Chapter 3 Instability

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CHAPTER 3 | Instability

The Cowboy’s Conundrum: Anterior Instability with Combined Bankart and HAGL Lesions The Surgeon’s Solution: Arthroscopic Bankart Repair and HAGL Repair History: ■ An 18-year-old male basketball had his feet knocked out from under him while coming down from a rebound. He landed on his outstretched right arm and dislocated his shoulder. ■ He now has apprehension with his right arm in the overhead position. Physical Exam: ■ Full range of motion and normal strength ■ Positive apprehension sign in abduction and external rotation Imaging: ■ X-rays are normal. ■ MRI scan showed Bankart lesion and HAGL lesion (Fig. 3-91). Arthroscopic Findings: ■ A Bankart lesion (Fig. 3-92) and a HAGL lesion (Fig. 3-93) were both discovered. ■ Repair of the Bankart lesion (Fig. 3-94) and repair of the HAGL lesion (Fig. 3-95) were both performed with suture anchors.

Video 3-14

Pearls, Pitfalls, and Decision-making: ■ If the HAGL lesion is repaired first, then the Bankart lesion must be repaired without the use of a 5 o’clock portal (since the 5 o’clock portal would have to be established through the repaired anterior capsule, thereby risking disruption of the HAGL repair). In this case, the HAGL was repaired after the Bankart lesion, leaving all options open for establishment of portals, including the 5 o’clock portal, which was used in this patient. ■ The HAGL lesion is best seen through an anterosu- perolateral viewing portal, so repairs should be per- formed while viewing through that portal (Fig. 3-96). FIGURE 3-92  Right shoulder, anterosuperolateral viewing portal. Hook probe reveals Bankart lesion. G, glenoid; H, humeral head.

FIGURE 3-91  MRI. A: Axial cut shows Bankart lesion. B: Coronal cut shows HAGL lesion ( white arrow ).