{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T13:46:33Z","timestamp":1776001593513,"version":"3.50.1"},"reference-count":11,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T00:00:00Z","timestamp":1741651200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T00:00:00Z","timestamp":1741651200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T00:00:00Z","timestamp":1741651200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T00:00:00Z","timestamp":1741651200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T00:00:00Z","timestamp":1739491200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["arthroscopytechniques.org","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["arthrosc. tech."],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>We present a tendon\u2010preserving approach for massive rotator cuff tears, focusing on the subacromial space rather than entering the glenohumeral joint. This technique aims to minimize iatrogenic injury to already compromised tendons, particularly the infraspinatus, while improving visualization and surgical efficiency. By accessing the subacromial space first, manipulation of retracted and weakened posterior cuff tissues is avoided, reducing the risk of further damage. The procedure is performed in the beach\u2010chair position using 4 portals strategically placed for optimal visualization and precise anchor placement. After addressing the subscapularis tear, a double\u2010row supraspinatus repair is completed without the need for intra\u2010articular exploration. Preserving tendon integrity may enhance biomechanical stability and potentially decrease retear rates. Additionally, the retracted tendon edges often provide an indirect view of intra\u2010articular structures, allowing for the management of biceps or labral lesions. Although selective intra\u2010articular inspection may still be required in certain cases, this approach represents a paradigm shift in managing massive cuff tears. Future studies comparing outcomes, such as functional recovery and retear rates, with conventional intra\u2010articular techniques are warranted to further validate this subacromial\u2010first method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Technique Video<\/jats:title>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"video\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" position=\"anchor\" xlink:href=\"urn:x-wiley:22126287:media:atn2bf03496:atn2bf03496-vimg-mmc1\">\n                          <jats:alt-text>video<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>See video under supplementary data.<\/jats:bold>\n                    <\/jats:p>\n                  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