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Subscapularis insufficiency continues to be a source of morbidity after anatomic total shoulder arthroplasty (TSA). Biologic augmentation following rotator cuff repair has shown promising results. Here we show the technique for performing subscapularis repair after anatomic TSA using a "peel-tenotomy" and bone marrow aspirate concentrate (BMAC). A standard deltopectoral approach is performed. The peel-tenotomy is performed by leaving 0 to 10 mm of subscapularis attached to the lesser tuberosity and peeling off the remainder of the tendon. A trocar is used to aspirate bone marrow from the humeral head, which is then processed. Prior to placing the humeral stem, drill holes are placed at the bicipital groove and lesser tuberosity. Sutures are placed through each drill hole. After impacting the humeral stem, suture is passed through the subscapularis to perform a secure double row repair. Prior to tying the sutures, BMAC is applied along the margins of the subscapularis repair. After securing the sutures, additional BMAC can be applied to the subscapularis repair. It is hypothesized that this technique could provide a more robust subscapularis repair and decrease the rate of subscapularis insufficiency after TSA without any known risk or morbidity to the patient, although further research is needed to show this., Competing Interests: The authors report the following potential conflicts of interest or sources of funding: G.C. is a board member of the Journal of Orthopaedic Experience & Innovation. L.M. receives speaking and lecture fees from Heron Therapeutics. S.S. is a board member of the 10.13039/100009885American Academy of Orthopaedic Surgeons, the American Orthopaedic Society for Sports Medicine, Arthroscopy, and the Arthroscopy Association of North America; is on the editorial or governing board for Arthroscopy; and receives consulting or advisory fees from Exactech. G.R. receives consulting or advisory and speaking and lecture fees from 10.13039/100007307Arthrex and 10.13039/100008894Stryker. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (© 2024 The Authors.)

High-energy anterior cruciate ligament (high-energy ACL) injury, occurring in high-energy rotatory trauma of the knee, can accompany a unique fracture pattern that involves depression of the slope of the posterolateral tibial plateau (PLTP). These injuries are challenging to manage due to the lack of a gold-standard arthroscopic procedure that addresses both ACL deficiency and depressed PLTP slope. In such injuries, a one-stage approach may be used to (1) reconstruct the ACL or (2) reduce and fix the avulsed tibial spine, while concomitantly performing an arthroscopy-assisted reduction of a PLTP fracture that restores the anatomic slope of the tibial plateau. To summarize, using combined arthroscopic and fluoroscopic visualization, a tibial tunnel reaching 1 cm distal to the depressed plateau fragment is created using a cannulated drill. The drill is used to punch up the depressed fragment to its anatomic location, restoring the original slope of the PLTP. The corrected slope is then fixed in situ using a press-fit fibular allograft to stabilize the corrected PLTP slope. Use of this minimally invasive arthroscopic technique to restore the PLTP slope may help prevent graft failure of the reconstructed ACL and improve patient outcomes., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier.)