Arthroscopic Labral Repair Using Knotless Suture Anchors in the Setting of a 270° Labral Tear of the Shoulder

ABSTRACT: Extensive glenoid labral tears, whether the result of repetitive instability or first-time dislocation, compromise the mechanical stability of the glenohumeral joint due to disruption of the anterior, inferior, posterior, and/or superior portions of the labrum. These lesions often result in recurrent multiplanar instability and pain that is nonresponsive to conservative management and difficult to diagnose due to variability in clinical presentation and advanced imaging findings. Arthroscopic repair techniques to address symptomatic shoulder instability have showed positive patient-reported outcomes, low failure rates, and high return-to-sport rates. The evolution of knotless suture anchors offers a fixation method that has proven to be functionally equivalent to knotted suture anchors while avoiding the risks of knotted anchors (knot loosening, knot migration, articular abrasion) and allowing easier placement and decreased operative time. The purpose of this technique is to describe our preferred method to treat a 270° labral tear through arthroscopic knotless anchor repair and demonstrate the expanded application of this technique for extensive glenoid labral pathology. Technique Video Video 1 For the treatment of a 270° labral tear in this left shoulder, the patient is placed in the lateral decubitus position and the standard diagnostic arthroscopy is performed using a posterior portal, anterior superior portal, and mid glenoid portal. Initial evaluation includes confirmation of the labral tear extending from 2 o’clock anteriorly to 11 o’clock posteriorly. Then attention is turned to the glenoid rim and torn labrum in preparation for repair. An arthroscopic shaver is used to debride the damaged labral tissue and create a bleeding surface on the glenoid rim to allow for better suture fixation and facilitate healing of the repaired labrum. A curved elevator is used to lyse capsulolabral adhesions and mobilize the labrum to allow for it to fall at the level of the glenoid articular surface. Suture repair is then performed using a ReelPass SutureLasso (Arthrex) to pass the repair suture through the capsule and grasp a several-millimeter (approximately 2-3 mm) portion of the labrum to integrate it into the repair. To address the anterior portion of the 270° labral tear, three 2.9 mm knotless PEEK PushLock Anchors (Arthrex) are fixed 5-7 mm apart from the 6 o’clock to 4 o’clock position. An accessory 7 o’clock portal is established for better accessibility to the posterior portion of the labral tear. A 3 mm knotless SutureTak Anchor (Arthrex) is placed at the 7 o’clock position followed by three additional 2.9 mm knotless PushLock Anchors 2-3 mm apart to the 11 o’clock position. A total of seven anchors are required to fully complete the capsulolabral repair and provide restoration of the labrum contour anterior, inferiorly, and posteriorly. Inspection with an arthroscopic probe is performed to check the integrity of the repair. The portal sites are then closed with no. 3-0 Monocryl suture, Dermabond, and Steri-Strips. A sterile dressing is placed, and then the shoulder is placed into a padded abduction sling.

SUBMITTER: Comfort S 

PROVIDER: S-EPMC8556671 | biostudies-literature |

REPOSITORIES: biostudies-literature