Reverse Rotator Interval Closure

We describe a technique for reducing capsular volume arthroscopically by shifting the anterior inferior glenohumeral ligament (AIGHL) and capsule up to the top of the subscapularis. This procedure is performed when laxity exists in the absence of a Bankart lesion. The AIGHL is first released from the capsule. This allows sutures to be placed through the capsule inferiorly so that it can be shifted up superiorly during the repair. The AIGHL and capsule are then released from the underlying subscapularis. Sutures are then passed through the capsule and out of the accessory anterior portal, progressing laterally. A BirdBeak suture passer (Arthrex, Naples, FL) is inserted through the superior edge of the subscapularis and is used to grasp each undersurface strand of suture and pull it through and out of the anterior portal. The sutures are then tied sequentially, effectively shifting the capsule and ligament up in a superior direction.