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Arthroscopic management of glenoid dysplasia.
This is a patient with extensive posterior and superior labrum tearing, and you can see
on his x rays, the boney glenoid tilts significantly posteriorly. This results in a significant
increase in posterior labrum tears and secondary anterior superior tearing of the rotator cuff
and premature arthritis in these patients.
This patient is a former professional baseball player who presented after a high-energy waterskiing
injury that resulted in this extensive amount of labrum tearing that involves almost the
entire glenoid.
We first start with tenodesis of the biceps, which has already been performed. And now,
we're moving on with SLAP lesion repair.
It's very important to restore the labrum back up on top of the glenoid face at the
articular margin so it can perform its bumper cushion effect.
We've completed that and now are looking from the 12 o'clock position down at the inferior
and posterior aspects of the glenoid.
We really have to create a bleeding bed that can accept the labrum back up on top of the
glenoid face, and in this case, because this posterior inferior labrum is really sloped
significantly away from us, we are seeing both the neck of the glenoid and the articular
margin, which is much closer to us.
So we spend a lot of time preparing this bed so that the labrum can heal nicely back up
onto this glenoid neck.
While some are proponents for boney osteotomy and other procedures, we find this arthroscopic
approach works very nicely.
Here we've turned off the pump and can see small amount of bleeding, confirming excellent
bleeding bed. For the posterior and inferior quadrants, we tend to place all our anchors
at once, which allows much more specific tailoring respiration of the tissue.
We use all-suture anchors. This allows us to avoid any complications from metal or varying
levels of resorption or third body wear. These are hollow, permanent braided sutures.
Once the anchors are placed, we start the capsular shift and labrum repair down at the
very inferior aspect.
Here the blue suture is just a shuttle that allows us to very accurately place the sutures
where we want them.
So we place this first suture and tie it, and then the process is repeated sequentially
until the entire capsular ligamentous and labrum complex are restored back anatomically.
Here we've completed the labrum restoration portion and now are performing a small area
of an inferior to superior shift at the site of our posterior inferior cannula.
Again, the shuttle suture is passed and it's created out for a permanent braided suture.
This is now retrieved once we determine the appropriate spot to create appropriate tension
and then tie it.
This results in excellent anatomic restoration and balance of the entire soft tissue complex
as seen here. You can learn more at The Shoulder Center dot com.