Single-Portal Arthroscopic Posterior Shoulder Stabilization

Abstract

Posterior shoulder instability occurs when the labrum detaches posteriorly from the glenoid owing to significant trauma and is a relatively uncommon type of shoulder dislocation. Although posterior instability has often been treated with open shoulder stabilization, modern arthroscopic procedures are being rapidly pursued by surgeons as an improved option because of decreased invasiveness and reduced operative times. Arthroscopic stabilization of the posterior glenoid labrum typically involves 2 working portals, but the procedure still yields successful results when performed with a single posterior portal and a suture passer. Our technique involves 1 less portal to reduce invasiveness, lower the risk of nerve damage, and decrease the operative time and postoperative pain. The purpose of this article is to describe an arthroscopic posterior stabilization technique with a single working portal.

Fig 1

The patient is positioned in the left lateral decubitus position. Diagnostic arthroscopy of the left shoulder from the posterior portal shows a tear of the posterior labrum extending from the 9- to 11-o’clock position.

Fig 2

The patient is positioned in the left lateral decubitus position on his right side with the left arm attached to a suspension device. An intraoperative image of the left shoulder shows the standard posterior working portal used to allow access to the posterior glenoid labrum. The anterior portal created via needle localization provides visualization of the interior glenohumeral joint and posterior labrum.

Fig 3

The patient is positioned in the left lateral decubitus position. An arthroscopic image of the left shoulder through the anterior portal shows an uncoiled No. 0 polydioxanone sulfate (PDS) monofilament suture at the 9:30 clock-face position, which is retrieved from the posterior portal to shuttle No. 2 FiberWire attached to its end.

Fig 4

The patient is positioned in the left lateral decubitus position. An arthroscopic image of the left shoulder through the anterior portal shows No. 2 FiberWire suture replacement of No. 0 polydioxanone sulfate monofilament suture, successful passage of No. 2 FiberWire suture around the glenolabral junction, and a successful suture configuration with No. 2 FiberWire suture cinched down to the glenolabral junction.

Fig 5

The patient is positioned in the left lateral decubitus position. An arthroscopic image of the left shoulder through the anterior portal shows a drill guide placed at the 10-o’clock position to drill a pilot hole for the 2.9-mm PushLock suture anchor.

Fig 6

Arthroscopic images of the left shoulder through the anterior portal with the patient positioned in the left lateral decubitus position. (A) The SutureTape is loaded onto a 2.9-mm PushLock suture anchor and tensioned to guarantee a sufficiently reduced glenoid labrum. The 2.9-mm PushLock suture anchor is positioned over the pilot hole at the 10-o’clock position. (B) The 2.9-mm PushLock suture anchor is impacted into the pilot hole with a mallet to secure the glenoid labrum.

Fig 7

The patient is positioned in the left lateral decubitus position. An arthroscopic image of the left shoulder through the anterior portal shows the final impression of the reduced posterior labral tissue after residual suture is trimmed off with an arthroscopic suture cutter.