The Modified Single-working Portal Technique Using Lasso-loop Stitch with Needle for Arthroscopic Subscapularis Repair

Traditional shoulder arthroscopy typically requires both anterior and posterior portals. However, in the traditional anterior portal, simultaneous operation of the suture device and the gripper is not possible, necessitating an additional anterolateral portal for anchor insertion and suture delivery, which poses technical challenges for novice surgeons. Additionally, the ulnar side of the conventional rotator cuff suture hook is large, and it frequently causes iatrogenic damage to rotator cuff tissues. Therefore, we propose a modified arthroscopic technique that uses a 16 G needle for suture passage, eliminating the need for traditional suture devices, which is easily available and effective in reducing iatrogenic injury to the rotator cuff. This approach not only resolves instrument collision and visualization challenges inherent to single-portal arthroscopy, but also innovatively converts the arthroscopic suture technique into an extracorporeal Lasso-loop configuration. This significantly simplifies the operation; moreover, Lasso-loop suture is more stable and can reduce the cost and increase the operation benefit without using other consumables.