Chapter 3 Instability

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CHAPTER 3 | Instability

■ Narrow bony Bankart fragments may be repaired with single-row fixation, but a large fragment such as the one in this case is most effectively stabilized with a double-row technique. ■ We always repair SLAP lesions that are associated with anterior instability because SLAP repair enhances ante- rior stability. FIGURE 3-126  Left shoulder, posterior viewing portal. A Labral Scorpion suture passer (Arthrex, Inc., Naples, FL) is used to pass sutures through the labrum above and below the fracture site for a standard suture anchor repair in those areas.

FIGURE 3-124  Left shoulder, anterosuperolateral viewing portal. The fracture has been anatomically reduced. The encircling sutures can be seen traversing the articular surface of the fracture fragment. G, glenoid; H, humeral head.

2. Suture anchor fixation (if the bone fragment is too small for screws) 3. Latarjet reconstruction (if the fragment is extremely comminuted, or if the fragment fractures during at- tempted fixation). We typically will have the patient consented for arthroscopic repair with possible open Latarjet reconstruction in the event that comminu- tion of the bone fragment precludes effective fixation.

FIGURE 3-125  Schematic of a two-anchor encircling technique. A: Sagittal view. Standard anchor repair is done above and below the fracture fragment and encircling sutures with two anchors are used around the fragment. B: Axial view of the encircling technique.