Chapter 3 Instability

164

CHAPTER 3 | Instability

■ A wide (but not too deep) Hill-Sachs was encountered as well (Fig. 3-65). ■ The Hill-Sachs as well as the Bankart lesions were both debrided and prepared for repair (Fig. 3-65). ■ The Bankart lesion was addressed first starting at the 6 o’clock position through a 5 o’clock portal (Fig. 3-66). ■ The FiberWire suture from the knotless 3.0 SutureTak anchor was then shuttled through the tissue (Fig. 3-67). ■ The suture is then shuttled back down into the splice locking mechanism within the body of the anchor (utilizing the 2.0 FiberLink shuttle suture) (Fig. 3-68). ■ The anchors for the remplissage are then passed through the infraspinatus tendon while visualizing intra-articularly through the ASL portal (Fig. 3-69). ■ The “double-pulley” construct is then completed on the subacromial side (Fig. 3-70) and the construct secured—thus securing the infraspinatus tendon down into the prepared Hill-Sachs lesion (Fig. 3-71). Pearls, Pitfalls, and Decision-making: ■ This patient had a moderate amount of anterior gle- noid bone loss. It measured ~24% glenoid bone loss. Drs. Burkhart and Joe de Beer have shown that bone loss of 25% likely does better with Latarjet procedure. However, when adding a remplissage to these “border- line” cases, it is possible in some cases to restore sta- bility, even in high-demand patients who would likely have failed a Bankart repair alone. ■ By performing the remplissage, this makes the Hill- Sachs essentially nonengageable. ■ In the presented technique, the remplissage anchors are placed independently in a transtendon fashion through the infraspinatus. No additional suture pas- sage is necessary in this method. However, a potential

FIGURE 3-63  Axial MRI demonstrates a significant anterior glenoid labral tear, likely anterior glenoid bone loss, and a Hill- Sachs lesion on the posterior humeral head.

Imaging: ■ Plain films normal ■ MRI demonstrated significant anterior labral pathol- ogy as well as a Hill-Sachs lesion (Fig. 3-63). Arthroscopic Findings: ■ The patient had a significant Bankart tear as well as significant glenoid bone loss anteriorly (Fig. 3-64).

FIGURE 3-64  A: The distance from the bare area to the posterior glenoid is ~17 mm. B: The distance from the anterior glenoid to the bare area is ~9 mm. Thus, the percentage glenoid bone loss is 8/34 = 0.24, or 24 bone loss. G, glenoid; H, humeral head.