Chapter 3 Instability

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CHAPTER 3 | Instability

FIGURE 3-46  Right shoulder, anterosuperolateral portal demonstrating suture passage for remplissage using a retrograde technique. A: Sutures are seen exiting a posterior portal following anchor placement via the posterior portal. Using a spinal needle as a guide, the inferior sutures are passed through the infraspinatus tendon with a Penetrator (Arthrex, Inc., Naples, FL). B: The superior sutures are passed. H, humeral head.

To inset the infraspinatus tendon into the Hill-Sachs lesion, we use the same double-pulley technique that we use for PASTA repairs. This technique entails creating two double-mattress sutures between the two anchors by tying the sutures of one anchor to those of the other anchor. Subacromial viewing is done either through a posterior or a lateral subacromial portal, depending on which one gives the best view. Although a bursectomy has been previously performed in order to aid in visualizing the sutures, placing Spear guides over the sutures is helpful for protecting and locating the sutures (Fig. 3-47).

portal, then perform retrograde retrieval of the sutures of each anchor through two separate transtendon passes with a Penetrator (Arthrex, Inc., Naples, FL) (Fig. 3-46). In either case, by placing the anchors transtendon or retrieving the sutures transtendon in this way, all four suture limbs from a given anchor will exit the same point in the tendon. Then, the double-pulley repair technique is used to complete the remplissage. However, prior to completing the remplissage, one should tie the knots for the Bankart repair, so that sub- acromial fluid extravasation during the remplissage will not compromise the space required for Bankart repair.

FIGURE 3-47  Right shoulder demonstrating use of Spear guides to locate and protect remplissage sutures. A: External view shows Spear guides ( blue arrow ) in place over sutures passed through the infraspinatus tendon. B: Lateral subacromial view in the same shoulder. The Spear guide ( blue arrow ) protects the sutures as a shaver clears the bursa overlying the muscle and tendon. RC, rotator cuff.