The Modified Single-working Portal Technique Using Lasso-loop Stitch with Needle for Arthroscopic Subscapularis Repair

This research focuses on arthroscopic surgery techniques and aims to improve the methods to make the surgery simpler and more effective. Traditional shoulder arthroscopy typically requires both anterior and posterior portals. However, recent developments have introduced simpler, less invasive single portal techniques.

Though these methods can present challenges in suture management and may increase trauma. This protocol significantly simplifies the operation. Moreover, less a loop suture is more stable and can reduce the cost and increase the operation benefit without using other consumables.

To begin, identify the superior third of the subscapular tear via the posterior portal created in the patient's shoulder area. Release the subscapular tendon to cover the lesser tuberosity, and freshen the lesser tuberosity to induce bleeding. Then implant a two load anchor into the subscapular's footprint.

Insert the needle through the tear from the anterior portal. Adjust the loop size and withdraw slowly. Next, pull out the PDS thread loop and one of the white and blue anchor sutures through the anterior portal with a grasper and pass two anchor sutures completely through the PDS thread loop in vitro.

Then, pull the PDS loop to pass the mid portion of the anchor suture through and create a suture loop in the subscapularis. Pass the free end of the suture through this suture loop and pull it tight to form a self-cinching stitch of the subscapularis. Do not tighten the self-cinching stitch, or it will move the subscapularis away from the lesser tuberosity footprint.

Then, tighten the other end of the anchor suture to secure the subscapularis to the lesser tuberosity. Finally, grab the two ends of the white and blue anchor sutures, tie and fix them successively. The procedure was performed on 18 patients and they were all assessed postoperatively.

Pain measured using the visual analog scale decreased significantly at 12 months post-operation compared to pre-operative values. Shoulder functionality and functional outcomes evaluated by the Constant-Murley score and the American Shoulder and Elbow Surgeons score improved significantly at 12 months post-operation relative to the pre-operative values. Shoulder flexion, external rotation, and internal rotation at 90 degrees abduction increased significantly at 12 months post-operation compared to the pre-operative measurements.