Subscapularis Repair Technique With Biphasic Cancellous Allograft in Anatomic Total Shoulder Arthroplasty

Subscapularis failure and insufficiency remain a devastating complication of anatomic total shoulder arthroplasty. In this Technical Note, we present a subscapularis repair with double-row compression and a biphasic cancellous allograft using a single anchor. Four holes are drilled in quadrilateral orientation at the lesser tuberosity. Two suture tapes are used to perform running, locking stitches in the subscapularis tendon, which are subsequently shuttled through the lesser tuberosity bone tunnels once, followed by a second passage back through the tendon and exchanging sides, to create a transosseous box and cross-compression of the tendon. Initial suture passage before tensioning creates an enclosure for placement of a biphasic cancellous allograft. Final tensioning and fixation into a single lateral anchor provides compression of the repair to the tuberosity, as well as secure fixation of the allograft at the tendon-bone interface. The use of a biphasic cancellous allograft has shown in vivo efficacy in reproducing the fibrocartilaginous interface seen in a native enthesis. This Technical Note discusses a viable technique for subscapularis repair in the total shoulder arthroplasty procedure with use of a biphasic cancellous allograft in effort to restore properties of the native enthesis to optimize subscapularis healing and integrity.