Combined All-arthroscopic Hill-Sachs Remplissage, Latarjet, and Bankart Repair in Patients With Bipolar Glenohumeral Bone Loss  David Saliken, M.D., F.R.C.S.C., Vincent Lavoué, M.D., Christophe Trojani, M.D., Ph.D., Jean-François Gonzalez, M.D., Ph.D., Pascal Boileau, M.D.  Arthroscopy Techniques  Volume 6, Issue 5, Pages e2031-e2037 (October 2017) DOI: 10.1016/j.eats.2017.08.001 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 1 (A) Preoperative sagittal computed tomography scan in a left shoulder showing significant glenoid bone loss (arrow). (B) Preoperative axial computed tomography scan showing a large Hill-Sachs bone defect (arrow). © 2017 Pascal Boileau. All Rights Reserved. Arthroscopy Techniques 2017 6, e2031-e2037DOI: (10.1016/j.eats.2017.08.001) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 2 (A) Positioning of a left shoulder with the patient in the lazy beach-chair position (30°-40°) and a mobile arm support. (B) Anterior portals: The northwest portal (NW) is located at the anterolateral corner of the acromion. Relative to the coracoid, the north portal (N) is 1 fingerbreadth proximal and just medial; the south portal (S) is distal in the axillary fold; the west portal (W) is lateral to the conjoint tendon and midway between the northwest and south portals; and the east portal (E) (passing obliquely at 45° through the pectoralis major muscle) is 3 fingerbreadths medial to the conjoint tendon in line with the west portal. © 2017 Pascal Boileau. All Rights Reserved. Arthroscopy Techniques 2017 6, e2031-e2037DOI: (10.1016/j.eats.2017.08.001) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 3 (A) The arm positioner is used to translate the humeral head anteriorly. (B) Arthroscopic view of left shoulder with arthroscope in posterior viewing portal: Anterior translation gives an excellent view of the Hill-Sachs defect from the posterior portal. Two anchors are inserted into the Hill-Sachs defect just lateral to the cartilage. (C) A penetrating tool is used to grasp 1 strand of the inferior suture anchor from the Hill-Sachs defect into the subdeltoid space. (D) As viewed through the posterior portal, the humeral head is reduced and the sutures are tied, filling the Hill-Sachs defect. © 2017 Pascal Boileau. All Rights Reserved. Arthroscopy Techniques 2017 6, e2031-e2037DOI: (10.1016/j.eats.2017.08.001) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 4 (A) Motorized rasp through the northwest portal to flatten the inferior surface of the coracoid. (B) Coracoid drill guide inserted through the north portal used to reproducibly drill the coracoid 5 mm from the tip and medial and lateral aspects. (C) Coracoid osteotomy with an oscillating saw is performed through the northwest portal 15 to 20 mm from the tip of the coracoid. (D) Motorized rasp to flatten the anterior glenoid neck. (E) Insertion of a Bankart anchor at the 3-o'clock position (arrow). (F) Placement of the glenoid drill guide at the 5-o'clock position (in a right shoulder) along the glenoid face. © 2017 Pascal Boileau. All Rights Reserved. Arthroscopy Techniques 2017 6, e2031-e2037DOI: (10.1016/j.eats.2017.08.001) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 5 (A) Postoperative sagittal computed tomography scan confirming subequatorial positioning and union of coracoid transfer. (B) Postoperative axial computed tomography scan confirming positioning of coracoid graft flush with articular surface. © 2017 Pascal Boileau. All Rights Reserved. Arthroscopy Techniques 2017 6, e2031-e2037DOI: (10.1016/j.eats.2017.08.001) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions