Placing Knotless Suture Anchor Through Mid-Glenoid Portal
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Procedure Outline
Table of Contents
- The mid-glenoid portal/anterior-inferior portal should be made approximately 1 cm lateral from the joint line of the humeral head and just superior to the subscapularis through the rotator interval. Portal placement is guided by the preliminary placement of an 18-guage spinal needle to ensure the trajectory of the portal is correct.
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Portal placement avoids injury to the labrum and should be determined after assessing both the thickness of the local soft tissues and the size of the relevant bony architecture.
- The drill hole for the knotless anchor should be drilled approximately 1–2 mm onto the face, or from the cliff, of the glenoid.
- The drill can be malleted down lightly to hold the drill in place while drilling anchor holes.
- The inferior-most anchor is placed first. Using the anterior portal, a drill hole is made on the lower part of the glenoid, about 2 mm onto the articular surface. This is usually at the 5:00 or 5:30 position. Ensuring this anchor is placed sufficiently low is crucial for effectively addressing the pathology and achieving a successful repair. A suture anchor is placed at a 45-degree angle to the glenoid face using a mallet. Through the anterior portal, a tissue penetrator with a monofilament wire loop is inserted through the capsule and under the torn labrum at the 5:00–5:30 position. The tissue is grasped more inferiorly than the anchor to achieve an inferior to superior and lateral to medial capsular shift. Be cautious of the axillary nerve near the 6:00 position.
- After passing through the soft tissue, the wire loop is released, and the penetrator is withdrawn from the capsule and removed from the shoulder.24
- The labral tape is passed a short distance through the eyelet of the knotless fixation device before the construct is inserted into the glenoid.
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The flatter, non-cylindrical labral tape provides a flat construct that wraps around the labrum to reaffix it to the face of the glenoid.
- A hemostat can be used to hold the tape as it is placed into the drill hole, and a mallet is used to drive the interference portion of the plastic implant to a marked depth on the percutaneous insertion device denoted by a black line.
- Once the suture anchor is securely affixed, the insertion device is unloaded and pulled out of the portal with 6 counterclockwise turns.
- Tightening the anterior band of the IGHL is crucial for a successful Bankart repair. This is done by suturing the labrum at the 6-o’clock position to an anchor at the 5-o’clock position, creating a south-to-north capsulolabral shift, typically using a curved suture passer.23
