C) a scalpel resects the remaining graft after graft suture on the adjustable cortical button loop; (D) the graft with the suture is secured to the cortical button; its thickness is then measured for appropriate humeral cortical drilling; (E) humeral cortical drilling in the lateral region of the brachial biceps tendon in an attempt to reproduce an anatomical region below the subscapularis tendon and at least 3 cm between the proximal and distal guidewires. Now the guidewires, especially the more proximal ones, have to be placed perpendicular to the humerus to avoid, with the excessive inclination of the guidewires during their progress, that the cortical buttons exit too proximally in the posterior part of the humerus in the region of the infraspinatus muscle, which would endanger the neurovascular structures; (F) guidewires passing through the skin in the posterior region of the arm after a small incision is made, preventing the guidewires with the non-absorbable adjustment sutures from being trapped in the skin; (G) adjustment of graft and PMM tension next to humeral cortical. Now it can be observed under direct vision through the anterior surgical access, the entry of the tendon grafts into the tunnels drilled in the humerus; (H) the pectoralis muscle is drawn up to the humerus after final tensioning of the cortical adjustment button.