Chapter 3 Instability

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CHAPTER 3 | Instability

FIGURE 3-149  Right shoulder, anterosuperolateral viewing portal. Arthroscopic Bankart repair has been completed. G; glenoid; H, humeral head.

on 3D CT scans (15%). By both methods, the glenoid bone loss is <25%, so even though this is a revision repair, it can be adequately treated by arthroscopic means. It should be noted that this case is unusual, since most revision instability cases will have >25% glenoid loss, necessitating Latarjet reconstruction. FIGURE 3-148  Anchors have been placed within the Hill- Sachs lesion, near the articular margin for remplissage. These anchors should be placed prior to doing the Bankart repair or else the anteriorly directed forces of anchor placement could cause disruption of the Bankart repair. H, humeral head; G, glenoid; HSL, Hill-Sachs Lesion.

■ After discovering that glenoid bone loss criteria favor an arthroscopic approach, we next need to see if the Hill-Sachs lesion is “off-track” (engaging) or “on-track” (not engaging). If it is off track , it will require an arthroscopic remplissage in order to complete an arthroscopic Bankart repair. If it is an on-track Hill- Sachs lesion, then arthroscopic Bankart repair alone will suffice.

FIGURE 3-150  A: Sutures from each anchor have been retrieved in retrograde fashion at a 45° angle to the Hill-Sachs lesion, so that they exit through the infraspinatus tendon. B: After remplissage by double-pulley technique, the infraspinatus and its underlying capsule have been inset into the Hill-Sachs lesion, converting the Hill-Sachs from an intra-articular defect to an extra-articular defect. H, humeral head.