Chapter 3 Instability

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CHAPTER 3 | Instability

■ Arthroscopic Bankart repair is performed (Fig. 3-149). ■ Arthroscopic remplissage is performed with double- pulley technique (Fig. 3-150). Pearls, Pitfalls, and Decision-making: ■ As noted under “Arthroscopic Findings,” direct mea- surement of glenoid bone loss (16%) was essentially the same as the indirect measurement of bone loss FIGURE 3-146  Left shoulder, anterosuperolateral viewing portal. The 4-mm tip of the calibrated probe is used to measure the Hill-Sachs interval (HSI). G, glenoid.

■ Anchors for remplissage of Hill-Sachs lesions are placed near the articular margin at the superior and inferior aspects of the Hill-Sachs lesion (Fig. 3-148). ■ 5 o’clock portal (trans-subscapularis) was used for lower Bankart anchors. FIGURE 3-144  Left shoulder, anterosuperolateral viewing portal. Glenoid radius (distance from the bare spot of the glenoid to the posterior glenoid rim) is 15 mm (three hash marks on probe). Therefore, the glenoid diameter (D) is twice the radius, or 30 mm. G, glenoid; H, humeral head.

FIGURE 3-145  Left shoulder, anterosuperolateral viewing portal. Since the distance from the anterior rim to the glenoid bare spot is only 10 mm (two hash marks), compared to the posterior radius of 15 mm, there had to be 5 mm of bone loss (d = 5). G, glenoid; H, humeral head.

FIGURE 3-147  Left shoulder, posterior viewing portal. SLAP lesion has been repaired with a Knotless SutureTak (Arthrex, Inc., Naples, FL). G, glenoid; BT, biceps tendon.