Chapter 3 Instability

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CHAPTER 3 | Instability

FIGURE 3-120  Left shoulder, posterior viewing portal. SLAP lesion is being repaired with a Knotless SutureTak (Arthrex, Inc., Naples, FL). BT, biceps tendon; G, glenoid.

Pearls, Pitfalls, and Decision-making: ■ In a case such as this, there are three possible ways of dealing with the bone fragment: 1. Screw fixation (if the bone fragment is large enough) FIGURE 3-121  Left shoulder, anterosuperolateral viewing portal. Although the bony Bankart lesion comprises a rather large piece, it is judged to be too small for screw fixation. H, humeral head.

The sutures span three sides of the bone fragment, and the tensioned sutures between the medial and lateral anchors appose the fragment to the fractured surface of the main glenoid (Figs. 3-124 and 3-125). Lateral fixation to anchors above the fracture site is performed by standard suture anchor techniques (Fig. 3-126).

FIGURE 3-123  Left shoulder, anterosuperolateral viewing portal. The sutures from the medial anchor are passed around the fragment and then fixed to a lateral anchor (BioComposite PushLock; Arthrex, Inc., Naples, FL), which is placed at the intra-articular aspect of the fracture site.

FIGURE 3-122  Left shoulder, anterosuperolateral viewing portal. A suture anchor is placed medial to the fracture surface of the intact glenoid.