18 Shoulder Arthroscopy and Labral Repair

10.1055/b-0040-174141

18 Shoulder Arthroscopy and Labral Repair

Steven F. DeFroda and Brett D. Owens

Summary

Anterior shoulder instability is a problem commonly encountered in medicine. While first time dislocations can potentially be managed nonoperatively, young, highly-active patients and recurrent dislocators should undergo stabilization. Historically, this was performed via open Bankart repair. However, advances in surgical technique and instrumentation have allowed this procedure to be more commonly performed arthroscopically in the absence of significant anterior glenoid bone loss (i.e. “simple” Bankart repair). The following chapter outlines our preferred technique for arthroscopic anterior shoulder stabilization; the so called “Bankart repair.”

18.1 Introduction

Shoulder arthroscopy is the second most common orthopedic surgery performed annually in the United States. ¹ Shoulder arthroscopy allows for the treatment of a variety of pathology, including shoulder instability, labral tears, rotator cuff tears, biceps tendonitis, acromioclavicular joint arthrosis, and subacromial bursitis. ² ^, ³ Shoulder arthroscopy allows for the management of complex shoulder problems through minimal incisions, not possible via open techniques. Labral tears, specifically tears of the anterior-inferior labrum (Bankart lesions), can be very common, particularly following traumatic dislocation, or subluxation in the young athletic population. ⁴ ^– ⁶ Mastery of the gross and arthroscopic anatomy of the glenohumeral joint and subacromial space are essential for performing shoulder arthroscopy. The purpose of this chapter is to review the basic techniques of shoulder arthroscopy, namely diagnostic arthroscopy and subacromial decompression.

18.2 Preop

MRI should be reviewed to evaluate for any rotator cuff tears, labral injury, biceps pathology, evidence of prior dislocation or subluxation, and any preexisting glenohumeral arthritis. Imagining findings should be correlated with a through history and physical examination.
Depending on the expected pathology and planned procedure, patients may receive regional brachial plexus block preoperatively.

18.3 Positioning

Patient placed in beach chair position with operative arm in pneumatic arm holder.
Anatomic landmarks should be palpated and marked including posterolateral and anterolateral corner of acromion, acromioclavicular joint, clavicle, and coracoid (▶Fig. 18.1).
Arthroscopic portals can be drawn. Posterior viewing portal should be drawn approximately 2-cm distal and medial to posterolateral corner of acromion.
Anterior portals can be marked as needed for expected pathology. Anterior-inferior portal is drawn midway between a straight line from the coracoid to the axillary fold. Anterior-superior portal will be just off the anterolateral edge of the acromion. These portals can be confirmed arthroscopically via an inside-out technique, which will be explained later.