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The posterolateral portal: optimizing anchor placement and labral repair at the inferior glenoid.

ABSTRACT: The Bankart lesion is considered the critical lesion in anterior shoulder instability, in which the anteroinferior glenoid labrum separates from the glenoid rim. Technical advances in arthroscopy have ushered in a shift from open to arthroscopic Bankart repair. When one is performing an arthroscopic Bankart repair, proper portal placement is critical for success in labral preparation and anchor placement. Frequently, standard anterior portals are insufficient for inferior glenoid anchor placement and suture shuttling. The posterolateral portal-located 4 cm lateral to the posterolateral corner of the acromion-simplifies and improves anchor placement, trajectory, and anatomic capsulolabral repair of the inferior glenoid. We present our preferred technique for capsulolabral repair of the inferior glenoid.

SUBMITTER: Cvetanovich GL

PROVIDER: S-EPMC3834628 | biostudies-other | 2013

REPOSITORIES: biostudies-other

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The posterolateral portal: optimizing anchor placement and labral repair at the inferior glenoid.

Cvetanovich Gregory L GL McCormick Frank F Erickson Brandon J BJ Gupta Anil K AK Abrams Geoff D GD Harris Joshua D JD Romeo Anthony A AA Bach Bernard R BR Provencher Matthew T MT

Arthroscopy techniques 20130531 3

The Bankart lesion is considered the critical lesion in anterior shoulder instability, in which the anteroinferior glenoid labrum separates from the glenoid rim. Technical advances in arthroscopy have ushered in a shift from open to arthroscopic Bankart repair. When one is performing an arthroscopic Bankart repair, proper portal placement is critical for success in labral preparation and anchor placement. Frequently, standard anterior portals are insufficient for inferior glenoid anchor placemen ...[more]

PMID: 24265983

Similar Datasets

Using a Posterolateral Portal to Pass and Tie the Suture of the Inferior Anchor During Arthroscopic Bankart Repair.

Project description:Using a posterolateral portal in passing and tying the inferior knot allows good labral reduction and adequate capsular shift to treat anterior shoulder instability. In this technique, the most inferior anchor is placed through a low anterolateral portal. A penetrating grasper is introduced from a posterolateral portal situated 2 to 3 cm distal and lateral to the viewing portal. This portal is used to pass the 2 limbs of the anchor suture as inferior as possible through the labrum and capsule close to 6 o'clock position to form the 2 limbs of the first mattress suture. Finally, knot tying is performed through this posterolateral portal, thus allowing better superior shift of the capsulolabral tissue. The other 2 anchor sutures are passed and tied through the low anterolateral portal.

| S-EPMC5439272 | biostudies-literature

Fluoroscopy-Guided Suture Anchor Placement Yields Excellent Accuracy for Arthroscopic Acetabular Labral Repair: A Cadaveric Study.

Project description:PurposeTo determine the accuracy of fluoroscopy-guided suture anchor placement for arthroscopic acetabular labral repair in cadaveric hip specimens.MethodsTwo sports medicine fellowship-trained surgeons performed arthroscopic hip surgery on 6 cadaveric specimens each. Suture anchors were placed at the 11-, 12-, 1-, 2-, 3-, and 4-o'clock positions of the acetabulum in each specimen using a previously described fluoroscopically guided technique. Gross dissection and thin-cut computed tomography scans were performed to assess for accuracy. The insertion angle between the subchondral bone and the drill bit immediately prior to suture anchor insertion was measured, and fluoroscopic visualization of the subchondral bone at each clock-face position was qualitatively graded as good, fair, or poor by 2 independent reviewers.ResultsOverall, 90.3% of attempts (65 of 72) were entirely intraosseous, 5.5% (4 of 72) perforated the articular cartilage, and 4.2% (3 of 72) perforated the far cortex, rates that are comparable with those in previous cadaveric studies. There was no statistically significant difference in accuracy between the surgeons (P = .42) or between the various clock-face positions (P = .63). Neither the insertion angle (P = .26) nor visualization of the subchondral bone (P = .35) was significantly correlated with accuracy by gross dissection.ConclusionsIn a cadaveric hip arthroscopy model, fluoroscopy-guided suture anchor placement yields excellent accuracy rates, similar to non-image-guided techniques.Clinical relevanceIntra-articular suture anchor placement and intrapelvic suture anchor placement are known complications of arthroscopic acetabular labral repair. Fluoroscopically guided suture anchor placement can be a useful tool for hip arthroscopy surgeons performing acetabular labral repair and reconstruction, potentially reducing the risk of these complications.

| S-EPMC8527325 | biostudies-literature

Arthroscopic glenoid labral repair with an oblique mattress configuration.

Project description:There have been several arthroscopic techniques described in the literature regarding the passage of sutures for an arthroscopic glenoid labral repair. With simple suture passage when tying knots, there is a concern of internal knot impingement, especially in the posterosuperior labrum. On the other hand, with simple suture passage with knotless technology, there is a concern of leaving the anchor hole exposed in the glenohumeral joint space, especially with anchors that are degradable over time. Whereas a horizontal mattress configuration may address these 2 issues in most cases, there is the issue of tissue cut-through with the labral tissue fibers being in the same plane as the horizontal mattress sutures. The purpose of this report is to describe the oblique mattress configuration, which allows the passage of suture through multiple labral tissue planes, covers up the anchor holes with labral tissue, and maintains the knots away from the articular surface if knots are tied.

| S-EPMC3834891 | biostudies-other

Lateral Meniscus Repair Using Posterolateral Portal: Suture Hook Technique.

Project description:Lateral meniscus lesions result in loss of meniscus hoop stresses and can lead to lateral compartment overload and early degenerative changes. Arthroscopic suture repair provides good long-term results. However, posterior vertical tears in the peripheral area of the meniscus can be technically challenging to resolve. This Technical Note describes the suture hook technique using an accessory posterolateral portal. We believe it is a safe, effective method for repairing full vertical tears of the lateral meniscus.

| S-EPMC7000335 | biostudies-literature

Arthroscopic Acetabular Labral Repair Using the Q-FIX Suture Anchor.

Project description:The goal of acetabular labral repair is to preserve/restore labral function. Maintaining labral function necessitates recreating the labrum's anatomy, especially avoiding a nonanatomic repair of the labrum to the acetabular rim. The purpose of this report is to detail the technique of acetabular labral repair using this Q-FIX all-suture anchor.

| S-EPMC6823793 | biostudies-literature

Double-Row Suture Anchor Repair of Posterolateral Corner Avulsion Fractures.

Project description:Posterolateral corner avulsion fractures are a rare variant of ligamentous knee injury primarily described in the skeletally immature population. Injury is often related to a direct varus moment placed on the knee during sporting activities. Various treatment strategies have been discussed ranging from nonoperative management, to excision of the bony fragment, to primary repair with screws or suture. The described technique is a means for achieving fixation of the bony avulsion using principles familiar to double-row transosseous equivalent rotator cuff repair. Proximal anchors are placed in the epiphysis, and sutures are passed in horizontal mattress fashion. Once tied, the limbs of these same sutures are then passed to more distal anchors. Remaining eyelet sutures can be used to manage peripheral tissue. The final repair provides anatomic reduction and compression of the fragment to its bony bed with minimal extracortical hardware prominence and no violation of the physis. Risks include potential for physeal injury or chondral damage to the lateral femoral condyle through aberrant anchor placement. Postoperative care includes toe-touch weight-bearing restrictions and range of motion restrictions of 0°-90° in a hinged brace for 6 weeks followed by gradual return to activity.

| S-EPMC5621161 | biostudies-literature

Arthroscopic Fixation of Glenoid Rim Fractures After Reduction by Labral Repair.

Project description:Surgical fixation of displaced, intra-articular glenoid fractures represents a clinical challenge. These fractures have traditionally been treated through open approaches to the glenohumeral joint; however, the morbidity associated with open surgery may be reduced with arthroscopic techniques. Previously described arthroscopic methods commonly use clamps and/or Kirschner wires to obtain and maintain provisional fixation. We describe our technique for minimally invasive, arthroscopic fixation of glenoid rim fractures using labral repair as an indirect reduction maneuver, followed by final fixation with an extra-articular screw. This method is safe, efficient, and reliable, and it can be used to approach a variety of intra-articular glenoid fractures.

| S-EPMC4947900 | biostudies-other

Anatomic Labral Repair in the Hip Using a Knotless Tensionable Suture Anchor.

Project description:To perform a proper labral repair, most surgeons use anchors to secure the labrum to the acetabular bone. We aim to describe a technique for labral repair with a knotless tensionable suture anchor. This technique uses a looped suture configuration, allowing selective tensioning of the repair to maintain the anatomic suction seal of the hip. The use of this technique is easily reproducible and reduces the surgical time compared with previous techniques.

| S-EPMC5124377 | biostudies-literature

Fluoroscopy-Guided Suture Anchor Placement for Acetabular Labrum Repair.

Project description:A narrow safe angle exists for placing suture anchors into the acetabular rim during arthroscopic acetabular labrum repair. Intra-articular suture anchor placement has been reported, and cadaver studies have shown the highest risk of errant suture anchor placement at the anterior acetabular rim. We describe a technique using intraoperative fluoroscopy to guide suture anchor placement into the anterior and superior acetabular rim, which may reduce the risk of iatrogenic injury during arthroscopic acetabular labrum repair.

| S-EPMC6551387 | biostudies-literature

Perceived vs. true glenoid anchor placement: a cadaveric comparison of the beach chair and lateral position.

Project description:PurposeTo explore whether patient position influences a surgeon's ability to accurately judge anchor position on the glenoid.Materials and methodsTwo anchors were inserted into the glenoid of 8 shoulders. Arthroscopic videos were taken from 3 views (posterior beach chair [pBC], posterior lateral decubitus [pLD], and anterosuperolateral decubitus [asLD]). The shoulders were disarticulated to identify "true" anchor position. Seventeen shoulder surgeons reviewed the videos and indicated anchor positions using the "clock face" method. Accuracy was measured within tolerances, ranging from zero (exact), 0.5 (half-hour), 1.0, and 1.5 hours of "true" position. Intra- and inter-rater agreement was calculated. Post hoc analyses explored for bias dependent on surgical side.ResultsThe overall accuracy was 34.0%. At tolerances of 0.5, 1.0, and 1.5 hours, accuracy increased to 82.4%, 95.4%, and 98.0%. With a 30° scope, identification of exact position was more accurate in pBC than pLD (odds ratio [OR] = 1.397; P = .029) but not asLD (OR =1.341; P = .197). At a tolerance of 0.5 hour, the 30° scope was more accurate in pBC than both pLD (OR = 1.444; P = .011) and asLD (OR = 1.728; P = .009). In left shoulders, anchors were perceived as more inferior than true position in asLD and pLD. In right shoulders, anchors were perceived as more superior than true position from pBC and pLD. Inter- and intrarater agreement were highest in pBC with a 30° scope (30° scope weighted kappa = 0.783 and 70° scope weighted kappa = 0.853, respectively).ConclusionJudgment of anchor position on video is most accurate in a pBC view. Inter- and intrarater reliability were also highest from a pBC view.

| S-EPMC7846687 | biostudies-literature

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