SHOULDER Suture-bridge subscapularis tendon repair technique using low anterior portals Jin-Young Park • Jun-Suk Park • Jae-Kyung Jung • Praveen Kumar • Kyung-Soo Oh Received: 5 March 2009 / Accepted: 7 September 2010 / Published online: 2 October 2010 Ó Springer-Verlag 2010 Abstract A suture-bridge technique has been introduced to facilitate fixation procedures and to achieve increased holding strength in posterosuperior rotator cuff. Based on biomechanical studies, this technique has been suggested as an effective method that could optimize rotator cuff tendon-footprint contact area and mean pressure, as well as holding strength. In this technique, the suture-bridge cre- ation is adapted for arthroscopic subscapularis repair to attain the ideal cuff integrity and footprint restoration. To obtain enough working portals and space, two accessory portals were made on the anterior aspect of the shoulder and use an elevator to retract the conjoined tendons and deltoid muscle. This technique could be useful for the repair of subscapularis tears, which are not easily approa- ched using other arthroscopic techniques. From a biome- chanical point of view, the subscapularis tendon could be restored more ideally using the suture-bridge technique. Keywords Subscapularis Á Suture-bridge Á Two accessory portals Introduction Although the popularity of arthroscopic rotator cuff repair has increased, several aspects remain that make it difficult to carry out arthroscopic subscapularis repair. Thorough inspection of the torn subscapularis tendon and manipulation of arthroscopic instruments can be very challenging tasks in the constricted working space [2, 3]. In addition, few authors have mentioned the possibility of subscapularis repair with a double-row technique to maximize the contact area for ten- don-to-bone healing and to obtain a more stable reconstruc- tion [9]. Recently, a suture-bridge technique has been introduced to facilitate fixation procedures and to achieve increased holding strength. Based on biomechanical studies, the suture-bridge rotator cuff repair technique has been sug- gested as one of the effective alternatives that could optimize rotator cuff tendon-footprint contact area and mean pressure, as well as holding strength [12, 13]. Although single-row repair for subscapularis tendon tears showed good results regarding shoulder function and repaired cuff integrity, concerns still remain for retear rate, as reported 35% for arthroscopic fixation of combined anterosuperior tears (sub- scapularis and supraspinatus tendon tears) [6, 8]. Recent biomechanical study revealed that double-row technique restored significant higher ultimate load and stiffness compared to those of single-row technique [14]. The suture- bridge technique has been adapted for arthroscopic subscapularis repair to attain the ideal cuff integrity and footprint restoration. To obtain enough working portals and space, two accessory portals were made on the anterior aspect of the shoulder and use an elevator to retract the conjoined tendons and deltoid muscle. The purpose of this study was to present the clinical application of suture-bridge technique in doing subscapularis tendon repair. Technical note Five portals are used for subscapularis tendon repair (Fig. 1)—three routine portals (anterior, posterior, and J.-Y. Park Á J.-S. Park Á J.-K. Jung Á P. Kumar Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea K.-S. Oh (&) Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, San 5, Paldal-gu, Suwon 442-721, Korea e-mail: orthopaedics11@gmail.com 123 Knee Surg Sports Traumatol Arthrosc (2011) 19:303–306 DOI 10.1007/s00167-010-1268-0