Anterior portals in shoulder arthroscopy.

The anterior portal has been the major operative portal through which hand and motorized instrumentation have been introduced into the glenohumeral joint. This portal has been limited with respect to its access to structures in the anteroinferior aspect of the joint. Anatomical and clinical studies were undertaken to evaluate the safety and effectiveness of the use of an anterior inferior, as well as an anterior superior portal. Seventy-eight unembalmed cadaver specimens and 34 operative cases were used in the studies. Only an "inside out" technique using blunt instrumentation is recommended in creating the anterior inferior portal. The margin of safety with respect to the musculocutaneous nerve is increased with adduction. The use of these two anterior portals greatly enhanced our ability to visualize and work directly on lesions of the glenohumeral ligament labral complex. These anterior portals can be safely created if guidelines are carefully followed by surgeons with considerable experience in shoulder arthroscopy.