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Anchorless Labral Repair for Recurrent Shoulder Instability in the Skeletally Immature.

ABSTRACT: The optimal treatment of recurrent shoulder instability in skeletally immature athletes remains controversial, especially if there is significant growth remaining. Some investigators advocate conservative treatment until patients are close to skeletal maturity, whereas others push for earlier surgery to avoid further damage. The objective of this technical note is to describe a technique for labral repair using an anchorless approach to avoid potential damage to the glenoid physis.

SUBMITTER: Clinker CE

PROVIDER: S-EPMC9705910 | biostudies-literature | 2022 Nov

REPOSITORIES: biostudies-literature

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Anchorless Labral Repair for Recurrent Shoulder Instability in the Skeletally Immature.

Clinker Christopher E CE Chalmers Peter N PN Romeo Anthony A

Arthroscopy techniques 20221020 11

The optimal treatment of recurrent shoulder instability in skeletally immature athletes remains controversial, especially if there is significant growth remaining. Some investigators advocate conservative treatment until patients are close to skeletal maturity, whereas others push for earlier surgery to avoid further damage. The objective of this technical note is to describe a technique for labral repair using an anchorless approach to avoid potential damage to the glenoid physis. ...[more]

PMID: 36457387

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Project description:Posterior instability, although an uncommon shoulder pathology, is reported most frequently in the athletic population. Arthroscopic repair has emerged as the main surgical treatment modality for posterior instability. However, when compared with arthroscopic repair for anterior instability, the results of this procedure remain suboptimal. The creation of iatrogenic defects in the capsule, due to cannula placement, is a possible culprit. Because these defects typically do not heal satisfactorily, they become stress risers within the capsule itself, which may lead to recurrent instability or an otherwise compromised repair construct. Therefore, we find that routine intraoperative repair of these defects after repair can reduce the risk of injury and possibly improve long-term outcomes. In this article, we illustrate the repair of a posterior segmental tear using all-suture knotless implants with closure of the posterior and posterior-inferior portals after stabilization. Technique Video Video 1 Arthroscopic repair of segmental posterior labral tear with portal closure. The patient is in the lateral decubitus position. Both 30° and 70° arthroscopes are used throughout the procedure. The observed segmental labral tear pattern is somewhat similar to a bucket-handle tear, beginning roughly at the 5:30 clock-face position and propagating to the 2-o’clock position. The labral fragment is preserved and incorporated into the repair. After glenoid preparation, knotless all-suture anchors (Arthrex) are placed starting posterior-inferiorly and continuing superiorly. The sutures are only partially tensioned until placement is complete. Final tensioning occurs from the inferior-to-superior direction. Concomitant capsulorrhaphy is also performed with the labral repair. After the repair, closure of the posterior portals is performed because open portals can potentially contribute to postoperative capsular laxity, as well as act as stress risers within the capsule. The accessory posterior-inferior portal is closed first by passing a suture through the portal’s adjacent capsule and tying in a blinded manner just outside the capsule. Finally, the standard posterior portal is closed using analogous steps.

Dataset Information

Anchorless Labral Repair for Recurrent Shoulder Instability in the Skeletally Immature.

Publications

Anchorless Labral Repair for Recurrent Shoulder Instability in the Skeletally Immature.

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