Chapter 3 Instability

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CHAPTER 3 | Instability

FIGURE 3-80  A HAGL lesion was identified, as the capsule has been avulsed from the humeral insertion ( white arrow ). C, capsule; SSc, subscapularis muscle.

FIGURE 3-78  MRI. T2 coronal image shows a full-thickness tear of the supraspinatus. There were no findings of either a Bankart lesion or a HAGL lesion on MRI.

■ Rotator cuff tear was repaired with a standard suture anchor technique (Fig. 3-83).

Pearls, Pitfalls, and Decision-making: ■ The fact that the patient had an anterior dislocation that remained dislocated yet did not have a true Bankart lesion (only some anterior labral scuffing) should lead the surgeon to look for either a capsular tear or a HAGL lesion with capsular avulsion from the humerus. ■ The instability lesion (HAGL lesion in this case) should be repaired first, prior to the supraspinatus repair, before swelling begins to obscure visualization.

Arthroscopic Findings: ■ There was scuffing of the anterior labrum but no defi- nite Bankart lesion (Fig. 3-79). ■ There was a HAGL lesion (Fig. 3-80). ■ The supraspinatus had full-thickness tear (Fig. 3-81). ■ The HAGL lesion was repaired with two knotless suture anchors (PushLock; Arthrex, Inc., Naples, FL) (Fig. 3-82).

FIGURE 3-81  Right shoulder, posterior intra-articular viewing portal. A supraspinatus tear is present. H, humeral head; RC, rotator cuff.

FIGURE 3-79  Right shoulder, anterosuperolateral portal. The anterior labrum was scuffed, but there was no Bankart lesion.