Marcaccio Stephen, Buerba Rafael, Arner Justin, Bradley James
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Video J Sports Med. 2024 Oct 8;4(5):26350254241262328. doi: 10.1177/26350254241262328. eCollection 2024 Sep-Oct.
Anterior glenohumeral instability is common in the young and athletic population and can develop from a dislocation or subluxation event. Avulsion of the anterior inferior glenoid labrum (Bankart lesion) occurs in over 90% of these events. In patients who have unsuccessful conservative management or present with a high risk for redislocation, surgical intervention is indicated. This video presents our technique for arthroscopic anterior and inferior labral repair.
In addition to those patients who have unsuccessful conservative management, surgical management of anterior glenohumeral instability is indicated in patients who are at high risk for redislocation after an initial instability event. These patients include young age and participation in contact sports. Generally, glenoid bone loss over 25% warrants open bony augmentation, but arthroscopic bony augmentation techniques are evolving. Further, the management of "near-track" lesions, or "on-track" lesions with a small distance to dislocation value, remains controversial.
This procedure is performed in the lateral decubitus position. A second anterior portal is created distal and lateral to the first anterior portal, entering the shoulder joint just above the subscapularis. The anterior-inferior labrum is prepared with an arthroscopic elevator, followed by a rasp and superior labral anterior and posterior burr. A suture tape is then shuttled around the labrum and the anchor drilled in the appropriate position at the glenoid rim, not violating the cartilage. Anchor placement occurs from an inferior to a superior fashion until the entire labral injury is repaired.
This video presents a technique to achieve arthroscopic fixation of an anterior-inferior labral tear in a young athlete with anterior glenohumeral instability. Patients are taken through 3 phases of rehabilitation before return to sport-specific activities, such as contact sports, around 6 months postoperatively. Return-to-sport rates for contact and collision athletes range from 80% to 100%, with recurrent rates ranging from 5% to 20%.
DISCUSSION/CONCLUSION: Arthroscopic anterior-inferior labral repair is a useful technique for minimally invasive glenohumeral stabilization in indicated patients who have minimal glenoid bone loss. Portal placement, labral mobilization, and glenoid preparation are paramount in optimizing the healing potential of the fixation construct.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
肩肱关节前侧不稳在年轻运动员人群中很常见，可由脱位或半脱位事件发展而来。超过90%的此类事件会发生肩胛下盂唇前下撕脱（Bankart损伤）。对于保守治疗失败或再脱位风险高的患者，需进行手术干预。本视频展示了我们的关节镜下前下盂唇修复技术。
除了保守治疗失败的患者外，初次不稳事件后再脱位风险高的患者也需进行肩肱关节前侧不稳的手术治疗。这些患者包括年龄较小且参与接触性运动的人群。一般来说，肩胛盂骨缺损超过25%需要进行切开植骨，但关节镜下植骨技术也在不断发展。此外，“近轨迹”损伤或距脱位值较小的“轨迹上”损伤的治疗仍存在争议。
该手术在侧卧位进行。在第一个前侧入路的远端和外侧创建第二个前侧入路，刚好在肩胛下肌上方进入肩关节。用关节镜下剥离器处理前下盂唇，随后用锉刀和上盂唇前后位磨钻处理。然后用缝线带环绕盂唇，并在肩胛盂边缘的合适位置钻孔植入锚钉，不损伤软骨。从下向上依次植入锚钉，直至修复整个盂唇损伤。
本视频展示了一种在患有肩肱关节前侧不稳的年轻运动员中实现关节镜下固定前下盂唇撕裂的技术。患者在术后约6个月恢复特定运动活动（如接触性运动）前需经过3个康复阶段。接触性和碰撞性运动运动员的重返运动率为80%至100%，复发率为5%至20%。
讨论/结论：关节镜下前下盂唇修复是一种对肩胛盂骨缺损最小的特定患者进行微创肩肱关节稳定的有用技术。入路位置、盂唇活动度和肩胛盂准备对于优化固定结构的愈合潜力至关重要。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可识别，作者已随本投稿附上患者的豁免声明或其他书面批准形式以供发表。
