Arthroscopic rotator interval repair and anterior portal closure: an alternative technique

The rotator interval capsule has been implicated as an important restraint to shoulder subluxation, and plays an important role in shoulder stability. Anterior portal placement during arthroscopic shoulder instability repair violates the interval capsule and compromises the biomechanical integrity of the rotator interval. The following is a technique for interval capsule repair. Using an 18-gauge needle via the anterior portal, a monofilament suture is passed through the capsule just above the subscapularis. A Penetrator suture retriever (Arthrex, Naples, FL) is passed high into the capsule just anterior to the biceps. The intra-articular end of the suture is then removed from the superior aspect of the interval capsule. The suture limbs are then tied into the portal onto the anterior capsule. The technique is advantageous because it may be repeated as needed until appropriate interval plication has been achieved. Furthermore, it does not require an interval portal through which to pass the suture. It appears to be a safe, effective, and reproducible technique for arthroscopic rotator interval closure.