Arthroscopic Labral Repair and Pancapsular Shift With Knotless All-Suture Anchors in the Setting of Multidirectional Instability of the Shoulder

Abstract

In the management of multidirectional type of shoulder instability (MDI), arthroscopic surgical stabilization is a preferred treatment option after failed conservative therapy regimens because of the ability to easily access all aspects of the capsule with one surgical procedure. As arthroscopic techniques have evolved, factors critical to postoperative success have been elucidated. Currently, optimal arthroscopic treatment of MDI involves circumferentially restoring labral integrity, a tailored, patient-specific surgical reduction of capsular volume, and adequately managing potential lesions of the biceps anchor. The purpose of this article and accompanying video is to present our technique for arthroscopic circumferential labral repair and pancapsular shift using knotless all-suture anchors in the setting of MDI with a concurrent type II SLAP lesion.

Fig 1

Arthroscopic view of right shoulder from the standard posterior viewing portal showing a SLAP type II lesion and tear of the anterior labrum. The SLAP complex (SC) can be seen shifted off the superior glenoid (G). (HH, humeral head.).

Fig 2

With the patient in the beach-chair position, placement of the first anchor at the 5.30-o’clock position through the anteroinferior working portal is visualized via a standard posterior viewing portal during repair of a right anterior labral tear. A 135° trajectory of the drill guide (DG) relative to the glenoid face (G) is visualized in the arthroscopic (A) and external (B) views, which ensures adequate deployment of the anchor in the subchondral bone. (CT, capsular tissue.).

Fig 3

Arthroscopic (A) and external (B) views of a right shoulder via standard posterior viewing portal during repair of a right anterior labral tear to the glenoid (Gl) with the first repair anchor at the 5:30 o’clock position during the tightening of the repair suture. The amount of capsular shift of capsular tissue (CT) in the labral repair construct determines the reduction of capsular volume. Employing a grasper (Gr) ensures anatomic reduction of the labrum–capsule complex to the anterior glenoid.

Fig 4

Arthroscopic (A) and external (B) views of a right shoulder via the anterosuperior portal presenting the placement of the first repair anchor for a repair of the right posterior labrum to the glenoid (G) in a 6:30-o’clock position. On both the arthroscopic (A) and external (B) views, the drill guide (DG) trajectory can be visualized.

Fig 5

Arthroscopic (A) and external (B) views of a right shoulder via standard posterior viewing portal during repair of a SLAP type II lesion at the 1:00 o’clock position during placement of the first anchor with the drill guide (DG). Glenoid (G).

Fig 6

Arthroscopic (A) and external (B) views view of right shoulder via an anterosuperior viewing portal showing the completed panlabral repair using 9 knotless, all-suture anchors (arrows) (6 visible). Due to the capsular shift resulting in a reduced capsular volume, this is the broadest overview to be obtained at this point. (G, glenoid.).