A Modified Double-Row Suture Repair Technique for Anterior Rotator Cable Preservation in Isolated Subscapularis Tears

After identification of rotator cuff pathology, the treatment of subscapularis tear has increased to restore the anterior rotator cable and increase the internal rotation. Initially, open repair was performed to treat subscapularis tears. However, arthroscopic repair is now mainly performed following the development of arthroscopy, and results show that it is effective. There are various arthroscopic repair techniques, such as single-row, double-row, and transosseous suture bridge. The biceps pulley is a structure directly involved in the stability of the long head of the biceps and is located within the rotator interval between the anterior edge of the supraspinatus tendon and the superior edge of the subscapularis tendon. The biceps pulley consists of the superior glenohumeral ligament and coracohumeral ligament, which is anatomically connected to the anterior rotator cable. Therefore, it is thought that damage to the rotator cable may also affect the bicep pulley, affecting its stability. In this Technical Note, we described a modified double-row suture repair technique for isolated subscapularis tears. Using this technique, we could keep the benefits of the double-row suture repair technique, including better biomechanical effect and footprint coverage; but also preserving the anterior rotator cable and biceps pulley using a modified suture vector from the existing double-row technique.