Under general anesthesia with interscalene block, the patient was placed in the lateral decubitus position. The Spider shoulder positioner was used to regulate the traction force at 2.5 ~ 3.5 kg to keep the arm in a position of 20° flexion and 30° abduction. All surgical procedures were performed by an experienced senior shoulder surgeon in our hospital. Standard portals for all patients, such as anterior, posterior, lateral, and posterolateral, were made. All repairs were done using a transosseous equivalent technique with peek anchors. The suture methods depended on the types of rotator cuff tear. The long head of the biceps tendon was cut if it had an inflammatory reaction. The acromioplasty was carried out according to the acromion situation during operation. Finally, local anesthetics were injected into subacromial and intraarticular spaces.

The patients in the releasing group underwent the decompression of SSN at the spinoglenoid notch before the repairment of the rotator cuff. A probe was used to locate the base of the scapular spine, and the neurovascular bundle was located at the spinoglenoid notch. The suprascapular neuropathy was believed to be caused by the traction of the nerve as the muscle retracted medially [4, 7, 21]. The spinoglenoid ligament was on the superior and lateral side of the nerve and didn’t directly compress the neurovascular bundle. The radiofrequency probe in the posterior portal was used to mobilize the tendon by performing both bursal and articular sided releases, resection of the coracohumeral ligament, and interval slide techniques. The lifting pliers were used to grasp the edge of the tendon tear, which could facilitate the arthroscopic releases [21].. We could see the spine of scapular and the neurovascular bundle. We could see the pulsating suprascapular artery that was a mark reminding us that the nerve was nearby. Using the probe to do blunt separation between the fascia of supraspinatus/infraspinatus and neurovascular bundle. Cutting the greater tension fascia around the neurovascular bundle. To avoid iatrogenic injury of the SSN, articular releases didn’t proceed more than 1.5 cm medial to the glenoid rim [21, 35]. After the decompression of SSN, the torn rotator cuff was repaired (Fig. 3).

a shows the torn rotator cuff. b shows the neurovascular bundle. c shows that the rotator cuff structure was repaired by the anchors. In d, the black arrow shows the scapular spine, we used the radiofrequency probe to release both bursal and articular sides. The lifting pliers were used to grasp the edge of the tendon tear to facilitate arthroscopic releases

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