Arthroscopic Posterior Labral Repair and Capsular Closure via Single Working Portal for Posterior Shoulder Instability

Figures

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  Fig 1. Arthroscopic view of right shoulder from anterosuperior viewing portal showing posterior labral tear (arrows). The posterior labrum can be seen shifted off the glenoid (G) face. (HH, humeral head.)

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  Fig 2. With the patient in the beach chair position and viewing through an anterosuperior portal, an 18-gauge spinal needle demonstrating the trajectory of the posterior working portal that will allow for posterior labral repair and capsular shift of the right shoulder (A). On the external view, the trajectory and location of the working portal are illustrated. The portal location is impactful, with more medial placement allowing for easier lasso-loop passage through the capsule and more lateral placement allowing for easier anchor placement (B).

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  Fig 3. With the patient in the beach chair position, placement of the first anchor at the 6-o’clock position is visualized via an anterosuperior viewing portal during repair of a right posterior labral tear. On both the arthroscopic (A) and external (B) views, the anchor trajectory can be visualized. It is important that the trajectory is somewhat obtusely oriented in relation to the glenoid to ensure that the anchor is deployed in subchondral bone rather than chondral tissue.

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  Fig 4. Arthroscopic view of right shoulder via an anterosuperior viewing portal showing completed right posterior labral repair using 4 knotless, all-suture anchors (arrows). In this view, the posterior bumper that has been re-created by the arthroscopic posterior labral repair and capsular shift may be seen. (G, glenoid; HH, humeral head.)

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  Fig 5. Arthroscopic visualization of posterior capsular defect created by 5-mm cannula of working portal. (A) A No. 1 polydioxanone suture (PDS) can be seen passing just medial to the defect. (B) The suture is retrieved from the medial aspect of the defect. After retrieval, the suture is tied, effectively closing the defect in the posterior capsule, which reduces laxity in the posterior capsule.