Fig 3.

Subacromial view from lateral arthroscopic portal (right shoulder, with patient in lateral decubitus position). (A) Massive posterosuperior rotator cuff tear retracted at glenoid level with tendon delamination. (B, C) We perform in all cases anterior slide release. In cases of massive retracted rotator cuff tears, the supraspinatus is often immobile and no excursion is obtained even after slide and articular side release. In these cases, a modified anterior release of the anterior supraspinatus that is too far retracted and immobile may be performed. The slide is performed more posteriorly than originally described,²³ approximately at the level of the biceps anchor and over it proceeding from laterally to medially, 1 to 2 cm medially from the superior glenoid rim. The purpose is to release and mobilize the posterior leaf that consists of the infraspinatus and part of posterior supraspinatus. Anteriorly to our slide, the anterior part of supraspinatus is useless as no mobility and excursion are obtained in such massive retracted chronic tears. (D) Articular and bursal side release of the rotator cuff is always performed to mobilize the cuff tendons, evaluate the excursion, and have an estimation for the tension on the site of the repair. The infraspinatus is pulled in the direction indicated (black arrow) with use of a pulling suture, in order to facilitate the articular side release. (d, deep layer of infraspinatus; G, glenoid; HH, humeral head; IS, infraspinatus and posterior portion of supraspinatus; SS, anterior portion of supraspinatus; sup, superior layer of infraspinatus).