Table 1.

Key Steps of the Procedure

A Thorough Diagnostic Assessment is Necessary to Assess associated Pathology. Subscapularis Tears and Biceps Lesions Necessitate Surgical Repair and Tenodesis Using Standard Techniques.

Subacromial space is accessed via posterior portal and subacromial bursa is preserved.

The subacromial bursa is dissected carefully as a thick layer from the posterior and posterolateral deltoid fascia. Medial and lateral continuity of the bursal layer is preserved, and vascular sheet along the tendon aspect (deep bursal layer) is left undisturbed.

Bursal layer mobility is assessed to determine best sites for suture passage for adequate bursal advancement and coverage.

The tuberosity and frayed edges of the torn tendons are debrided and prepared for repair.

Three or four all-suture anchors are used in a single-row configuration.

Sutures are passed from anterior to posterior through the tendons and posterior and posterolateral bursal aspects, either in a single pass or separate passes through the 2 tissues. The lateral bursal layer is left undisturbed to prevent disruption of its continuity with deltoid fascia.

Sutures are tied using sliding locking knots and these are then tensioned laterally. Bursal advancement and adequate tendon coverage are confirmed while sutures are tied.

Static and dynamic assessment of the repair is performed to confirm adequacy of repair and bursal augmentation, and to ensure that the bursal tissue is not under undue stresses that may result in bursal disruption with physiological movements in the healing period.