Seven surgical steps demonstrate both arthroscopic and open repairs to the right shoulder. Findings include acromioclavicular joint arthritis, supraspinatus tears and anterior labral tears. The glenoid labrum is debrided, and the arthroscopic surgery is converted to open procedure. The distal clavicle and acromial spur are resected. A bursectomy is performed next, and a bone trough is created in the humerus. Three Mitek suture anchors are then inserted in the bone trough, with sutures securing the supraspinatus to the humerus.