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Slap Lesion in a Professional Soccer Player- Biceps Intra-articular Tenodesis
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Slap Lesion in a Professional Soccer Player- Biceps Intra-articular Tenodesis
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T00H15M50S
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https://cadmoreoriginalmedia.blob.core.windows.net/6cee3e32-77e2-4fa1-a40b-4fa04bc7cb90/SLAP LESION IN A PROFESSIONAL SOCCER PLAYER - BICEPS INTRA-A.mp4?sv=2019-02-02&sr=c&sig=abPB1YukZhRvJ72O0A9XxPKh3gjpsavNt1eMBHxUNeI%3D&st=2024-11-21T17%3A03%3A23Z&se=2024-11-21T19%3A08%3A23Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Hello, my friends, how are you? This is me, Dr. Sergio Rowinski, from shoulder planet. here from Sao Paulo, Brazil. In this video, I'm presenting to you a nice way to do a biceps tenodesis, in the lesser tuberosity, when dealing with a complex SLAP lesion in a young athlete. This video is from 2013. Nowadays,
in 2020, I would do something a little bit different, I will do a SUB PECTORALIS tenodesis. Nevertheless, this patient had a nice evolution, so I hope you like the video. Don't forget to subscribe. Give your thumbs up. Give us your light. Leave your comment and let us see the video.
SLAP lesions are quite uncommon lesions and, nowadays, we know that they are much less common than what was initially proposed, about 10 or maybe 12 years ago. SLAP lesions can occur in the shoulder in two different populations. So the first one, the first group, is the one composed by young patients, generally male, usually before 40 years old, when these patients have a very well defined trauma event onto his shoulder.
So the SLAP is caused by a fall, onto an outstretched arm during sports activity, just like the fall that we are seeing here, in this photo. Obviously, a fall like this can happen in any sports activity, and still even a fall like this can happen accidentally. But, generally, the fall is related to some kind of sports participation. Also, in the second population, we have the overhead athletes, and they develop the SLAP
due to the repetitive so-called peel-back mechanism, in sports activities, in sports modalities, like baseball, volleyball, handball, basketball and even others. So in this present case, I'm showing a case about a 23-year-old male, who is a professional soccer player, in Brazil. He had a fall, in January 2013, during a professional soccer match, onto his outstretched left arm.
He felt intense pain in his left shoulder, just after the trauma, and he had to immediately leave that soccer match, in which he was playing. He was so taken to the emergency room, and some X-rays were taken, revealing absolutely no abnormalities. He was told, so, by the doctor who saw him, that he had a simple shoulder contusion, and he was given nothing but ice, rest and some painkillers.
But, since then, he started to feel pain in his left shoulder, during his soccer games, and he insistently complained that he felt that his shoulder was quite loose when he was playing soccer. In spite of not having any shoulder dislocation in his medical history, he had a vague sensation that he could dislocate his shoulder. So after five months of complaints, five months after the trauma, he came to my office.
This patient was sent to me. And he had absolutely no signs or not even symptoms of rotator cuff pathology. On physical exam, he had pain and some slight apprehension, especially in Jobe's relocation test. We asked for an MRI, and the exam revealed a very large SLAP tear. And the SLAP there, as we are seeing here, had a continuity with a large Bankart tear
also. Anyway, it's very important to say that usually, in SLAP cases, the MRI images are not so clear as it was in this present case. Anuway, an arthroscopy was indicated, and so this is arthroscopy. So here we are, This is a last shoulder, here we are seeing the labrum, and a very important tear in the root of the biceps.
Very important indeed, and here we are seeing a large Bankart tear, also. So, as usual, we started to establish the anterior portal with a spinal needle, and then we opened the capsule with a mosquito, to enter with the anterior cannula. So now the cannula is inside the joint, and once we would have to perform a biceps tenotomy and a biceps tenodesis, we passed a whipstitch, with a spinal needle, with a number two Prolene suture, through the biceps, and we retrieved that out of the anterior cannula.
And then we started to perform the biceps tenotomy that it's supposed to be a very fast and simple procedure. So now the tenotomy is finished, and here we can see a very large Bankart and SLAP lesion again, and the labrum was literally falling into the gleno-humeral joint, in this case. So, again, with a spinal needle, we established a good position for an antero-supero-lateral portal, and then we, very delicately, very softly, entered with 11 blade and we opened the capsule to enter with the second cannula.
We entered, then, with a mosquito, to open the capsule, and then we used a vissinger device to enter with the second cannula. So, then, with the second cannula in place, we started to debride and to create a bony bed, in the very anterior part of the glenoid, just to fix the labrum and the Bankart, with the SLAP lesion, and this is exactly what we are used to do, in standard Bnakart repairs.
But, in this case, the difference is that we would have to go a little bit upper. So now we are in something about 1 o'clock, and now we are in the upper part of the glenoid, just creating a bony bed in which the labrum would be reattached. So here we can see, again, the labrum falling into the glenohumeral joint, and the difficulty that we had to see the Bankart itself.
So with a simple basket, we removed something about 2 or 3 millimeters of the articular cartilage, to put the first anchor, as inferior as we could, this is something about the 5 o'clock position. And here we are introducing a 3.0 mono loaded bio- absorbable anchor. This is an anchor from LINVATEC. And, then, at this moment we inverted the camera because we wanted to look as low as we could.
And, through the anterior cannula, we entered with a bird beak, to pick up as much labrum as we could, and as inferior as we could, and here we are something about the 6 o'clock position, so through the antero-supero-lateral portal, we used a suture manipulator to bring the sutures to that very inferior bird beak. And, in a retrograde fashion, we passed the first suture through the very inferior part of the tear.
Now we are tying the first knot, putting a lot of compression in order for the labrum to heal in the bony bed that we had just created. Then the knot was cut. And then we would have to put a second anchor, here we are something about the three or 2 o'clock position, when we are putting, again, a 3.0 mono loaded, bio absorbable anchor. And once the anchor was in place, through the anterior portal, the anterior cannula, we entered with a bird beak, as inferior as we could, and, in a retrograde fashion again, we passed
the second suture through the labrum, and here we are tying, through the anterior cannula, the second knot. So here the knot is finished. And, at that moment, we would have to put a third anchor, in the very upper part of the glenoid, To fix the SLAP itself. So now we are putting the anchor, this is the third anchor and, again, bio absorbable 3.0 mono loaded one and, in the same fashion, we entered with a bird beak and, in a retrograde fashion, we passed that suture out of the antero superior cannula,
and here we are tying the third suture, from the third anchor. Here we can see that the knot was cut and, at that moment, we analyzed the construction, and we decided to put a fourth anchor in something about three or 2 o'clock position, to give a better fixation, because the patient is very strong, and is a professional athlete. And here we are
putting, so, he fourth anchor, in something about 2 o'clock position. We again entered, through the anterior portal, with a bird beak, and in a retrograde fashion again, we passed and fixed and tied the fourth suture. So this is the construct of the labrum, a bumper sticker, fixing the SLAP and the Bankart tear. At that moment, we removed the camera from the posterior portal, and we entered with the camera through the anterior cannula, just to check that the posterior labrum was OK, and it was,
the patient had no signs, in physical exam, of a posterior tear, nor in the MRI and, in fact, the posterior labrum was OK, so we came back to the posterior camera. So here we are entering, again, through the procedure portal, and now we are seeing the biceps with the tenotomy, and the whipstitch. So, at that moment, we entered with the burr, to create a bony bed in the Lesser tuberosity just up to the subscapularis insertion, in which we would tenodese the biceps with an articular tenodesis.
So now we are just creating the bony bed and, once the bony bed was created, we entered, through the anterior portal, with a 5.0 titanium anchor, a double loaded one. Once we found a good position, we started to insert it, in the humeral head, in the lesser tuberosity and, obviously, it must be very well inserted, to avoid all the problems that we do know.
So now we are checking that the anchor is being well inserted. And once the anchor was in a good place, and whell inserted, through the antero-supero-lateral cannula, we entered with a suture manipulator to isolate the blue suture, the two legs of the blue suture, in the antero-supero-lateral portal. Then still through the antero-supero-lateral portal, we entered with a grasper and, through the anterior portal, We entered with a simple Bird beak, and very gently, very softly,
we passed the bird beak through the long head of the biceps, and, in a retrograde fashion again, we passed one leg of the blue suture through the long head of the biceps and out of the anterior cannula. And, through the antero-supero-lateral cannula, we entered with a suture manipulator, and we removed that leg, that was passing through the biceps, out of the anterior cannula, and through the antero-supero-lateral cannula.
And this is exactly what we are doing now. And here we can see that both legs of the blue suture were passing through the antero-supero-lateral cannula, and then we repeated the procedure. So, through the antero-supero-lateral cannula, we isolated one of the legs of the white suture, and again we grasped the tendon, the long head of the biceps, through the antero-supero-lateral cannula, with a grasper,
and we passed a spectrum device, with a prolene suture, through the long head of the biceps, through the anterior portal, and we isolated that prolene in the antero-supero-lateral cannula, and in a retrograde fashion, we passed one leg of the white suture through the long head of the biceps. So, at that moment, we started to tie the knots. First the blue one, through the antero- supero-lateral cannula, and here
we can see that we were putting a lot of compression. And then the second one, through the anterior cannula. So now we are tying the second suture, the white one, through the anterior cannula. And here we can see that we were really putting a lot of compression, in order for the tendon to heal and then we cut it. So here we see the final construct, in here we can see, as we internally and externally rotate the shoulder,
how stable was the biceps, with the intra-articular biceps tenodesis in the lesser tuberosity. And here we can see, again the final construct of the labrum repair, with the Bankart and the SLAP lesion very well fixed. And so, at that moment, the surgery was then finished. Thank you.
So my friends, I hope you liked the video, showing how to manage a SLAP lesion, a big SLAP lesion, doing not only the fixation of the whole labrum, back to the glenoid, but also a tenodesis of the long head the biceps in the lesser tuberosity. So again, subscribe, give us your thumbs up. Your like, leave your comment and I'll see you in the next video. And as Doctor Sergio always says and loves to say, never stop flying.
See you, folks. Bye bye.
Segment:0 .
Hello, my friends, how are you? This is me, Dr. Sergio Rowinski, from shoulder planet. here from Sao Paulo, Brazil. In this video, I'm presenting to you a nice way to do a biceps tenodesis, in the lesser tuberosity, when dealing with a complex SLAP lesion in a young athlete. This video is from 2013. Nowadays,
in 2020, I would do something a little bit different, I will do a SUB PECTORALIS tenodesis. Nevertheless, this patient had a nice evolution, so I hope you like the video. Don't forget to subscribe. Give your thumbs up. Give us your light. Leave your comment and let us see the video.
SLAP lesions are quite uncommon lesions and, nowadays, we know that they are much less common than what was initially proposed, about 10 or maybe 12 years ago. SLAP lesions can occur in the shoulder in two different populations. So the first one, the first group, is the one composed by young patients, generally male, usually before 40 years old, when these patients have a very well defined trauma event onto his shoulder.
So the SLAP is caused by a fall, onto an outstretched arm during sports activity, just like the fall that we are seeing here, in this photo. Obviously, a fall like this can happen in any sports activity, and still even a fall like this can happen accidentally. But, generally, the fall is related to some kind of sports participation. Also, in the second population, we have the overhead athletes, and they develop the SLAP
due to the repetitive so-called peel-back mechanism, in sports activities, in sports modalities, like baseball, volleyball, handball, basketball and even others. So in this present case, I'm showing a case about a 23-year-old male, who is a professional soccer player, in Brazil. He had a fall, in January 2013, during a professional soccer match, onto his outstretched left arm.
He felt intense pain in his left shoulder, just after the trauma, and he had to immediately leave that soccer match, in which he was playing. He was so taken to the emergency room, and some X-rays were taken, revealing absolutely no abnormalities. He was told, so, by the doctor who saw him, that he had a simple shoulder contusion, and he was given nothing but ice, rest and some painkillers.
But, since then, he started to feel pain in his left shoulder, during his soccer games, and he insistently complained that he felt that his shoulder was quite loose when he was playing soccer. In spite of not having any shoulder dislocation in his medical history, he had a vague sensation that he could dislocate his shoulder. So after five months of complaints, five months after the trauma, he came to my office.
This patient was sent to me. And he had absolutely no signs or not even symptoms of rotator cuff pathology. On physical exam, he had pain and some slight apprehension, especially in Jobe's relocation test. We asked for an MRI, and the exam revealed a very large SLAP tear. And the SLAP there, as we are seeing here, had a continuity with a large Bankart tear
also. Anyway, it's very important to say that usually, in SLAP cases, the MRI images are not so clear as it was in this present case. Anuway, an arthroscopy was indicated, and so this is arthroscopy. So here we are, This is a last shoulder, here we are seeing the labrum, and a very important tear in the root of the biceps.
Very important indeed, and here we are seeing a large Bankart tear, also. So, as usual, we started to establish the anterior portal with a spinal needle, and then we opened the capsule with a mosquito, to enter with the anterior cannula. So now the cannula is inside the joint, and once we would have to perform a biceps tenotomy and a biceps tenodesis, we passed a whipstitch, with a spinal needle, with a number two Prolene suture, through the biceps, and we retrieved that out of the anterior cannula.
And then we started to perform the biceps tenotomy that it's supposed to be a very fast and simple procedure. So now the tenotomy is finished, and here we can see a very large Bankart and SLAP lesion again, and the labrum was literally falling into the gleno-humeral joint, in this case. So, again, with a spinal needle, we established a good position for an antero-supero-lateral portal, and then we, very delicately, very softly, entered with 11 blade and we opened the capsule to enter with the second cannula.
We entered, then, with a mosquito, to open the capsule, and then we used a vissinger device to enter with the second cannula. So, then, with the second cannula in place, we started to debride and to create a bony bed, in the very anterior part of the glenoid, just to fix the labrum and the Bankart, with the SLAP lesion, and this is exactly what we are used to do, in standard Bnakart repairs.
But, in this case, the difference is that we would have to go a little bit upper. So now we are in something about 1 o'clock, and now we are in the upper part of the glenoid, just creating a bony bed in which the labrum would be reattached. So here we can see, again, the labrum falling into the glenohumeral joint, and the difficulty that we had to see the Bankart itself.
So with a simple basket, we removed something about 2 or 3 millimeters of the articular cartilage, to put the first anchor, as inferior as we could, this is something about the 5 o'clock position. And here we are introducing a 3.0 mono loaded bio- absorbable anchor. This is an anchor from LINVATEC. And, then, at this moment we inverted the camera because we wanted to look as low as we could.
And, through the anterior cannula, we entered with a bird beak, to pick up as much labrum as we could, and as inferior as we could, and here we are something about the 6 o'clock position, so through the antero-supero-lateral portal, we used a suture manipulator to bring the sutures to that very inferior bird beak. And, in a retrograde fashion, we passed the first suture through the very inferior part of the tear.
Now we are tying the first knot, putting a lot of compression in order for the labrum to heal in the bony bed that we had just created. Then the knot was cut. And then we would have to put a second anchor, here we are something about the three or 2 o'clock position, when we are putting, again, a 3.0 mono loaded, bio absorbable anchor. And once the anchor was in place, through the anterior portal, the anterior cannula, we entered with a bird beak, as inferior as we could, and, in a retrograde fashion again, we passed
the second suture through the labrum, and here we are tying, through the anterior cannula, the second knot. So here the knot is finished. And, at that moment, we would have to put a third anchor, in the very upper part of the glenoid, To fix the SLAP itself. So now we are putting the anchor, this is the third anchor and, again, bio absorbable 3.0 mono loaded one and, in the same fashion, we entered with a bird beak and, in a retrograde fashion, we passed that suture out of the antero superior cannula,
and here we are tying the third suture, from the third anchor. Here we can see that the knot was cut and, at that moment, we analyzed the construction, and we decided to put a fourth anchor in something about three or 2 o'clock position, to give a better fixation, because the patient is very strong, and is a professional athlete. And here we are
putting, so, he fourth anchor, in something about 2 o'clock position. We again entered, through the anterior portal, with a bird beak, and in a retrograde fashion again, we passed and fixed and tied the fourth suture. So this is the construct of the labrum, a bumper sticker, fixing the SLAP and the Bankart tear. At that moment, we removed the camera from the posterior portal, and we entered with the camera through the anterior cannula, just to check that the posterior labrum was OK, and it was,
the patient had no signs, in physical exam, of a posterior tear, nor in the MRI and, in fact, the posterior labrum was OK, so we came back to the posterior camera. So here we are entering, again, through the procedure portal, and now we are seeing the biceps with the tenotomy, and the whipstitch. So, at that moment, we entered with the burr, to create a bony bed in the Lesser tuberosity just up to the subscapularis insertion, in which we would tenodese the biceps with an articular tenodesis.
So now we are just creating the bony bed and, once the bony bed was created, we entered, through the anterior portal, with a 5.0 titanium anchor, a double loaded one. Once we found a good position, we started to insert it, in the humeral head, in the lesser tuberosity and, obviously, it must be very well inserted, to avoid all the problems that we do know.
So now we are checking that the anchor is being well inserted. And once the anchor was in a good place, and whell inserted, through the antero-supero-lateral cannula, we entered with a suture manipulator to isolate the blue suture, the two legs of the blue suture, in the antero-supero-lateral portal. Then still through the antero-supero-lateral portal, we entered with a grasper and, through the anterior portal, We entered with a simple Bird beak, and very gently, very softly,
we passed the bird beak through the long head of the biceps, and, in a retrograde fashion again, we passed one leg of the blue suture through the long head of the biceps and out of the anterior cannula. And, through the antero-supero-lateral cannula, we entered with a suture manipulator, and we removed that leg, that was passing through the biceps, out of the anterior cannula, and through the antero-supero-lateral cannula.
And this is exactly what we are doing now. And here we can see that both legs of the blue suture were passing through the antero-supero-lateral cannula, and then we repeated the procedure. So, through the antero-supero-lateral cannula, we isolated one of the legs of the white suture, and again we grasped the tendon, the long head of the biceps, through the antero-supero-lateral cannula, with a grasper,
and we passed a spectrum device, with a prolene suture, through the long head of the biceps, through the anterior portal, and we isolated that prolene in the antero-supero-lateral cannula, and in a retrograde fashion, we passed one leg of the white suture through the long head of the biceps. So, at that moment, we started to tie the knots. First the blue one, through the antero- supero-lateral cannula, and here
we can see that we were putting a lot of compression. And then the second one, through the anterior cannula. So now we are tying the second suture, the white one, through the anterior cannula. And here we can see that we were really putting a lot of compression, in order for the tendon to heal and then we cut it. So here we see the final construct, in here we can see, as we internally and externally rotate the shoulder,
how stable was the biceps, with the intra-articular biceps tenodesis in the lesser tuberosity. And here we can see, again the final construct of the labrum repair, with the Bankart and the SLAP lesion very well fixed. And so, at that moment, the surgery was then finished. Thank you.
So my friends, I hope you liked the video, showing how to manage a SLAP lesion, a big SLAP lesion, doing not only the fixation of the whole labrum, back to the glenoid, but also a tenodesis of the long head the biceps in the lesser tuberosity. So again, subscribe, give us your thumbs up. Your like, leave your comment and I'll see you in the next video. And as Doctor Sergio always says and loves to say, never stop flying.
See you, folks. Bye bye.
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