Chapter 3 Instability

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CHAPTER 3 | Instability

FIGURE 3-116  Plicating a tuck of capsule and incorporating it into the labral repair requires that (A) a suture from the

treatment should be successful, an “off-track” Hill-Sachs lesion [one in which HSI > GT] must be treated by rem- plissage in conjunction with arthroscopic Bankart repair in order to prevent engagement of the Hill-Sachs lesion). The Cowboy’s Conundrum: Anterior Instability with Large Bony Bankart Lesion The Surgeon’s Solution: Arthroscopic Repair with Double Row of Suture Anchors History: ■ A 42-year-old man fell from a bicycle while trying to show his son how to “pop a wheelie” Physical Exam: ■ Apprehension with any attempted range of motion ■ Neurovascular status intact anchor is initially placed through the labrum, and then, a standard suture retriever is used to pinch a tuck of capsule; (B) while the tuck of capsule is being pinched, a Labral Scorpion (Arthrex, Inc., Naples, FL) is used to pass the same suture limb through the tuck of capsule. (C) The knot is tied, accomplishing plication to the suture anchor. G, glenoid; H, humeral head.

Imaging: ■ Pre-op x-rays show a large bony Bankart fracture (Fig. 3-117). ■ Pre-op CT scan shows that the large bony Bankart lesion involves about 20% of the glenoid sur- face area associated with a small Hill-Sachs lesion (Fig. 3-118). ■ Pre-op MRI confirms the bony lesions and does not show any additional soft tissue damage (Fig. 3-119). Arthroscopic Findings: ■ SLAP lesion is repaired with a knotless SutureTak anchor (Arthrex, Inc., Naples, FL) (Fig. 3-120). ■ Bony Bankart is a single large fragment but is too small for screw fixation (Fig. 3-121). ■ Medial row anchors are placed. Their sutures will encircle the bone fragment (Fig. 3-122) and will be tensioned and fixed with BioComposite PushLock anchors (Arthrex, Inc., Naples, FL) laterally at the intra-articular aspect of the fracture site (Fig. 3-123).

Video 3-20