Christoph Bartl1, Andreas B Imhoff2. 1. Department of Orthopaedic Trauma Surgery, University of Ulm, Steinhoevelstrasse 9, 89075 Ulm, Germany. E-mail address: christoph.bartl@uniklinik-ulm.de. 2. Department of Orthopaedic Sports Medicine, Technical University Munich, Ismaningerstrasse 22, 81675 Munich, Germany. E-mail address: a.imhoff@sportortho.de.
Abstract
INTRODUCTION: Arthroscopic capsulolabral reconstruction via the anteroinferior 5:30 portal allows secure placement of the suture anchors in the lower half of the glenoid and adequate retensioning of the inferior glenohumeral ligament. STEP 1 EXAMINATION UNDER ANESTHESIA: With the patient under anesthesia, and prior to surgical intervention, assess the direction of glenohumeral instability and the presence of joint hyperlaxity to confirm the repair strategy preoperatively and to determine if additional procedures such as rotator interval closure or inferior capsular plications are needed. STEP 2 ARTHROSCOPIC EVALUATION AND PORTAL PLACEMENT: Underestimating the anteroinferior bone loss is one of the most common failures of arthroscopic capsulolabral revision repairs. STEP 3 MOBILIZATION OF CAPSULOLABRAL COMPLEX: Mobilize the capsulolabral complex down to the 6:00 position with a bent rasp to create a bleeding surface for biological healing. STEP 4 ANCHOR PLACEMENT: Place anchors at 5:30, 4:30, and 3:00, with additional anchors in the inferior half of the glenoid if more capsular material has to be shifted. STEP 5 CAPSULOLABRAL SHIFT AND KNOT TYING: A sufficient capsular shift of the anterior band of the inferior glenohumeral ligament at the lowest fixation point (5:30 anchor) is a key step of the procedure. STEP 6 ADDITIONAL TISSUE RECONSTRUCTION: Consider performing a rotator interval closure in patients with joint hyperlaxity or if a residual "drive through" sign with inferior instability remains after retensioning of the capsulolabral structures. STEP 7 REHABILITATION: Start with passive exercises and increase to active-assisted and active exercises. RESULTS: In our study of fifty-six patients treated with arthroscopic capsulolabral revision repair for recurrent anterior shoulder instability, arthroscopic evaluation at the revision repair showed glenoid bone loss measuring up to 10% of the inferior glenoid width due to compression fracture of the glenoid rim in almost 50% of the cases and glenoid bone loss measuring 10% to 20% in about 20% of the cases. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: Arthroscopic capsulolabral reconstruction via the anteroinferior 5:30 portal allows secure placement of the suture anchors in the lower half of the glenoid and adequate retensioning of the inferior glenohumeral ligament. STEP 1 EXAMINATION UNDER ANESTHESIA: With the patient under anesthesia, and prior to surgical intervention, assess the direction of glenohumeral instability and the presence of joint hyperlaxity to confirm the repair strategy preoperatively and to determine if additional procedures such as rotator interval closure or inferior capsular plications are needed. STEP 2 ARTHROSCOPIC EVALUATION AND PORTAL PLACEMENT: Underestimating the anteroinferior bone loss is one of the most common failures of arthroscopic capsulolabral revision repairs. STEP 3 MOBILIZATION OF CAPSULOLABRAL COMPLEX: Mobilize the capsulolabral complex down to the 6:00 position with a bent rasp to create a bleeding surface for biological healing. STEP 4 ANCHOR PLACEMENT: Place anchors at 5:30, 4:30, and 3:00, with additional anchors in the inferior half of the glenoid if more capsular material has to be shifted. STEP 5 CAPSULOLABRAL SHIFT AND KNOT TYING: A sufficient capsular shift of the anterior band of the inferior glenohumeral ligament at the lowest fixation point (5:30 anchor) is a key step of the procedure. STEP 6 ADDITIONAL TISSUE RECONSTRUCTION: Consider performing a rotator interval closure in patients with joint hyperlaxity or if a residual "drive through" sign with inferior instability remains after retensioning of the capsulolabral structures. STEP 7 REHABILITATION: Start with passive exercises and increase to active-assisted and active exercises. RESULTS: In our study of fifty-six patients treated with arthroscopic capsulolabral revision repair for recurrent anterior shoulder instability, arthroscopic evaluation at the revision repair showed glenoid bone loss measuring up to 10% of the inferior glenoid width due to compression fracture of the glenoid rim in almost 50% of the cases and glenoid bone loss measuring 10% to 20% in about 20% of the cases. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
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