- 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
- 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
- ref:
Over-pointing technique: an approach to past-pointing arthroscopic knots on alternating suture posts without alternating the knot pusher.
- Complications:
- recurrent instability;
- ref:
Revision of Failed Arthroscopic Bankart Repairs.
- 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.
The rationale and technique for arthroscopic reconstruction of anterior shoulder instability using multiple sutures.
LF McIntyre and RB Caspari. Orthop Clin North Am. Vol 24. 1993. p 55-58.
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.
A mechanical evaluation of a simulated Bankart lesion.
KP Speer et al. JBJS-Am. Vol 76. 1994. p 1819-1826.
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.
