Chapter 3 Instability

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CHAPTER 3 | Instability

Pearls, Pitfalls, and Decision-making: ■ ALPSA lesions, with medialized healing of the capsu- lolabral complex, have been shown to be associated with a high rate of recurrent dislocation when treated solely with an arthroscopic Bankart repair. For this reason, it is important to achieve meticulous capsulo- labral mobilization so that the labral margin “floats up” to the level of the glenoid rim (Fig. 3-57). FIGURE 3-56  Left shoulder, anterosuperolateral viewing portal. Arthroscopic remplissage into the Hill-Sachs lesion converts the bone defect to an extra-articular defect. H, humeral head.

FIGURE 3-54  Left shoulder, anterosuperolateral viewing portal. The torn capsulolabral complex has healed medial to the glenoid rim. H, humeral head.

■ The glenoid track was calculated to be 14.5 mm (0.83D − d). ■ Since the Hill-Sachs Interval (HSI) is greater than the glenoid track (GT), this is an off-track Hill-Sachs lesion. ■ An arthroscopic Bankart repair (Fig. 3-55) and an arthroscopic remplissage (Fig. 3-56) were performed.

FIGURE 3-57  Left shoulder, anterosuperolateral viewing portal. After mobilization, the labrum has “floated” up to the level of the glenoid rim. G, glenoid.

FIGURE 3-55  Left shoulder, anterosuperior viewing portal. View of arthroscopic Bankart repair. G, glenoid; H, humeral head.