Chapter 3 Instability

172

CHAPTER 3 | Instability

FIGURE 3-82  A: Suture passage for HAGL repair is accomplished with a Labral Scorpion (Arthrex, Inc., Naples, FL). B: A knotless BioComposite PushLock anchor (Arthrex, Inc., Naples, FL) is used in the repair of the HAGL lesion. H, humeral head.

Physical Exam: ■ Full range of motion ■ Normal strength ■ Positive posterior drawer and positive posterior load-and-shift Imaging: ■ X-rays are normal ■ MRI scan shows a small Hill-Sachs lesion indicating ante- rior instability (Fig. 3-84). No definite anterior Bankart lesion or posterior lesion was identified on the MRI scan.

Cowboy’s Conundrum: Combined Posterior and Anterior Instability with Posterior HAGL Lesion, Kim Lesion, and Anterior Bankart Lesion Surgeon’s Solution: Arthroscopic Bankart Repair, Kim Lesion Repair, and Posterior HAGL Repair History: ■ A 29-year-old male subluxed his left shoulder while doing a bench press in the gym. He can no longer do bench press due to pain and sensation of instability. ■ History of remote “dislocation” of left shoulder 12 years ago in a football game; this self-reduced.

Video 3-13

FIGURE 3-84  MRI does not reveal the reverse HAGL lesion. However, it does show the Bankart lesion, the Kim lesion, and a small Hill-Sachs lesion.

FIGURE 3-83  Final repair of supraspinatus tear.