Comprehensive Arthroscopic Shoulder Stabilization in the Lateral Decubitus Position

Abstract

Arthroscopic shoulder stabilization offers a safe and effective means for restoring glenohumeral mechanics in the setting of shoulder instability. Modern arthroscopic techniques have allowed improved access and efficiency when treating patients with shoulder instability. However, access to certain areas of the labrum and the creation of safe accessory portals can still prove difficult for the arthroscopic surgeon. Currently, there is debate as to the ideal patient position, portal location, equipment, and technique for addressing anterior-inferior labral pathology. The following article presents a safe and effective approach to accessing the labrum for treatment of shoulder instability in the lateral decubitus position. In addition, this paper highlights the use of accessory portals, including a percutaneous "7-o'clock" portal for suture anchor placement, along with multiple types of suture anchor and suture shuttling techniques.

Fig 1

The patient is positioned into the lateral decubitus position using a bean bag. We also use a Lateral Jack device to provide upwards force on the humeral head, which is positioned just opposite and distal to the axilla of the patient. Positioning of the portals (high lateral posterior, 7-o’clock and traditional posterior) also can be visualized.

Fig 2

Arthroscopic view of the left shoulder from the posterior viewing portal. With the patient positioned in the lateral decubitus position, the anterior portal is established, which is positioned just superior to the subscapularis.

Fig 3

Arthroscopic view of the left shoulder from the posterior viewing portal. The anterosuperior canula is established and positioned just superior to the biceps tendon.

Fig 4

Arthroscopic view of the left shoulder from the posterior viewing portal. A Bankart elevator is introduced from the anterior portal and is used to release and mobilize any torn labrum.

Fig 5

Arthroscopic view of the left shoulder from the anterosuperior portal. A percutaneous accessory “7-o’clock” portal is used to place the first anchors at the posteroinferior and inferior labrum.

Fig 6

Arthroscopic view of the left shoulder from the posterior viewing portal. The anteroinferior anchor is inserted through the anterior cannula.

Fig 7

Arthroscopic view of the left shoulder from the anterosuperior portal. This image demonstrates the final repair constructs, with labral fixation beginning at the posteroinferior labrum and continuing anteriorly. Note the low-profile nature of the mattress repair configuration of the labral fixation points.