Fig 3.

Arthroscopic visualization from the posterolateral portal in a right shoulder with the patient in the beach-chair position. (A) After the sutures have been tensioned into the laterally placed anchors (LA) (BioComposite SwiveLock SP, 4.75 mm × 24.5 mm) with a SutureBridge conformation, the awl (asterisk) is introduced from the lateral portal to microfracture the insertion bed. (B) Blood flow out of the microfractured areas (arrow) can be observed. The parietal sheet of the subacromial bursa (BS) in the subdeltoid region (SR) is perforated with a lasso introduced from the lateral portal, and a No. 2 PDS suture (polydioxanone monofilament thread) is shuttled through. (C) The same procedure is performed with the tendon tissue (asterisk) using a lasso from the anterolateral or anteroinferior portal to shuttle the same PDS wire. Tensioning both ends of the PDS wire, the bursal tissue is converging on the tendon, covering the tendon margin and the insertion area. (D, E) The procedure is repeated until the whole insertion area is covered with highly vascularized bursal tissue. (F) An acromioplasty provides additional blood support descending on the tendon insertion area. (ACR, acromion.)