Arthroscopic Bankart Repair for Anterior Shoulder Instability Using a Posterolateral Portal
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A successful surgical outcome for patients with shoulder instability requires a complete preoperative evaluation, a thorough diagnostic arthroscopy to evaluate for concomitant co-pathology, and an effective postoperative therapy program tailored to the repair strategy. In addition to the Bankart lesion, the surgeon must be aware of other co-pathologies such as the HAGL lesion, the ALPSA lesion and SLAP tears, all of which may occur in concert with capsular pathology and which present as potential barriers to a successful outcome. We have previously described the use of a posterolateral arthroscopic portal, 4 cm lateral to the posterolateral corner of the acromion. This portal simplifies and improves anchor placement, trajectory, and anatomic capsulolabral repair of the inferior glenoid. In this case, we perform a hybrid repair using the posterolateral portal to place the first suture anchor at the 6 o’clock position on the glenoid and the mid-glenoid portal to place two labral tape knotless anchors.
Obtain a history which includes past injury, trauma, and/or repetitive motions.- Has the patient dislocated? If so, how many times? What was the mechanism? How strong was the force required to dislocate?
- What limitations in activity have occurred? Is pain or instability present at rest? Does it interfere with sleep?
- What prior treatments, if any, has the patient already tried (i.e. physical therapy, rest, anti-inflammatory medication) and to what degree did these help?
- Palpate the shoulder for tenderness and document range of motion compared to the contralateral extremity. Differences between active and passive motion may indicate pain or capsular contracture.
- Test for impingement to determine whether rotator cuff tendinitis is present. If weakness is present during strength testing, it may be from deconditioning or from underlying rotator cuff or deltoid pathology.
- Tests for anterior instability
- Apprehension sign - performed with patient supine and the arm forward flexed 90 degrees and the elbow flexed 90 degrees. The patient exhibits apprehension when an anterior force is applied to the shoulder
- Relocation sign - the patient’s apprehension decreases when a posterior, supporting force is applied to the shoulder
- Sulcus sign - an inferior force is applied to the shoulder with the patient standing, arm at their side. Appearance of a depression below the acromion indicates a positive sulcus sign
- Recurrent instability
- Stiffness
- Infection
- Neurovascular injury
- Spectrum MVP suture passer ConMed Linvatec, Largo, FL
- 3.0mm Suture Tak Anchors, Arthrex, Naples, FL
- 2.9mm PEEK Knotless Labral Tape Anchor, Arthrex, Naples, FL
- 0 PDS Sutures, Ethicon, Somerville, NJ
Citations
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Cite this article
Provencher M. Arthroscopic Bankart repair for anterior shoulder instability using a posterolateral portal. J Med Insight. 2014;2014(5). doi:10.24296/jomi/5.