Chapter 3 Instability

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CHAPTER 3 | Instability

FIGURE 3-42  Left shoulder, anterosuperolateral portal demonstrating absence of glenoid bone loss in an individual with anterior glenohumeral instability. A: A calibrated probe inserted from a posterior portal measures a distance of 10 mm from the bare area to the posterior glenoid rim. B: The distance from the anterior glenoid rim to the bare area is also 10 mm. G, glenoid; H, humeral head.

externally rotated to provide a better angle of approach to the bone (Fig. 3-45A). We then use a 5-mm transtendon metal cannula (Arthrex, Inc., Naples, FL) parallel to each of the two spinal needles to place two suture anchors, one at the top of the Hill-Sachs lesion and the other at the bottom (Fig. 3-45B, C). A Spear drill guide (Arthrex, Inc., Naples, FL) is used to stabilize the drill for creating the sockets for insertion of double-loaded BioComposite SutureTak suture anchors (Arthrex, Inc., Naples, FL). In some cases, anchor placement requires an angle of approach that begins too far lateral for the anchors to be placed transtendon. In this case, the solution is to place the anchors through the posterior

The arthroscope is then reinserted intra-articularly through the anterosuperolateral viewing portal. The con- cept of our technique of remplissage is to inset the infraspi- natus tendon into the Hill-Sachs defect, in contradistinction to other methods that insert capsule and muscle into the defect. This means that our sutures must obtain fixation more laterally than these other techniques, in order to ensure capture of the tendon rather than muscle. Continuing to view through an anterosuperolateral portal, we next place two spinal needles percutaneously through the infraspinatus tendon, at a 30° to 45° angle to the Hill-Sachs lesion. The humerus may be internally or

FIGURE 3-43  Left shoulder, anterosuperolateral viewing portal demonstrates a Hill-Sachs lesion. A: A calibrated probe inserted from a posterior portal estimates the depth of the lesion to be 5 mm. B: Removing the arm from traction and placing it in the 90-90 position demonstrates that the Hill- Sachs lesion does not engage the anterior glenoid. G, glenoid; H, humeral head.