Arthroscopic Repair of a Glenoid Avulsion of the Glenohumeral Ligament Jonathan C. Riboh, M.D., M. Michael Khair, M.D., Anthony A. Romeo, M.D.  Arthroscopy Techniques  Volume 4, Issue 6, Pages e795-e799 (December 2015) DOI: 10.1016/j.eats.2015.07.027 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 Magnetic resonance appearance of a glenoid avulsion of the glenohumeral ligament. A T2-weighted magnetic resonance arthrogram in the axial (A) and coronal (B) planes is shown. The anteroinferior glenoid labrum is normal in appearance. A patulous anteroinferior capsule is seen on both the axial (A) and coronal (B) views. The leading edge of the avulsed inferior glenohumeral ligament can be seen on both views (asterisks) and correlates with the intraoperative appearance of the injury. Arthroscopy Techniques 2015 4, e795-e799DOI: (10.1016/j.eats.2015.07.027) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 Arthroscopic appearance of a glenoid avulsion of the glenohumeral ligament. (A) Viewing from the posterior portal with the patient in the lateral decubitus position and the arm in traction, one can see that the anteroinferior labrum is firmly attached to the glenoid rim with no fraying or hemorrhage. (B) A patulous anteroinferior capsule is seen, with the leading edge of the avulsed inferior glenohumeral ligament retracted laterally and distally from its origin on the glenoid. The typically taut anterior band of the inferior glenohumeral ligament is not visualized. Arthroscopy Techniques 2015 4, e795-e799DOI: (10.1016/j.eats.2015.07.027) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 Reduction of the capsule back to the glenoid (Glen). Viewing from the anterior portal with the patient in the lateral decubitus position and the arm in traction, one can visualize the entire anteroinferior quadrant. (A) A grasper introduced from the anterior portal is used to grasp the torn anterior band of the inferior glenohumeral ligament (AIGHL). The capsule is pulled in a superior direction until appropriate tension is restored in the inferior glenohumeral ligament. (B) To facilitate subsequent anchor repair, the capsule is fixed to the labrum with a single high–tensile strength suture, maintaining an anatomic reduction during the rest of the procedure. This is achieved by introducing a Spectrum suture hook through the 7-o'clock portal, piercing the inferior glenohumeral ligament, and then piercing the labrum in a separate bite. The anterior portal is used for suture shuttling. Arthroscopy Techniques 2015 4, e795-e799DOI: (10.1016/j.eats.2015.07.027) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 Anchor-based fixation in the inferior capsular recess. (A) Anchor repair should begin at the 6-o'clock position. The first anchor is inserted percutaneously through the subscapularis. (B) A Spectrum suture hook is passed through the 7-o'clock portal and used to perforate both the capsule and the labrum. Care should be taken to shift the capsule from posterior to anterior, as well as medial to lateral. (C) A double-loaded anchor allows for 2 simple stitches to be placed, creating a robust capsulolabral “bumper.” Two double-loaded anchors are used to re-create inferior capsular tension. Arthroscopy Techniques 2015 4, e795-e799DOI: (10.1016/j.eats.2015.07.027) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 Anchor-based fixation in the anteroinferior quadrant. The repair is completed with a third anchor in the anteroinferior quadrant. (A) The anchor is inserted percutaneously through the subscapularis. (B) The Spectrum suture hook is inserted through the anterior portal while the surgeon is viewing through the posterior portal. A “pinch-tuck” technique is used to capture the anterior capsule and then the anteroinferior labrum. The surgeon places 2 simple stitches in this fashion, completing the repair of the glenoid avulsion of the glenohumeral ligament. (C) A panoramic view of the repair can be obtained by placing the camera in the anterior portal. Arthroscopy Techniques 2015 4, e795-e799DOI: (10.1016/j.eats.2015.07.027) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions