All‐Arthroscopic Muscle Advancement Technique for Repair of Massive Posterosuperior Rotator Cuff Tears in the Lateral Decubitus Position

Massive posterosuperior rotator cuff tears remain challenging because of the high retear rate after arthroscopic repair. Muscle advancement has been reported as an effective technique for reducing repair tension and improving healing in severely retracted supraspinatus and infraspinatus tendons. Although all‐arthroscopic muscle advancement has recently been reported, previously described techniques were performed in the beach‐chair position. We describe an all‐arthroscopic muscle advancement technique in the lateral decubitus position. This technical note describes the indications, technique, and technical aspects of this procedure. Indications include massive posterosuperior rotator cuff tears in which the supraspinatus and infraspinatus tendons cannot be reduced to the greater tuberosity with conventional release alone, particularly in patients without severe fatty degeneration. The procedure is performed in the lateral decubitus position using a traction device and a 30° arthroscope. Stepwise release of the supraspinatus and infraspinatus from the scapula is performed arthroscopically, followed by rotator cuff repair after sufficient advancement to the greater tuberosity is confirmed. This technique may allow anatomic reduction and low‐tension repair even in difficult‐to‐repair tears. The lateral decubitus position may provide a wider working space and improved visualization around the scapula; however, advanced arthroscopic skills and careful attention to the suprascapular nerve are required.