Chapter 3 Instability

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CHAPTER 3 | Instability

■ When LabralTape and PushLock anchors are used for knotless instability repair, placement of the LabralTape as a vertical mattress suture will position the anchor underneath the labrum (see Fig. 3-134), so that the bone socket for the anchor is totally covered by the labrum (see Fig. 3-135). The Cowboy’s Conundrum: Anterior Instability with ALPSA Lesion, Poor- quality Anterior Capsule and Borderline On-track Hill-Sachs Lesion plus SLAP Lesion and PASTATear of SupraspinatusTendon The Surgeon’s Solution: Arthroscopic Bankart Repair, Knotless SLAP Repair, Knotless PASTA Repair, and Knotless Remplissage History: ■ A 31-year-old highly competitive recreational basket- ball player. ■ He has a 9-year history of frequent anterior sublux- ations following an initial dislocation while playing basketball. ■ Two days ago, he had an anterior dislocation that he was not able to reduce on his own. Two hours later, it was reduced in the emergency room. Physical Exam: ■ Pain with any motion of shoulder, precluding a mean- ingful exam. ■ Neurovascular status is intact. ■ MRI showed a Bankart lesion with a deficient ante- rior labrum and large redundant sulcus anterior to the glenoid (Fig. 3-137) as well as a SLAP lesion (Fig. 3-138). ■ 3D CT scan (en face view) showed a small amount of comminution of the anterior rim of the glenoid (Fig. 3-139). Arthroscopic Findings: ■ There was a large ALPSA lesion, with the anteroinfe- rior capsulolabral complex healed far medial to the glenoid rim (Fig. 3-140). ■ There was a type II SLAP lesion (Fig. 3-141). ■ There was 10% loss of the inferior glenoid diameter. Imagery: ■ X-rays showed a small Hill-Sachs lesion.

Video 3-23

FIGURE 3-137  MRI T2 axial image. This shows a Bankart lesion with a deficient anterior labrum and large redundant sulcus anterior to the glenoid.

■ There was a moderate-sized Hill-Sachs lesion. Calculation of the glenoid track (GT) based on intraoperative measurements was 21.9 mm, and the Hill-Sachs interval (HSI) was measured as 18 mm. Therefore, this was an “on-track” Hill-Sachs lesion, but it was “on track” by only a small amount. ■ There was a PASTA (partial articular surface tendon avulsion) lesion of the supraspinatus tendon.

FIGURE 3-138  MRI T2 coronal image demonstrates a type II SLAP lesion.