Position
| Beach chair | Lateral decubitus |
|---|---|
| Patient seated upright | Patient on side in beanbag / lateral supports |
| Head attached / protect eyes / neck in normal position | Skin traction to forearm with traction pole / lateral support |
| Arm free draped on mayo / hydraulic arm holder | Arm abducted / lateral traction to glenohumeral joint |
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Portals
| Posterior portal | Anterosuperior portal | Anteroinferior portal |
|---|---|---|
| 2 cm below and 2 cm medial to posterolateral acromion |
Below AC joint Rotator interval at angle between biceps and glenoid |
Inferior and lateral to Anterosuperior portal Midpoint of subscapularis |
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Glenohumeral joint assessment
Labrum
|
Anterior inferior labral tears |
SLAP tears | Posterior labral tears |
|---|---|---|
|
Below equator 3 - 6 o'clock |
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Variations in anterior labral anatomy above equator
| Sublabral foramen | Sublabral foramen with cord like MGHL | Absent labrum with cord like MGHL |
|---|---|---|
| Buford complex | ||
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Glenoid assessment
Anterior chondral damage
Anterior glenoid bone loss
Hill Sachs lesion
Results
Glenoid bone loss
- systematic review of 500 patients
- recurrent instability after arthroscopic Bankart
- associated with glenoid bone loss > 15%
Remplissage
- RCT of 100 patients with <15% glenoid bone loss
- arthroscopic Bankart v Bankart + Remplissage
- Bankart only: recurrent instability 18%
- Bankart + Remplissage: recurrent instability 4%
Knotless versus knotted anchors
Wang et al BMC Musculoskelet 2025
- systematic review of 9 studies and 700 patients
- no difference in recurrence
- shorter operative times with knotless
Number of anchors
- systematic review of arthroscopic stabilization
- increased instability with use of 2 anchors v 3 or more
Complications
- systematic review of 14,000 procedures
- overall complication rate 0.7%
- frozen shoulder 0.3%
- persistent pain 0.2%
- nerve injury 0.1%
- wound complications 0.03%
Technique arthroscopic anterior labral / Bankart repair
Vumedi arthroscopic Bankart repair video
Steps
Mobilize anterior labrum
Debride anterior glenoid to bleeding bone
Insert minimum 3 anchors between 5.30 and 3 o'clock
Repair capsulolabral tissue
Mobilize labrum
Labral mobiliser / rasp
- labral tear can be obvious, but may have partially healed or healed medially
- change camera to anterosuperior portal for better view
- mobilize until can see subscapularis muscle underneath
- need to be able to advance labrum medially and superiorly for repair
Debride anterior glenoid bone to bleeding bone
Insert anchors
Inferior anchor at 5.30 o'clock
- curved anchor guide / trans-subscapularis
- on rim of glenoid
Other anchors typically at 3 and 4 o'clock
Pass sutures and tie knots
Typically curved suture passers
Aim to tighten capsule medially and superiorly onto glenoid
