This video provides an educational, highly detailed surgical demonstration performed by orthopedic surgeon Dr. Anthony A. Romeo. The procedure focuses on treating an active 48-year-old male who sustained a significant shoulder injury after falling off a mountain bike.

The comprehensive surgical overview covers three distinct procedures performed sequentially:

Patient Background & Initial Joint Assessment

• Initial Diagnosis: The patient presented with a severe bursal-sided rotator cuff tear that failed conservative (non-surgical) management.
• Joint Navigation: Dr. Romeo begins by mapping out the patient's shoulder anatomy externally to establish optimal portal placements.
• Arthroscopic Exploration: Upon entering the glenohumeral (shoulder) joint with the arthroscope, the surgeon notes substantial inflammation and joint fluid. He identifies a much larger, full-thickness tear than originally indicated by the MRI, noting that the tear has compromised the lateral stability of the biceps tendon.

1. Biceps Tenotomy & Preparation

• Debridement: The surgeon uses an arthroscopic shaver to clear away heavily inflamed tissue and smooth out the joint margins.
• Tenotomy: Due to extensive bicep involvement, the long head of the biceps tendon is carefully released from its attachment point at the superior labrum. It is temporarily trimmed back to stay out of the way for the primary repair.

2. Acromioplasty & Rotator Cuff Repair

• Subacromial Space Clearance: Moving the scope into the subacromial space, the surgical team clears away thick, fibrous bursal tissue to create a clear working view.
• Acromioplasty: To lower the patient's high critical shoulder angle (which increases the risk of future tears), a bone burr is utilized to reshape and flatten the lateral edge and under-surface of the acromion bone.
• Footprint Preparation: The surgeon lightly scuffs the bony footprint of the greater tuberosity to promote healing. He punches micro-holes into the bone to allow marrow-derived blood supply to migrate into the repair site.
• Advanced Biologic Interposition & Double-Row Fixation:
  • A synthetic nanofiber scaffold patch (Rhodium) is introduced as an interposition graft to hold biological healing factors directly at the site.
  • A high-strength double-row "SpeedBridge" fixation technique is executed. Medial anchors are placed, and side-to-side tension-reducing stitches are tied. The fiber tapes are crisscrossed and secured laterally into the bone using swivel-lock anchors, compressively holding the tendon flat against its anatomical footprint.

3. Open Subpectoral Biceps Tenodesis

• Approach: The team shifts to an open, mini-incision approach near the lateral aspect of the axilla (armpit) to access the subpectoral region.
• Inflammation Removal: The surgeon isolates the previously cut biceps tendon and cleans off severe tenosynovitis (lining inflammation) extending toward the muscle belly.
• Anatomical Anchor Placement: A target hole is drilled and reamed into the bicipital groove of the humerus. A second protective biologic nanofiber patch is wrapped around the tendon.
• Fixation: Using a interference screw system, the tendon is securely anchored down inside the bone at its correct anatomical tension, positioning the muscle-tendon junction cleanly beneath the pectoralis major muscle.

The procedure concludes with a final structural assessment verifying that the normal contour of the arm is restored, ensuring the patient can safely return to high-level physical activities like mountain biking.