Chapter 3 Instability

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CHAPTER 3 | Instability

FIGURE 3-65  A: The Hill-Sachs lesion is prepared from the posterior portal while visualizing through the ASL portal. B: The glenoid is prepared through the anterior portal with an Arthrex Torpedo shaver. HSL, Hill-Sachs lesion; H, humeral head; G, glenoid.

rotation can also help with this angle. It is imperative that the surgeon be sure not to penetrate the humeral head with anchor drilling or insertion! ■ When the anchors are placed transtendon, the inserters (and inserter guides) are left in position. Thus, when you go subacromial to retrieve the sutures (for cre- ation of the double-pulley construct), the sutures are protected from the shaver by the metal inserter guide. Once both guides are identified, they can be pulled out and then the suture construct can be completed.

pitfall of this method is placing the anchors (and thus sutures) too medial within the muscular portion of the infraspinatus rather than more laterally in the tendi- nous portion. ■ Another potential pitfall is that if the anchors are placed laterally through the infraspinatus (as is appro- priate), the insertion angle on the humerus can be too steep and result in penetration of the humeral head. A pearl to avoid this complication is to utilize the stout anchor inserter guide to push down on the inserter to force a good angle into the Hill-Sachs defect. Arm

FIGURE 3-67  The FiberWire suture from the 3.0 Knotless SutureTak anchor is passed through the inferior labrum utilizing a shuttle suture passer (ReelPass; Arthrex, Inc.; Naples, FL). G, glenoid; H, humeral head.

FIGURE 3-66  The inferior glenoid anchor is placed through a 5 o’clock portal. H, humeral head; G, glenoid.