- Discussion:
- shoulder arthroscopy:
- drive through sign:
- refers to the ability to pass the arthroscope easily between the humeral head and the glenoid
at the level of the anterior band of the inferior glenohumeral ligament;
- considered diagnostic of shoulder laxity or instability;
- ref: Clinical significance of the arthroscopic drive-through sign in shoulder surgery. Edward G. McFarland, MD. Jan 2001 Vol 17 No 1
- arthroscopic findings:
- ALPSA lesion:
- may have higher chance of dislocation because these may heal medially on the scapular neck;
- Neviaser’s Contribution to the Treatment of ALPSA lesions
- www.verusmed.com/articles/view/57713/
- glad lesion
- glenolabral articular disruption;
- lesion consists of an anterior-inferior labral tear associated with an injury to the glenoid articular cartilage;
- perthes lesion:
- variation of the Bankart lesion;
- lesion occurs when the scapular periosteum remains intact but is stripped medially
- torn anterior labrum is displaced only minimally
- Which labral lesion can be best reduced with external rotation of the shoulder after a first-time traumatic anterior shoulder dislocation?
- advantages:
- the subscapularis remains intact;
- disadvantages:
- failure rate is about 20 % at 3.5 years followup;
- arthroscopic Bankart repair does not address the plastic capsular deformation that generally occurs in truamatic anterior dislocation;
- arthroscopic repair often tends to repair the torn labrum too medially (away from the glenoid rim);
- arthroscopic repair is unable to address the rotator interval lesion, which occurs in about 10% of patients;
- acute dislocations:
- references:
- Arthroscopic staple capsulorrhaphy for anterior shoulder instability. L Coughlin et al. Am J. Sports Med. vol 20. p 253. 1992.
- Arthroscopic verus open Bankart procedures: a comparison of early morbidity and complications. MR Green. Arthroscopy Vol 9. p 371. 1993.
- Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. Am J. Sports Med. 1994. p 589-594.
- Pathologic changes associated with shoulder dislocations: Arthroscopic and physical examination findings in first time, traumatic anterior dislocations.
DC Taylor and RA Arciero. Am J. Sports Med. Vol 25. 1997. p 306-311.
- Arthroscopic Bankart suture repair: Technique and early results. Arthroscopy Vol 3. 1987. p 111-122.
- Arthroscopic Bankart suture repair. WA Grana. Am J. Sports Med. Vol 21. p 348. 1993.
- Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization
and rehabilitation in first traumatic anterior dislocations of the shoulder: Long-term evaluation.
- recurrent anterior instability
- references:
- Arthroscopic staple capsulorrhaphy for recurrent anterior shoulder instability. LS Matthews et al. Arthroscopy. Vol 4. 1988. p 106-111.
- multidirectional instability
- Technique Considerations:
-
importance of portal placement:
- it is imperitive that the instrument portal be placed as perpendicular as possible to the anterior glenoid surface (other wise
there will be a tendency to skive off of the osseous surface);
- in the case of a Bankart lesion, this may mean placing the anterior portal through the substance of the subscapularis muscle;
- it is also important to keep the instrument portal as lateral as possible (again to be as perpendicular as possible);
-
assesment:
-
rotator interval lesion
-
drive through sign:
- refers to the ability to pass arthroscope easily between humeral head and glenoid at level of anterior band of inferior glenohumeral ligament;
- considered diagnostic of shoulder laxity or instability;
- ref: Clinical significance of the arthroscopic drive-through sign in shoulder surgery. Edward G. McFarland, MD. Jan 2001 Vol 17 No 1
-
thermal capsular shrinkage:
-
anchor insertion site:
- it is important to insert bone anchor right at the edge of the articular surface;
- if the anchor drill hole is inserted slightly away from the articular edge the surgeon will be unable to visualize
the anchor insertion and there will be a tendency to skive off of the osseous surface;
-
arthroscopic inferior capsular shift:
- the surgeon establishes an antero-superior portal and a antero-inferior portal;
- an arthroscopic graber is inserted thru the superior portal and grasps the inferior capsule and then elevates this superiorly;
- the guide wire (or hollow trochar - depending on the specific technique used), is passed through the elvated inferior capsule;
- the rest of the technique (depending on the implant) is performed in the usual manner;
- this technique allows the surgeon to perform as much capsular shift as necessary in a controled fashion;
- anatomic considerations:
- rim angle is narrow over the anterior inferior glenoid and carefull drill placement is essential;
- ref:
Variations in glenoid rim anatomy: implications regarding anchor insertion.
-
thermal shrinkage;
- case example:
- 35 year old male with anterior instability, w/ obvious drive through sign demonstrated at arthroscopy;
- using a Mitek knotless anchor system, a arthroscopic grasper is inserted through the anterior-superior portal and is used
to grasp the anteior-inferior capsule and to draw it superiorly;
- a suture passer is then inserted through the elevated capsule, which then sets up the Mitek knotless system;
- Arthroscopic Knots:
- Roeder
- Weston
- SMC
- Tennessee Slider
- arthroscopic nonsliding Surgeon’s knot
- references:
-
Over-pointing technique: an approach to past-pointing arthroscopic knots on alternating suture posts without alternating the knot pusher.
-
Arthroscopic sliding knot: how many additional half-hitches are really needed?
- Complications:
- recurrent instability;
- ref:
Revision of Failed Arthroscopic Bankart Repairs.
- axillary nerve injury;
-
axillary nerve
- ref:
Arthroscopic perspective of the axillary nerve in relation to the glenoid and arm position: a cadaveric study.
- References:
Arthroscopic Treatment of Anterior-Inferior Glenohumeral Instability. Two to Five-Year Follow-up*
GM. Gartsman MD, TS. Roddey, PH.D., SM. Hammerman MD. JBJS Jul 2000, Vol 82-A, NUMBER 7 PAGE 991
Arthroscopic manifestations of shoulder subluxation and dislocation.
Effect of a chondral-labral defect on glenoid concavity and glenohumeral stability. A cadaveric model.
Pathologic changes associated with shoulder dislocations: Arthroscopic and physical examination findings in first time, traumatic anterior dislocations.
DC Taylor and RA Arciero. Am J. Sports Med. Vol 25. 1997. p 306-311.
Effect of lesions of the superior portion of the glenoid labrum on glenohumeral translation.
Arthroscopic suture repair of superior labral detachment lesions of the shoulder.
Arthroscopic resection of glenoid labral tears in the athlete: a report of 29 cases.
Osteolysis and Arthropathy of the Shoulder After Use of Bioabsorbable Knotless Suture Anchors.
Revision of Failed Arthroscopic Bankart Repairs.
