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Irreparable supraspinatus tendon tears are challenging to treat, especially in a young and high-demanding patient population. Whereas interposition tendon grafting and partial repair are limited by the quality of the remaining rotator cuff tendons and muscles, superior capsular reconstruction and subacromial spacers do not provide the active biomechanical principle of a contracting supraspinatus. The purpose of this technical note is to introduce an arthroscopic middle trapezius transfer below the acromion to replace the former supraspinatus unit. This technique might combine the benefits of both the static concepts seen with subacromial spacers or superior capsular reconstruction and dynamic concepts such as interposition grafting and partial repairs.

Irreparable rotator cuff tears are challenging to treat. Especially in younger patients without concomitant osteoarthritic changes, joint-preserving procedures are warranted. To date, no treatment guideline exists because none of the available techniques has shown superiority over the others, and long-term survivorship data are missing. The aim of the “Strings” is to provide an arthroscopic solution to anatomically reconstruct presumably irreparable rotator cuff tears by bridging the gap with multiple string-like tendon interposition autografts.

To date, specific surgical procedures are available for the treatment of anterior shoulder instability with substantial bony glenoid defects, as well as for patients without osseous lesions. However, specific treatment options are lacking for the frequently observed small to intermediate glenoid defects, which may not necessitate glenoid reconstruction surgery according to current guidelines but can still jeopardize the outcome after mere soft-tissue stabilization procedures. This article describes the so-called arthroscopic Bankart-Plus procedure for the treatment of anterior shoulder instability with small to intermediate bony glenoid defects. In addition to the conventional capsulolabral repair, an allogeneic demineralized spongy bone matrix is inserted between the glenoid neck and the labrum with the aim of compensating for the glenoid bone loss by increasing the volume of the labrum and thus its stabilizing effect.