An Arthroscopic-Plus-Open Method of Repair for Combined Tears of the Subscapularis, Supraspinatus, and Infraspinatus Tendons

Tears involving the subscapularis and posterosuperior rotator cuff comprise a distinct clinical entity. An aggressive treatment involving operative repair has demonstrated superior results compared with delayed intervention, yet there is no consensus as to the optimal method of repair. Various methods are evolving, but they are not without their pitfalls. Methods of fixation, patient positioning, and biceps management are emerging as points of contention. In this technical note, we describe an arthroscopic-plus-open approach in which arthroscopic repair of the posterosuperior rotator cuff is followed by an open subscapularis repair. Advantages of this method include ability to address concomitant pathology, relative ease of repair, and creation of a strong, reliable construct. The interval- splitting approach affords minimal additional morbidity and does not preclude use of allograft or biological augmentation for salvage procedures. Overall, this method is an effective, efficient technique that yields reproducible, reliable repair of these combined rotator cuff tears.