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Fig. 4 Representation of the posterior portal arthroscopic view of the trans-subscapular transposition of the long head of the biceps using the double double-pulley on a right shoulder in the beach chair position. Fig. 4-A Two knots of the double double-pulley are tied after all suture limbs were passed through the long head of the biceps (LHB) tendon; (Fig. 4-B) the remaining 4 opposing suture limbs are pulled and the LHB tendon reaches the anteroinferior glenoid rim after passing through the subscapularis tendon (SC) split; (Fig. 4-C) the dashed line represents the final course of the LHB tendon through and anteriorly to the subscapularis tendon. The opposing 4 suture limbs will each be used to obtain an additional 2 knots to reinforce the fixation of the LHB to the glenoid rim. Figure reproduced with permission from de Campos Azevedo and Ângelo.