Rockwood Adults CH34

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CHAPTER 34 • Glenohumeral Instability

muscle belly (Fig. 34-31B, star ) is visualized below. This step will allow adequate shifting of the capsulolabral complex and reduce the anteroinferior capsular volume to stabilize the shoulder joint. A curved passer is used from the anteroinferior cannula to penetrate the capsule ∼ 1 cm distal and ∼ 1 cm away from the glenoid rim (Fig. 34-31C, arrow ) to allow shifting and mobili- zation of the capsulolabral complex. For the right shoulder, the right curve is used and vice versa. The authors prefer a metal- tipped passer to allow ease of passage through the soft tissue. Either knotless or knotted fixation repair of the Bankart lesion can be used. The authors prefer a knotless fixation using Labral Tape and Arthrex 2.9-mm pushlock anchors (Arthrex, Naples, FL). The first anchor position must be low on the glenoid face (Fig. 34-31D). The labral tape is shuttled across the labrum

and both limbs are passed into the anteroinferior portal. They are loaded up onto a 2.9-mm pushlock anchor (Fig. 34-32A). Using the drill guide and a 2.9-mm drill, the first fixation is placed at the 5:30 position (right shoulder) or 6:30 position (left shoulder). It is essential that the first anchor position is low on the anterior glenoid face (Figs. 34-31D and 34-32B). A labral tape cutter is used to cut the tape down to the rim of the glenoid (Fig. 34-32C). The same steps are repeated with two to three additional passages of the passer, labral tape, and fixation to the anterior glenoid rim. The anchors are placed sequentially at the 4:30, 3:30, and 2:30 position or 7:30, 8:30, and 9:30 position as needed depending on the right or left shoulder, respectively. The authors prefer at least three anchors for arthroscopic Bankart repair. A bumper is created at the end

A

B

C

D

Figure 34-32.  A: Labral tape ( star ) is shuttled across the labrum and loaded up onto a 2.9-mm pushlock anchor ( arrow ). B: The anchor is pushed locked onto the drill hole. C: A labral tape cutter is used to cut the suture flush to the glenoid rim. D: At least three anchors are used for the Bankart repair. In this patient, knotless technique is done with labral tape ( star ) and 2.9-mm pushlock anchors (Arthrex, Naples, FL). A bumper is created at the end of the repair.