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Arthroscopic Management of Shoulder Instabilities: Anterior, Posterior, and Multidirectional

February 24, 2016

Contributors: Larry D Field, MD

This video demonstrates shoulder instabilities using the following cases: anterior instability with reconstruction and remplissage, a bony Bankart fragment repair example, a posterior instability example, and MDI case examples. First, a Hill-Sachs lesion is repaired with remplissage prior to a bony Bankart repair. It is important for remplissage to be carried out prior to Bankart repair to allow for access to the posterior humeral head defect. Next, a large, bony Bankart is debrided and repaired with anchors into the glenoid neck and the suture limbs passed medially to the fracture fragment to allow for labral ligamentous tissue reapproximation and retensioning. The next case is a 24 year old athlete with a history of posterior instability. After four months of conservative treatment and no improvement, the posterior labrum is arthroscopically repaired to give good reapproximation of the labrum, complete coverage of the articular cartilage defect, and supplemental capsular plication. Two cases of multidirectional instability are next demonstrated. Suture capsulorrhaphy is accomplished with a retrograde suture retriever through the inferior capsule using a horizontal mattress suture construct pattern. A second case of MDI demonstrates significant capsular laxity, and a probe demonstrates the lack of labrum pathology as well as the underdeveloped labral tissue often found in patients with MDI. This lack of tissue can make capsule fixation difficult, and creates a need for suture anchors. The finished capsulorrhaphy is demonstrated through the anterior portal camera.

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