Chapter 3 Instability

FIGURE 3-76  Left shoulder, viewed from an anterosuperolateral portal with a 70° arthroscope, demonstrates repair of a humeral avulsion of the glenohumeral ligaments (HAGL) lesion. A: View of the HAGL lesion. Note: The muscle of the subscapularis tendon is visible anteriorly (right in the image). B: An anchor has been placed in the humeral head. Sutures are passed retrograde through the avulsed ligaments. C: Final repair demonstrates restoration of the glenohumeral ligament insertion. H, humeral head; HAGL, humeral avulsion of the glenohumeral ligament; SSc, subscapularis muscle.

FIGURE 3-77  The killer angle. A: External view in a left shoulder demonstrates the location of the medial low anterior portal ( black arrow ). Note: This portal begins medial to the 5 o’clock portal, which is normally directly inferior to the anterior portal. B: Anterosuperolateral viewing portal demonstrates spinal needle ( white arrow ) location in the glenohumeral joint. C: Up-close view shows the killer angle. The white line parallels the trajectory of the spinal needle. The blue line parallels the humeral head. The angle between these two lines is acute with little room for error. Thus, the phrase “killer angle.” A, anterior portal; ASL, anterosuperolateral portal; H, humeral head; HAGL, humeral avulsion of the glenohumeral ligaments.