Chapter 3 Instability

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CHAPTER 3 | Instability

FIGURE 3-142  A: Axial section of a left shoulder shows a Hill-Sachs defect at the posterior aspect of the humeral head. There is a posterior cannula that is placed intra-articularly and through which two suture anchors are placed into the Hill-Sachs defect. The other cannula is a posterolateral cannula whose orientation is first determined by observing trial needle placements from an anterosuperolateral intra-articular portal. This cannula is advanced bluntly into the subacromial space until it abuts against the infraspinatus tendon. B: The posterolateral cannula is swept back and forth over the surface of the infraspinatus tendon to create a virtual space. Then, a straight BirdBeak suture retriever (Arthrex, Inc., Naples, FL) is used to sequentially retrieve the two sets of sutures through two different points in the infraspinatus tendon. C: Both sets of sutures have been retrieved through the posterolateral cannula. D: Working extracorporeally, the surgeon passes the main suture (coreless tensionable suture) of anchor #1 through the loop passer of anchor #2, and vice versa. By pulling on the nonloop ends of the passers ( arrows ), the splice of each anchor assembly is threaded by the coreless suture of the opposite anchor. Once the passers have pulled the two coreless limbs back out the cannula, they are further tensioned to bring down the two loops as a knotless double mattress construct. E: After complete tensioning, the infraspinatus tendon has been inset into the Hill-Sachs lesion by the knotless double mattress construct.