L-Shaped Three-Portal Configuration for Arthroscopic Double-Row Suture Repair of Lafosse Type III and IV Subscapularis Tears.

Lafosse type III and IV subscapularis tendon injuries are severe rotator cuff tears. Current repair uses anterolateral, anterior, and lateral portals, which have restricted visualization and difficult maneuverability. This technical note describes an L-shaped three-portal (LST) combination: anterosuperolateral, anteroinferolateral, and anteroinferomedial portals. The L-shaped three-portal configuration establishes an unobstructed surgical field free from bony interference, allowing comprehensive subscapularis tendon exposure. It optimizes anchor insertion angles and suture passing path, promoting accurate anchor fixation and effective suture management. Ultimately, it minimizes surgical complications and improves double-row repair efficiency for Lafosse type III/IV injuries, presenting a secure and efficient approach. This article outlines the technique, highlighting procedural aspects, potential risks, advantages, and limitations.