Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.Identification and subsequent repair of subscapularis tears can be difficult. It is necessary to rapidly recognize the tear during arthroscopy and repair it before anterior swelling occurs because swelling makes the repair more difficult. To avoid recurrent subscapularis tears, the surgeon must also treat associated pathology such as coracoid impingement and biceps tear or dislocation. This DVD shows a simplified approach to identification and repair of upper and partial subscapularis tendon tears, which frequently appear as fraying. Overlying capsular tissue may make it more difficult to identify tears. A partial tear often looks like a mushroom cloud with the upper portion of the subscapularis peeling medially. This DVD shows the anatomy of the subscapularis attachment to the lesser tuberosity. It also demonstrates how to identify a subscapularis tear, from either the posterior or anterior view, during rotation of the arm. The "comma sign" can also help identify the subscapularis as it retracts, but the sign is more helpful in complete tears with retraction of the subscapularis tendon, frequently to the glenoid. The procedure includes evaluation of the distance between the coracoid and subscapularis, followed by coracoplasty if necessary. The optimal clearance is 8 mm to eliminate the ringer effect of the subscapularis against the coracoid. The simplified approach to performing a subscapularis repair involves visualization from the post portal, using the shaver to abrade the lesser tuberosity, tapping and inserting the anchor through an anterosuperolateral portal, "preplacing" the sutures further into the joint, using a penetrating suture retriever through an anterior inferior portal, and then passing the sutures through the subscapularis as a simple suture. The surgeon then makes a second pass through the same portal (or the anterosuperolateral portal) and ties through the cannula. Although a mattress suture works well for a complete tear, simple patterns work very well for partial and upper subscapularis tears. The surgeon can also perform this simplified approach if there is no need for coracoplasty because it requires less room than using most antegrade passers. The video also describes the rehab protocol for standard repairs.