Background: A lesser tuberosity osteotomy is frequently performed during anatomic total shoulder arthroplasties. Healing of the LTO repair is critical to optimize outcomes and relies on stability and compression across the osteotomy site.

Purpose: This video includes a case presentation and demonstration of a standard anatomic total shoulder arthroplasty which uses a lesser tuberosity osteotomy and subsequent repair using a knotless compression bridge technique.

Methods: A simplified subscapularis repair technique is demonstrated using 2 holes in the proximal humerus and 2 passes through the subscapularis tendon. This technique uses suture tape and preformed racking hitches with subsequent tensioning of the repair. (Tendon Compression Bridge, Arthrex, Inc., Naples FL, USA). A 77 year old male with chronic right shoulder pain and a diagnosis of glenohumeral arthritis is presented. After a thorough discussion of risks and benefits, the patient elected to proceed with an anatomic total shoulder arthroplasty.

Results: The patient underwent a successful aTSA with an LTO repair utilizing a knotless, tension compression bridge technique. At 2 week followup, he is doing well and has good motion of his shoulder.

Conclusion: A knotless compression technique is an effective and efficient method to establish sustained compression at the osteotomy site, minimize risks of suture pullout or failure, and provide adequate stability across the osteotomy site to facilitate bony healing.