Rockwood Adults CH34

1096

SECTION TWO • Upper Extremity

Surgical Approach Either an anterior deltopectoral or mid-axillary crease approach is performed. With the anterior deltopectoral approach, a 5- to 6-cm incision is centered over the coracoid and extended down to the deltoid. For the mid-axillary crease approach ( green line ), the incision is centered over the coracoid to the axilla (Fig. 34-33A).

of the case, which shows excellent shift of the anterior-inferior capsulolabral complex (Fig. 34-32D). An arthroscope is inserted to the anterolateral portal to eval- uate the repair. Both the SLAP lesion and posterior labral tear must be addressed at this time if indicated. The patient is placed in a sling with an abduction pillow. Standard postoperative pro- tocol is followed.

Open Anterior Labral (Bankart) Repair Preoperative Planning ✔ ✔ Open Anterior Labral (Bankart) Repair: PREOPERATIVE PLANNING CHECKLIST

Technique

✔ ✔ Open Anterior Labral (Bankart) Repair: KEY SURGICAL STEPS

❑❑ Beach chair position with arm holder ❑❑ Examination under anesthesia ❑❑ Deltopectoral or mid-axillary crease approach ❑❑ Open the deltopectoral interval ❑❑ Superior half to two-thirds subscapularis tenotomy ❑❑ Separate the capsule from the subscapularis muscle belly ❑❑ “T” capsulotomy ❑❑ Expose and elevate the Bankart lesion off the glenoid rim ❑❑ Abraded the anterior glenoid rim with a burr ❑❑ Place 3-mm anchors on the anterior glenoid rim and suture ❑❑ Shift and repair capsule with the arm in 30 degrees of flexion and

❑❑ Beach chair with arm holder

OR table

❑❑ Open shoulder set ❑❑ Links shoulder retractor, anterior Bankart retractor ❑❑ Anchors with preloaded sutures ❑❑ Drill bits and drill guide specific to the anchors used ❑❑ Suture passer ❑❑ 4.5- to 5.5-mm anchor for the repair of the subscapularis tendon depending on either a tenotomy or a peel was performed.

Equipment

30 degrees of external rotation ❑❑ Repair subscapularis tenotomy ❑❑ Close deltopectoral interval and skin ❑❑ Place patient a sling and abduction pillow

Preoperative planning is the same as for arthroscopic anterior labral (Bankart) repair, described above.

Positioning The patient is positioned upright in the beach chair position. An arm holder is placed to allow for different positioning and rotation of the shoulder throughout the case.

The patient is placed in the beach chair position with an arm holder to allow different arm positions throughout the case. Load and shift examination under anesthesia is performed to document humeral head translation. ROM and the sulcus

A

B

Figure 34-33.  A: Anterior approach to the shoulder with the incision centered over the coracoid and down to the axilla ( green line ). B: Deltopectoral approach performed with the cephalic vein retracted either medially or laterally. Retractors are placed between the deltoid and the conjoint tendon. The coracoid ( purple star ), conjoint tendon ( orange arrow ), lesser tuberosity ( yellow star ), and biceps tendon ( blue arrow ) are identified.