The “Floating Labrum”: Bankart Lesion Repair With Anterior Capsular Extension Using 2 Anterior Working Portals Allison J. Rao, M.D., Nikhil N. Verma,

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Presentation transcript:

The “Floating Labrum”: Bankart Lesion Repair With Anterior Capsular Extension Using 2 Anterior Working Portals Allison J. Rao, M.D., Nikhil N. Verma, M.D., Scott W. Trenhaile, M.D. Arthroscopy Techniques Volume 6, Issue 5, Pages e1607-e1611 (October 2017) DOI: 10.1016/j.eats.2017.06.017 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 1 Viewing from the anterior-superior portal in a left shoulder, the Bankart and capsular split becomes evident. The capsule is torn in addition to the labrum (as indicated with the long arrows), which also needs to be addressed. Recognition of the capsular tear creates a floating labrum, which needs to be addressed in addition to the labral repair. Arthroscopy Techniques 2017 6, e1607-e1611DOI: (10.1016/j.eats.2017.06.017) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 2 Viewing from the anterior-superior portal in a left shoulder, the capsular and Bankart lesion becomes evident. This is a unique pattern in which the labrum is torn away from both the bone and capsule more anteriorly (as indicated with the long arrows). Recognition requires looking from both posterior and anterior portals to view the entire labrum and capsule. Arthroscopy Techniques 2017 6, e1607-e1611DOI: (10.1016/j.eats.2017.06.017) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 3 Viewing posteriorly in a left shoulder, an anterior-inferior interval portal and an additional anterior-superior portal are used to allow for both a grasper and suture passer to work in the same area for labral and capsular repair. (BT, biceps tendon; C, cannula; HH, humeral head; L, labrum.) Arthroscopy Techniques 2017 6, e1607-e1611DOI: (10.1016/j.eats.2017.06.017) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 4 Viewing posteriorly in a left shoulder, while using an anterior-inferior interval portal and anterior-superior portal, a total of five 1.7-mm SutureFix anchors are placed at the articular margin edge. (GL, glenoid; L, labrum.) Arthroscopy Techniques 2017 6, e1607-e1611DOI: (10.1016/j.eats.2017.06.017) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 5 Viewing posteriorly in a left shoulder, while using an anterior-inferior interval portal and anterior-superior portal, sutures are placed circumferentially in a single fashion around the labrum while also incorporating them into the split in the capsule, taking care to shift the capsule superiorly. (GL, glenoid; HH, humeral head; L/C, labrum and capsule.) Arthroscopy Techniques 2017 6, e1607-e1611DOI: (10.1016/j.eats.2017.06.017) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 6 Final repair of the Bankart labral tear and capsular tear in a left shoulder, showing retensioning of the inferior and middle glenohumeral ligaments (as indicated with the long arrows). The final repair addresses both the capsular and labral tears, recentering the humeral head from anterior to posterior. Arthroscopy Techniques 2017 6, e1607-e1611DOI: (10.1016/j.eats.2017.06.017) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions