Chapter 3 Instability

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CHAPTER 3 | Instability

FIGURE 3-107  Right shoulder, anterosuperolateral viewing portal (A) revealed a posterior HAGL lesion. (B) Outside view demonstrating a posterior clear 8.25-mm clear Twist-In hard cannula (Arthrex, Inc., Naples, FL) and a percutaneous posterolateral accessory portal made with an 18-gauge spinal needle (C) , which provides a good angle of approach for retrograde suture passage. (D) Placement of #2 FiberWire sutures (Arthrex, Inc., Naples, FL) from a 5.5-mm BioComposite CorkScrew FT suture anchor (Arthrex, Inc., Naples, FL) were passed through the two leaves of the posterior HAGL lesion. (E) An additional #2 FiberWire suture was passed through the posterior HAGL lesion. (F) Final repair after all of the sutures were tied “blind” through the posterior working cannula and a strong anatomic repair was achieved. H, humeral head.

Arthroscopic Findings: ■ There was an inverted pear glenoid with 30% glenoid bone loss and an ALPSA lesion (Fig. 3-108). ■ A SLAP lesion was discovered and arthroscopically repaired with a knotless technique (LabralTape plus PushLock anchor) (Fig. 3-109). ■ AposteriorHAGL lesion(capsular split variant)was found and was repaired with side-to-side sutures (Fig. 3-110).

Pearls, Pitfalls, and Decision-making: ■ Whenever an open Latarjet is done, we believe that it is important to first do an arthroscopy of the involved shoulder in order to address any concomitant damage within the shoulder. In this case, there was a SLAP lesion that was detected on the pre-op MRI. However, SLAP lesions are much more easily repaired arthroscopically than open, so this lesion demanded arthroscopic repair.