Chapter 3 Instability


CHAPTER 3 | Instability

Physical Exam: ■ Full range of motion ■ Normal strength ■ Apprehension in abduction and external rotation

and have found it to be almost twice as strong as a standard double-pulley construct with knots between two PEEK SutureTaks. Furthermore, it can be per- formed very rapidly and reproducibly. ■ After addressing all the instability components, we repaired the rotator cuff with a transtendon knotless technique. This was done last, as is our routine for all rotator cuff repairs, so as not to cause premature swell- ing that could hinder the intra-articular repairs. The Cowboy’s Conundrum: Failed Arthroscopic Bankart Repair in a Contact AthleteWithout Significant Glenoid Bone Loss but with Off-track Hill-Sachs The Surgeon’s Solution: Arthroscopic Bankart Repair plus Arthroscopic Remplissage History: ■ An 18-year-old high school football player had an arthroscopic Bankart repair done on his left shoulder 1½ years ago by another surgeon. ■ One week ago, he redislocated his left shoulder in a football game.

Imaging: ■ X-rays are normal.

■ 3D CT scan en face projection shows 16% loss of infe- rior glenoid diameter compared to the opposite side (Fig. 3-143). Arthroscopic Findings: ■ Glenoid radius (R) is 15 mm (Fig. 3-144). Glenoid diameter (D) is 2R = 30 mm. ■ Anterior “pseudoradius” (P) is 10 mm (Fig. 3-145). Bone loss (d) is R minus P = 15 − 10 = 5 mm. ■ Percentage glenoid bone loss = d/D = 5/30 = 16%. Since glenoid bone loss is <25%, Latarjet is not necessary. ■ Hill-Sachs Interval (HSI) is measured using 4-mm tip of calibrated probe (Fig. 3-146). ■ SLAP repair is done with Knotless SutureTak anchor (Arthrex, Inc., Naples, FL) (Fig. 3-147).

Video 3-24

FIGURE 3-143  3D CT scan, en face view of the left glenoid (A) can be compared to that of the right glenoid (B) , and the glenoid bone loss is calculated to be 16%.

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