Figure 2

Schematic drawings and intraoperative findings of the present surgical technique. A, the modified anterior axillary incision used in our procedure. B, anatomic attachment of the pectoralis major (PM) muscle (white arrows). C and D, a rectangular bone trough (about 10 mm width × 40 mm height square, and about 20 mm depth through the cortical bone, white arrows in D) was made in the proximal humerus at the anatomic insertion of PM. Three sets of horizontal and vertical grasping stitch (Krackow sutures technique) were inserted using non-absorbable sutures (Fiberwire N°2; Arthrex, Inc, Naples, FL, USA) to adequately grasp the posterior surface (muscle fascia) of the PM muscle (C, E, and F). Endobuttons (Acufex; Smith & Nephew, Inc., Andover, MA, USA) were secured at the ends of the non-absorbable sutures (F). The tendon stump about 20 mm was introduced into this trough in order to transfix it to the other side of the cortex using endobuttons (I; postoperative X-ray, white arrows) and non-absorbable sutures (G; schema of transfixion technique and H; intraoperative view after transfixion technique). DM, deltoid muscle; PM, pectoralis major; LHB, long head of biceps.