Chapter 3 Instability

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CHAPTER 3 | Instability

FIGURE 3-51  Steps in performing knotless interlocking remplissage. A: Two working cannulas are used. A posterior intra-articular cannula is used for placing two anchors (Knotless SutureTak; Arthrex, Inc., Naples, FL) into the Hill-Sachs lesion, adjacent to the medial margin of the defect. A posterolateral subacromial cannula will be used for retrieving the sutures transtendon into the subacromial space. The cannula is swept to-and-fro just above the tendon to create a virtual space. B: A Penetrator Suture Retriever (Arthrex, Inc., Naples, FL) is passed through the infraspinatus tendon at a 45° angle to retrieve a set of sutures from one anchor. Then, the Penetrator is redirected to penetrate the tendon again (with a 1- to 2-cm bridge of tendon between the two sets of sutures). C: The two suture pairs have a tendon bridge between them. D: The working suture from anchor #1 is passed through the loop of the passing suture from anchor #2 and vice versa. E: The splices are threaded by pulling on the threading sutures. Then, the two loops are sequentially cinched down to inset the tendon into the Hill-Sachs defect. This creates a very strong knotless double mattress configuration.