Rockwood Adults CH34

1113

CHAPTER 34 • Glenohumeral Instability

C

D

Figure 34-40.  ( Continued ) C: Pushlock anchor inserted with knotless fixation and labral tape ( green star ). D: Final repair construct with a total of four anchors in the posterior glenoid rim ( blue star ) with labral tape knotless fixation of the posterior labral tear ( yellow star ).

Open Posterior Labral (Bankart) Repair or Capsular Shift Preoperative Planning ✔ ✔ Open Posterior Labral (Bankart) Repair or Capsular Shift: PREOPERATIVE PLANNING CHECKLIST

underneath the spine with the medial border of the scapula draped (Fig. 34-41A).

Technique

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

❑❑ Lateral decubitus with arm holder or beach chair. The surgical area that is prepped must be medial enough to allow for the open posterior incision at the joint line. A bump can be placed under the scapula to help bump the posterior joint line up and allow for the open approach ❑❑ Peg board or bean bag with axillary roll ❑❑ Beach chair position with spider arm holder (Tenet Medical) ❑❑ Open shoulder set ❑❑ Linked Kobel shoulder retractor, anterior Bankart retractor ❑❑ Anchors with preloaded sutures ❑❑ Drill bits and drill guide specific to the anchors used ❑❑ Curved and straight suture passers ❑❑ 4.5–5.5-mm double-loaded anchor for the repair of the infraspinatus tendon ❑❑ 2.9- or 3.0-mm double-loaded suture anchors for capsulolabral repair

OR table

❑❑ Lateral decubitus position with arm holder or beach chair position with spider arm holder ❑❑ Posterior longitudinal incision centered over the posterior joint line and deltoid split ❑❑ Open the interval between the infraspinatus and teres minor ❑❑ Separate the capsule from the infraspinatus and teres minor muscles ❑❑ Horizontal capsulotomy or “T” capsulotomy ❑❑ Tag both leaflets with sutures ❑❑ Elevate the labral lesion off the glenoid rim and abrade the posterior glenoid rim superficially with a burr ❑❑ Place double-loaded suture anchors on the posterior glenoid rim along the extent of the tear ❑❑ Shuttle the sutures from the anchor on the glenoid rim through the capsulolabral tissue ❑❑ Shift the capsule and repair it using interrupted sutures ❑❑ Repair the infraspinatus teres minor ❑❑ Close the deltoid split and skin ❑❑ Place the patient in an external rotation sling The patient is placed in the lateral decubitus position with arm holder to allow different arm positions throughout the case or beach chair position with spider arm holder. A longitudinal incision over the posterior shoulder extending from the postero- lateral acromion to the level of the posterior axillary fold is per- formed (Fig. 34-41A, green line ). The deltoid is split in-line with its fibers to the level of the posterior axillary fold (Fig. 34-41B). The incision must be lateral enough to access the insertion of the infraspinatus and teresminor (Fig. 34-41B, star ). Two to three cen- timeters of the deltoid can be elevated off of the acromion to assist

Position/positioning aids

Equipment

Similar to that for arthroscopic posterior labral repair.

Positioning The patient is positioned in the lateral decubitus and an adjustable arm holder is used to allow adjustment of arm positioning during the case. Alternatively, the patient can also be positioned in the beach chair position with a bump