Division of Sports Medicine, Department of Orthopaedic Surgery, Rothman Institute/Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
Arthroscopy. 2010 Jan;26(1):12-8. doi: 10.1016/j.arthro.2009.07.004. Epub 2009 Nov 25.
To compare the most commonly used portals with a novel, lateral transmuscular portal for the treatment of anterior and posterior SLAP lesions.
Six paired cadaveric shoulders underwent arthroscopy to assess 3 different instrumentation portals: the anterior-superior lateral (AL) portal, the Neviaser (N) portal, and the Rothman-lateral (RL) transmuscular portal. After each portal was established, 5-mm cannulas were inserted followed by guidewire-assisted placement of implant fixation instruments. Each shoulder was then dissected to assess the relation of the instruments to the surrounding anatomic structures.
When the AL portal was used, instrumentation consistently passed through the rotator interval. When the N and RL portals were used, instrumentation penetrated the rotator cuff muscle belly at a mean distance of 25.75 and 7.67 mm, respectively, from the tendon. The mean angles of entry into the glenoid rim with respect to the glenoid articular surface were 32 degrees, 38 degrees, and -6 degrees for the AL, RL, and N portals, respectively. There was no violation of subchondral bone; however, 2 specimens showed weakened articular surfaces with use of the N portal. The RL portal was the only portal that allowed placement of instrumentation into all 3 zones of the superior glenoid rim (anterior superior, direct superior, and posterior superior) without violation of the subchondral bone and at the recommended 30 degrees to 45 degrees angle of entry.
The RL portal provides a safe and efficient method of arthroscopic fixation and knot tying of anterior and posterior SLAP lesions by use of a single instrumentation portal.
This novel, lateral transmuscular portal allows optimal angles of implant placement in all areas of the superior glenoid and provides a direct, simplified approach for arthroscopic knot tying.
比较最常用的入路与一种新型的外侧经肌肉入路在治疗前、后 SLAP 病变中的应用。
6 对尸体肩关节行关节镜检查，评估 3 种不同的器械入路：前上外侧（AL）入路、Neviaser（N）入路和 Rothman-外侧（RL）经肌肉入路。每个入路建立后，插入 5mm 套管，然后用导丝辅助置入植入物固定器械。然后，每个肩关节都进行解剖，以评估器械与周围解剖结构的关系。
当使用 AL 入路时，器械始终穿过旋转间隔。当使用 N 和 RL 入路时，器械从肌腱分别穿透肩袖肌肉腹部的距离为 25.75mm 和 7.67mm。相对于关节盂表面，进入关节盂边缘的平均角度分别为 AL、RL 和 N 入路的 32 度、38 度和-6 度。没有侵犯软骨下骨；然而，使用 N 入路时有 2 个标本显示关节面减弱。RL 入路是唯一一种能够在不侵犯软骨下骨的情况下，以推荐的 30 度至 45 度的进入角度，将器械置入关节盂上缘的所有 3 个区域（前上、直接上和后上）的入路。
RL 入路为前、后 SLAP 病变的关节镜固定和打结提供了一种安全有效的方法。
这种新型的外侧经肌肉入路允许在关节盂上缘的所有区域以最佳的植入物角度放置，并提供了一种直接、简化的关节镜打结方法。
