The Combined “Double Pulley”–Simple Knot Technique for Arthroscopic Shoulder Posterior Labral Repair and Capsular Shift

Posterior shoulder instability is more prevalent than traditionally believed. Surgical repairs of posterior shoulder instability have overall good success rates. However, in elite overhead and throwing athletes, a low rate of return to the preinjury level of play after repair remains a challenge. The 2 goals of posterior shoulder stabilization surgery are secure fixation of the labrum to the glenoid and retensioning of the posterior capsulolabral complex. Recent studies have shown significant advantages of arthroscopic anatomic repair over open nonanatomic techniques. We report a combined double pulley–simple knot technique for arthroscopic fixation of posterior labral tears and capsular shift. The technique incorporates several advantages of this hybrid fixation method

The Double-Pulley Anatomic Technique for Type II SLAP Lesion Repair

The annual incidence and number of repairs of SLAP lesions in the United States are constantly increasing. Surgical repairs of type II SLAP lesions have overall good success rates. However, a low satisfaction rate and low rate of return to preinjury level of play remain a challenge with elite overhead and throwing athletes. Recent anatomic studies suggest that current surgical techniques over-tension the biceps anchor and the superior labrum. These studies suggest that restoration of the normal anatomy will improve clinical outcomes and sports performance. We present a “double-pulley” technique for arthroscopic fixation of type II SLAP lesions. In this technique the normal anatomy is respected by preserving the mobility of the articular aspect of the superior labrum while reinforcing the biceps anchor and its posterior fibers medially

The Combined “Double-Pulley” Simple Knot Technique for Arthroscopic Transtendon Fixation of Partial Articular-Sided Tear of the Subscapularis Tendon

Subscapularis tendon tears occur more frequently than previously suspected. Most subscapularis tendon tears are partial tears that have the potential to progress to complete tears. Repairs of partial tears of the tendon are performed to preserve normal shoulder function. This report describes a combined transtendon double-pulley and simple knot technique for repair of partial articular tears of the subscapularis tendon. This technique incorporates the advantages of transtendon repair, the double-pulley technique, and simple knot fixation

Arthroscopic Repair of Inferior Labrum Anterior to Posterior Lesions of the Shoulder Using a Combined “Double-Pulley” Simple Knot Technique

Inferior labrum anterior to posterior lesions as an isolated injury or as part of an extensive traumatic labral tear are uncommon and may present as multidirectional instability of the shoulder. These lesions are hard to visualize radiographically and many times are diagnosed only during surgery. Arthroscopic repair of these lesions requires advanced arthroscopic skills and is required for restoration of glenohumeral stability. We report a combined double-pulley simple knot technique that anatomically reconstructs the inferior labrum while overcoming the typical technical challenges, providing a large footprint for healing along the inferior glenoid rim and minimizing the amount of suture material in direct contact with the articular cartilage and the risk of knot migration

Arthroscopic fixation of posterior bankart lesion in the beach chair position

Posterior labral injuries and posterior shoulder instability are becoming an increasingly recognized and treated entity in those with shoulder pain. Arthroscopic stabilization may be performed in either the beach chair or lateral decubitus position. We will describe in detail the arthroscopic technique of posterior labral repair in the beach chair position for the treatment of symptomatic posterior labral lesions or posterior instability in patients who have failed conservative treatment. Postoperative rehabilitation and clinical results will be summarized. © 2008 Lippincott Williams & Wilkins, Philadelphia

The Oblique Mattress Lasso-Loop Stitch for Arthroscopic Capsulolabral Repair

Arthroscopic capsulolabral repair during shoulder stabilization surgery requires the use of suture anchors. Several arthroscopic suturing techniques for capsulolabral repair have been described, and each carries very specific advantages and disadvantages with regard to risk, patient satisfaction, and functional outcomes. The purpose of this report is to describe the oblique mattress lasso-loop stitch. This stitch (1) provides strong initial fixation of the labrum, (2) establishes labral height and allows for larger capsular plication if needed, (3) prevents the suture from cutting through the radial fibers of the glenoid labrum, (4) prevents knot migration to the articular side and loosening of the knot, and (5) requires fewer implants and preserves glenoid bone stock by increasing the amount of labrum and capsule that can be reattached to the glenoid with a single-loaded suture anchor

Arthroscopic Reconstruction of the Coracoclavicular Ligaments Using a Coracoid Cerclage Technique

This technical note discusses the arthroscopic coracoid cerclage technique for double-bundle coracoclavicular ligament reconstruction in patients with nonacute symptomatic high-grade acromioclavicular separation injuries. This technique allows for an anatomic graft reconstruction of the coracoclavicular ligaments through an arthroscopic approach without the requirement to drill into the coracoid process. Early results are promising with high patient satisfaction and excellent reported clinical and radiographic outcomes. We believe this technique to be an anatomic, less invasive alternative to a complex shoulder procedure while sparing the structural integrity of the coracoid process and also allowing the surgeon to convert easily to a more traditional open surgical technique as necessary

Management of failed hemiarthroplasty with reverse prosthesis

Rotator cuff arthropathy has been historically treated with humeral hemiarthroplasty and, more recently, reverse shoulder arthroplasty. Patients that undergo shoulder hemiarthroplasty may have persistent symptoms or develop new symptoms secondary to glenoid erosions and/ or shoulder instability, mainly pain and limited mobility. Revision to a reverse shoulder replacement is a viable salvage option in these patients. The objective of this article is to describe the surgical technique for revising a shoulder hemiarthroplasty into a reverse prosthesis. © 2008 Lippincott Williams & Wilkins

Prevalence of cerebrovascular events during shoulder surgery and association with patient position

The beach chair position is commonly used in both arthroscopic and open shoulder procedures. There has been recent concern that beach chair positioning may be an independent risk factor for intraoperative cerebrovascular insult, especially in concert with hypotensive anesthesia. We attempted to quantify the prevalence of intraoperative cerebrovascular events during shoulder surgery in the beach chair position. Two hundred and eighty-seven members of the American Shoulder and Elbow Surgeons (ASES) Society were e-mailed surveys, and 93 (32%) responded. The majority of these surgeons average \u3e300 shoulder cases annually. Most of these cases are arthroscopic, and patient position is primarily beach chair. The total number of beach chair-position surgeries was estimated between 173,370 and 209,628, and lateral decubitus-position surgeries were estimated between 64,597 and 100,855. The overall rate of intraoperative cerebrovascular event was 0.00291% (8/274,225). All cerebrovascular events were associated with surgeries in the beach chair position. The rate in the beach chair position ranged from 0.00382% (8/209,628) to 0.00461% (8/173,370). If reported primary patient position was used 675% of the time, no significant difference in observed cerebrovascular event rates was found between positions (P=.051-.0233). In relation to orthopedic procedures performed in the supine position, beach chair positioning does not appear to increase the risk of intraoperative cerebrovascular event. Copyright © 2009 SLACK Incorporated. All rights reserved

Lower Reoperation and Higher Return-to-Sport Rates After Biceps Tenodesis Versus SLAP Repair in Young Patients: A Systematic Review

Purpose: To evaluate patient-reported outcomes, return to sport, and adverse events after SLAP repair versus biceps tenodesis (BT) in a young patient population undergoing treatment of SLAP tears. Methods: We performed a systematic review and meta-analysis of the PubMed (MEDLINE), Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Web of Science databases for comparative studies discussing outcomes after SLAP repair and BT in patients younger than 40 years with at least 1 year of follow-up. Results: Four studies were included, comprising a total of 274 patients who underwent treatment of SLAP tears with SLAP repair (169 patients) or BT (105 patients). Most patients were male patients (79.8%) and athletes (74.5%). Preoperative and postoperative pain visual analog scale scores decreased similarly in both groups (range, 6.6-6.7 preoperatively to 0.8-2.6 postoperatively in SLAP repair group vs 5.6-7.3 preoperatively to 0.7-1.9 postoperatively in BT group). Similar and substantial American Shoulder and Elbow Surgeons Standardized Shoulder Assessment score increases were observed after both procedures (range, 40.6-45.8 preoperatively to 75.4-92.0 postoperatively in SLAP repair vs 41.9-55.0 preoperatively to 85.7-91.2 postoperatively in BT group). Patient satisfaction rates were similar but showed slightly higher ranges after BT (8.5-8.8 vs 8.0-8.2). Rates of return to sport were higher after BT (63%-85% vs 50%-76%), with higher odds of returning to sport after BT reported by all studies. Surgical complications were rare after SLAP repair and BT. Rates of reoperation were substantially higher after SLAP repair (3%-15% vs 0%-6%), with 3 of 4 studies reporting no reoperations after BT. BT comprised 78% to 100% of reoperation procedures after SLAP repair. Conclusions: Postoperative pain, function, and patient satisfaction were similar after SLAP repair and BT in patients younger than 40 years. There are higher rates of reoperation and lower rates of return to sport after SLAP repair than after BT. Level of Evidence: Level III, systematic review of Level III studies