Simplified Arthroscopic Rotator Interval Capsule Closure: An Alternative Technique

The anatomy of the “coracoid eclipse” of the rotator cuff, the rotator interval, has been studied extensively. Its importance in shoulder stability with respect to inferior and posterior translation has been described. Historically, open repairs for instability indirectly addressed interval lesions and closure based simply on the definition of the deltopectoral approach with its subscapularis advancement and capsular shift in a “pants-over-vest” manner. With results of arthroscopic repairs of glenohumeral instability approaching those of open procedures, the importance of simplification without sacrificing outcome has become a forefront in arthroscopic shoulder surgery. We present an alternative technique for interval closure by means of a 3/32-inch smooth Steinmann pin modified at its proximal and distal ends. A standard 3-portal technique consisting of the anterior superior portal, anterior mid-glenoid portal, and the posterior superior portal is used. The technique does not require the use of a suture shuttle nor does it require the placement of the arthroscope in the subacromial space for suture tying. A Tennessee slider knot is tied intra-articularly, thus allowing for tension modification before definitive alternate locking half-hitch placement. Intra-articular knot tying also allows for added security because suture slack is eliminated, thus avoiding air knots.