Chapter 3 Instability

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CHAPTER 3 | Instability

are swept back and forth to create a “virtual space” above the tendon. Two Knotless SutureTak anchors are placed near the medial margin of the Hill-Sachs lesion through the pos- terior working portal. Then, a Penetrator Suture Retriever (Arthrex, Inc., Naples, FL) is introduced through the subacromial cannula. It penetrates the infraspinatus tendon at a 45° angle and retrieves the working suture FIGURE 3-50  Method of fixation with Knotless SutureTak (Arthrex, Inc., Naples, FL). A: The suture from the anchor is passed through the soft tissue and then threaded through the loop of the suture threader. Inset : Sectioned anchor shows the segment of coreless suture that the threader traverses. B: The free end of the suture threader (black limb) is pulled in order to thread the splice. C: The splice is threaded and the suture is tensioned to create a knotless loop around the soft tissue. Inset : Sectioned anchor shows the section of coreless suture that has now been threaded. This enlarged portion of the suture creates a one-way self- cinching splice that can be tightened by pulling on the free suture end but cannot be loosened.

While viewing the Hill-Sachs, the surgeon introduces a switching stick adjacent to the spinal needle and watches the switching stick indent the tendon and capsule, sig- nifying that the switching stick is just above the tendon. Then, the cannula and its cannulated introducer are delivered into the subacromial space by advancing them over the switching stick. When these are seen to indent the tendon and capsule, the cannula and its introducer