The Use of All-Arthroscopic Autologous Matrix-Induced Chondrogenesis for the Management of Humeral and Glenoid Chondral Defects in the Shoulder  Adrián Cuéllar, M.D., Miguel Ángel Ruiz-Ibán, M.D., Ph.D., Ricardo Cuéllar, M.D., Ph.D.  Arthroscopy Techniques  Volume 5, Issue 2, Pages e223-e227 (April 2016) DOI: 10.1016/j.eats.2015.11.003 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 Arthroscopic access portals for shoulder: anterior portal (a), anterosuperior portal (as), and posterior portal (p). A right shoulder is shown. Arthroscopy Techniques 2016 5, e223-e227DOI: (10.1016/j.eats.2015.11.003) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 A glenoid chondral defect in a patient with right shoulder instability (posterior portal view with 30° arthroscope). (A) The fibrous tissue and unstable cartilage are debrided with curettes and motorized shavers to expose the subchondral bone of the glenoid. (B) Linear strips are then made using arthroscopic Steadman microfracture awls. Arthroscopy Techniques 2016 5, e223-e227DOI: (10.1016/j.eats.2015.11.003) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 Placement of glenoid membrane (anterosuperior portal view with 30° arthroscope in right shoulder). The glenoid membrane (gm) is positioned over the glenoid lesion (asterisk). Arthroscopy Techniques 2016 5, e223-e227DOI: (10.1016/j.eats.2015.11.003) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 Placement of humeral membrane (anterosuperior portal view with 30° arthroscope). The humeral membrane (hm) is positioned over the humeral lesion with the help of a blunt-tipped device (Bt) from the anterior portal that fixes one corner of the matrix against the humeral lesion; then, with the help of a grasper from the posterior portal (Pp), the membrane is attached over the chondral defect. Arthroscopy Techniques 2016 5, e223-e227DOI: (10.1016/j.eats.2015.11.003) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 Final placement of matrix (anterosuperior portal view with 30° arthroscope). (A) A Foley catheter balloon (f) is placed into the joint through the posterior cannula and is then inflated. The asterisks indicate the matrixes. (B) After removal of the Foley catheter, the placement of the matrixes (asterisks) can be fully assessed. (Hu, humerus chondral surface.) Arthroscopy Techniques 2016 5, e223-e227DOI: (10.1016/j.eats.2015.11.003) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions