Subscapularis Tendon Repair Using Transtendon Double-Pulley Technique With All-Suture Anchor

The management of subscapularis tears presents a significant challenge because of the complexity of the rotator cuff injury. The conventional suture technique, employing either a single-row or double-row stitch, has been shown to have inherent limitations, including inadequate mechanical stability, compromised blood supply, and the potential for postoperative stiffness. We propose a transtendon double-pulley technique. This technique involves the placement of an all-suture anchor through the subscapularis tendon, a dynamic double-pulley in the footprint area to construct a dynamic tension system through cross-stitching. This technique integrates the biological advantages of tendon fixation with the mechanical adaptability of the dynamic pulley system, offering a repair option for subscapularis tears.