Anterior Approach to Retracted Anterosuperior Cuff Tear With Biceps Superior Capsular Reconstruction and Subscapularis Release and Repair With Transosseous Equivalent Double-Row Repair

The incidence of a subscapularis tear combined with any other rotator cuff tear is around 19% to 49% among all rotator cuff lesions. On the contrary, less attention has been given to the treatment of anterosuperior rotator cuff tears, particularly by arthroscopic methods. Subscapularis lesions are hard to access and require advanced surgical technique along with optimum visualization to achieve an anatomic repair. Use of an anterior portal helps in obtaining a good visualization with a 30° arthroscope in viewing the tendon along its axis as well as the posterior, superior, and anterior sides. Incorporation of the biceps tendon along with supraspinatus repair helps strengthen the supraspinatus repair as well as preserve the acromiohumeral index. Double-row repair of both subscapularis and supraspinatus ensures an adequate bone bed for tendon healing.