Chapter 3 Instability

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CHAPTER 3 | Instability

FIGURE 3-141  Left shoulder, posterior viewing portal. There is a type II SLAP lesion with an unstable biceps root. G, glenoid.

FIGURE 3-139  En face view from 3D CT scan shows a small amount of comminution at the anterior rim of the glenoid.

were able to calculate the width of the glenoid track (GT = 0.83% D − d, where D = glenoid diameter and d = width of the anterior glenoid bone defect). In this case, GT = 21.9 mm. We also were able to directly mea- sure the width of the Hill-Sachs interval (HSI = width of Hill-Sachs lesion plus width of bone bridge between Hill-Sachs and rotator cuff attachments). In this case, HSI = 18 mm. ■ Since HSI (18 mm) < GT (21.9 mm), this was an “on- track” Hill-Sachs lesion, and ordinarily we would not do a remplissage for an “on-track” lesion. However, in this case, there was a fairly rigid ALPSA lesion, which is known to contribute to higher recurrence rates, and quality of the tissue comprising the anterior capsule was poor. For those reasons, we elected to do a rem- plissage as an added safeguard to further strengthen the repair construct. ■ The Bankart repair was performed with double-loaded BioComposite SutureTak anchors in order to maxi- mize the strength of the repair with two fixation points for each anchor. This seemed important because the patient had a rigid ALPSA lesion with a poor-quality capsule. ■ The SLAP lesion was repaired with a Knotless SutureTak (Arthrex, Inc., Naples, FL), which is our preferred implant for SLAP lesions. This implant eliminates intra-articular knot abrasion in areas where the tissue quality is good, when double-loaded anchors are not necessary. ■ For the remplissage, we used a “blind” technique of interlocking Knotless SutureTak anchors (Fig. 3-142). We have tested this construct in the biomechanics lab

Pearls, Pitfalls, and Decision-making: ■ The patient had only 10% glenoid bone loss, so a Latarjet reconstruction was not indicated. ■ By measuring the distance from the bare spot of the glenoid to the posterior and anterior glenoid rims, we

FIGURE 3-140  Left shoulder, anterosuperolateral viewing portal. There is an ALPSA lesion, with healing of the anteroinferior capsulolabral complex in a medialized location. G, glenoid.