Table 1.

Surgical Steps, Pearls, and Pitfalls

Surgical Step	Pearls	Pitfalls
Diagnostic arthroscopy	Biceps present with intact anchor	Biceps not present, or with pathology, consider use of allograft
Infraspinatus tendon repair	Partial or medialized repair performed with single-row triple-loaded anchor	Some type of repair is needed to be able to relink to the anterior cable
Greater tuberosity preparation	A trough is created, using a burr, on the greater tuberosity next to the repaired infraspinatus tendon. Within the trough, next to the articular cartilage, a double-loaded Corkscrew anchor is placed	Prevent creating too deep of a trough in the bone that compromises receiving an anchor
Graft securing to capsular footprint	Loop around fixation with sutures passed around biceps tendon, and not through the tendon itself. Arm positioned in 30° abduction and 30° external rotation when tensioning the graft.	Sutures passed through the biceps tendon graft have been found to cut through the graft. Not rotating the arm to 30° external rotation when tensioning the graft can lead to shortened length of the biceps and overconstraint of the glenohumeral joint
Native posteriorsuperior capsule repaired to biceps tendon	Loop around fixation links the biceps tendon to the repaired rotator cuff. #2 FiberWire is passed through the repaired tendon and wrapped around the biceps with arm in 30° abduction and 30° external rotation	Side-to-side repairs should be performed with the loop passed around the biceps and not through the biceps to avoid disrupting the integrity of the graft
Lateral anchor fixation of transferred biceps tendon	Lateral end of biceps at edge of greater tuberosity is released from remaining biceps. #2 FiberWire is passed through end of transected biceps and passed through 4.75-mm SwiveLock Anchor to be fixated into lateral edge of greater tuberosity	Securing the graft at the lateral edge helps prevent the graft from subluxation out of the trough and prevents the end of the graft from flipping over