Rockwood Adults CH34

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CHAPTER 34 • Glenohumeral Instability

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Figure 34-38.  A: Arthroscopic posterior labral repair in the beach chair position. Anterior portal ( blue star ) is used for viewing with the arthroscope, anterior lateral portal ( red star ) is the working portal for elevator and CoVator to facilitate elevation of the posterior labrum off the glenoid so that adequate capsulolabral shift is performed. Posterior working portal ( blue circle ) is used for suture shuttling devices. Typically, an 8-mm threaded cannula is used here to allow passing for these devices. Posterior lateral portal ( arrow ) is used for drilling and placement of anchors. This portal must be in line with the scapular spine so that the anchor does not penetrate the glenoid fossa. B: Arm is externally rotated 30 degrees to open up the posterior recess or space to allow suture passage and anchor placement. Arthroscopic drill guide is inserted into the posterior lateral accessory portal ( yellow arrow ). Camera is inserted into the anterior portal for viewing. C: Arthroscopic CoVator ( red star ) is inserted into the anterior lateral portal to help elevate the posterior labral tear ( blue arrow ) off the glenoid rim ( blue star ). D: The posterior labrum ( yellow star ) is elevated off the glenoid rim.

suture tying, and a variety of sliding locking knots with adequate loop security are available. Regardless of the style of knot used, three alternating half hitches should be tied to ensure adequate knot security is achieved. The post limb should always come from the labral/capsular side and not from the glenoid side so as to ensure the tied knots do not sit on the glenoid and create a nidus for humeral articular-sided wear and damage. Alterna-

tively, using a knotless labral tape with pushlock anchors alle- viates any risk of having knots on the glenoid surface (see Fig. 34-40). Depending on the severity and extent of the lesion, two to four anchors should be placed to allow for restoration of the labrum back to its anatomical position on the glenoid labrum. The patient is placed in a sling with external rotation pillow. Standard postoperative protocol is followed.