- Discussion: 
- indicated for irreparable injury to the subscapularis which is causing recurrent instability; 
- Anterior Approach to the Shoulder 

- Release of Superior Pectoral Tendon: 
- superior 2.5-3 cm of the pectoralis tendon is released off the humerus; 
- stay sutures are inserted into the tendon edge; 
- tension is placed on the stay sutures, and the tendon is dissected medially for 10 cm, or a sufficient distance to allow it to be mobilized to the insertion site of the subscapularis; 
- the insertion site of the scapularis is freshened down to a bleeding surface; 
- the tendon is placed under tension, and the optimal position for anchor placement is determined; 
- 3 or 4 biologically quiet screws are inserted into this bed;   
- the tendon is then anchored down 

Operative Treatment of Irreparable Rupture of the Subscapularis.