case_images: PMC9826548_01
case_images: Arrow showing retracted subscapularis tear.
case_images: JOCR-12-91-g001.jpg
case_images: PMC9826548_01_JOCR-12-91-g001.jpg
case_images: F1
case_images: Magnetic resonance imaging MRI is showing subscapularis tear retracted medial to glenoid as in (Fig. 1) and anterior supraspinatus tear with minimal retraction.
case_images: Portals.
case_images: JOCR-12-91-g002.jpg
case_images: PMC9826548_01_JOCR-12-91-g002.jpg
case_images: F2
case_images: After establishing a standard posterior viewing portal which is 2 cm inferior and 1 cm medial from the posterolateral corner of acromion and a standard anteroinferior working portal through the rotator interval which is is inferolateral to the the tip of coracoid process as in (Fig. 2) using outside in technique with 18- guage Guage spinal needle.
case_images: Retracted subscapularis.
case_images: JOCR-12-91-g003.jpg
case_images: PMC9826548_01_JOCR-12-91-g003.jpg
case_images: F3
case_images: The rotator cuff is carefully examined which showed a retracted subscapularis tear, as shown in (Fig. 3).
case_images: Glenoid decorticated.
case_images: JOCR-12-91-g004.jpg
case_images: PMC9826548_01_JOCR-12-91-g004.jpg
case_images: F4
case_images: With anterolateral portal as viewing portal and anteroinferior portal as working portal, glenoid anterior surface is decorticated with a burr, as shown in (Fig. 4) and curetted for bleeding bony surface preserving the anterior labrum.
case_images: Two knotless anchors on glenoid.
case_images: JOCR-12-91-g005.jpg
case_images: PMC9826548_01_JOCR-12-91-g005.jpg
case_images: F5
case_images: Two knotless all suture anchors (arthrex - fibereTak 1.8mm) were drilled on anterior glenoid, one at 2.30' o clock and other at 4.30 ' o clock positions as in (Fig. 5).
case_images: Lesser tuberosity Anchor 1.
case_images: JOCR-12-91-g006.jpg
case_images: PMC9826548_01_JOCR-12-91-g006.jpg
case_images: F6
case_images: Two all suture anchors (conmed - Y Knot RC 2.8 mm) are deployed on the superior and inferior aspect, in the middle of subscapularis footprint as in (Fig. 6, 7).
case_images: Lesser tuberosity Anchor 2.
case_images: JOCR-12-91-g007.jpg
case_images: PMC9826548_01_JOCR-12-91-g007.jpg
case_images: F7
case_images: Two all suture anchors (conmed - Y Knot RC 2.8 mm) are deployed on the superior and inferior aspect, in the middle of subscapularis footprint as in (Fig. 6, 7).
case_images: Distance between glenoid anchors.
case_images: JOCR-12-91-g008.jpg
case_images: PMC9826548_01_JOCR-12-91-g008.jpg
case_images: F8
case_images: With anterolateral portal as viewing portal and anteroinferior portal as working portal, the distance between glenoid anchors is measured to be 10 mm, as shown in (Fig. 8) and between lesser tuberosity anchors is 15 mm.
case_images: Distance from glenoid to humerus.
case_images: JOCR-12-91-g009.jpg
case_images: PMC9826548_01_JOCR-12-91-g009.jpg
case_images: F9
case_images: The distance between superior anchors of glenoid & and humerus is 30 mm, as shown in (Fig. 9).
case_images: Graft harvest incision.
case_images: JOCR-12-91-g010.jpg
case_images: PMC9826548_01_JOCR-12-91-g010.jpg
case_images: F10
case_images: From ipsilateral thigh an S- shaped incision is given, as shown in (Fig. 10) and fascia lata graft (3x18 cm) is harvested, as shown in (Fig. 11).
case_images: Graft after preparation - arrow indicates glenoid side.
case_images: JOCR-12-91-g012.jpg
case_images: PMC9826548_01_JOCR-12-91-g012.jpg
case_images: F12
case_images: Traction sutures with 2--0 vicryl are passed at lateral corners of the graft to keep graft in tension during graft passage, as shwon in (Fig. 12).
case_images: 10 mL syringe as cannula.
case_images: JOCR-12-91-g013.jpg
case_images: PMC9826548_01_JOCR-12-91-g013.jpg
case_images: F13
case_images: A 10 ml syringe is cut at the tip and used as cannula in the anteroinferior portal (interval portal) for the graft to pass, as shown in (Fig. 13).
case_images: Final repair with remaining subscapularis (shown with white arrow) sutured along with upper border of graft (black arrow).
case_images: JOCR-12-91-g014.jpg
case_images: PMC9826548_01_JOCR-12-91-g014.jpg
case_images: F14
case_images: Final repair was checked as in (Fig. 14).
case_images: One year post-operative shoulder elevation.
case_images: JOCR-12-91-g015.jpg
case_images: PMC9826548_01_JOCR-12-91-g015.jpg
case_images: F15
case_images: At 1 year follow -up, the patient is having full range of forward and lateral elevation and active external rotation sideways (ERS) is 0-70, as shown in Figs.15 & and 16.