Name:
Arthroscopic Shoulder Stabilization
Description:
Arthroscopic Shoulder Stabilization
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/c23932a3-7559-415d-8d51-7fa43e0e38ea/videoscrubberimages/Scrubber_1.jpg
Duration:
T00H17M09S
Embed URL:
https://stream.cadmore.media/player/c23932a3-7559-415d-8d51-7fa43e0e38ea
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/c23932a3-7559-415d-8d51-7fa43e0e38ea/Arthrscopic Shoulder Stabilization.mp4?sv=2019-02-02&sr=c&sig=3ejyO9gJZ6gmlO3IMVQqChr%2FXYZ%2BAGdMletCCNCWMh0%3D&st=2024-11-21T20%3A56%3A49Z&se=2024-11-21T23%3A01%3A49Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
BIJAYENDRA SINGH: Hello, everyone. Today, I'm going to demonstrate arthroscopic stabilization of the shoulder with Bankart repair using a knotless technique. The patient today is a 38-year-old male who has a history of instability in his shoulder for about five years. Initially, it was manageable, but over the last six months, this has become more troublesome.
BIJAYENDRA SINGH: The shoulder seems to be slipping out with minimal effort. These are his MRI scans, which show a soft tissue Bankart lesion, as well as suggestion of possible small bony Bankart tear for entry anterior aspect of the glenoid. The sagittal images show a small Hill-Sachs lesion, which goes in line with um instability. The further sections of the sagittal image
BIJAYENDRA SINGH: does confirm this and the suspicion of a bony Bankart but seems to be manageable using arthroscopic soft tissue repair. Because of the bony lesion, we got a CT scan to assess the size of his glenoid deficiency, but it looks only a small fragment and hence we decided to proceed with the microscopic stabilization.
BIJAYENDRA SINGH: The scope of the posterior portal and the first you can see is the shallow Bankart, sorry Hill-Sachs lesion, the rotator cuff on top being supraspinatus top [?]. I'm trying to push this humeral head to see if I can sublat or engage the lesion. You can see although it sits slightly anteriorly, I'm unable to dislocate the shoulder completely.
BIJAYENDRA SINGH: Now inserting the, making the anterior portal using an inside out technique. I drive the scope just above the subscapularis into the rotator interval and then using a switching stick I make an incision onto the skin and then they're suture sticking delivered just above the subscapularis.
BIJAYENDRA SINGH: Then dilators are used to open up the capsule, followed by insertion of the cannula. This is a large board, usually an 8 to 8.5 millimeter diameter cannula, which is the main working portal for this procedure. It needs to be fairly low, as low as possible, just skirting over the subscapularis as this will allow access through the,
BIJAYENDRA SINGH: all of the part of the glenoid. Once I'm happy with the position of this cannula, I make a second portal just above this cannula using a knife. I make a small incision in the rotator interval.
BIJAYENDRA SINGH: I would only advise this once you've done a few procedures otherwise you could end up making a cut into the rotator cuff. Here I insert a smaller diameter cannula, usually about point 75 millimeter cannula and it goes just next to the biceps. This will be used for suture management. You need to make sure that both of these cannula are in the rotator interval.
BIJAYENDRA SINGH:
BIJAYENDRA SINGH: Once you've done the initial assessment, then you start to lift up the torn labrum using a liberator. You can also use an electrical device, which is now available but I prefer this as it gives a better control and also has a better feedback than using the electrical device. You need to make sure that the labrum is released enough medially because sometimes it can be stuck
BIJAYENDRA SINGH: and you need to make sure that it's mobilized well to get across the face of the glenoid. You can see the tear is extending right nearly up to six o'clock position. Sometimes getting an assistant to lift the humeral head off the glenoid makes this access easier, and I would certainly recommend this
BIJAYENDRA SINGH: with the assistant putting the hand in the patient's axilla and lifting the humeral head slightly up. This is all, this maneuver is also useful when inserting the first suture right at the bottom of the glenoid. Once the labrum has been released, then use a rasp to freshen up the bone.
BIJAYENDRA SINGH: Again, this can be done using a small burr but I prefer this as it gives a better feedback and control and you can actually feel the grating sensation as this is run. Now we're going to pass the first suture. Try and get as low as possible. Key here is to get enough tissue but not try and get too much otherwise, it can be very difficult in that angle.
BIJAYENDRA SINGH: I use this device with a stiff suture so it avoids the step of shuttling the suture through. This is the quite important
BIJAYENDRA SINGH: and the most difficult suture to pass. Do take a few minutes to and patience to get this through. So this is the stiff suture with rolls over the, and this is retrieved through the suture management portal and brought and then brought out through the main
BIJAYENDRA SINGH: cannula. Both the sutures are through the same working portal. You get your trocar and the sharp sorry trocar and the cannula, followed by drill, I generally use a 2.9 or a 3.5 millimeter
BIJAYENDRA SINGH: anchors works well. Need to be sure that this is on the face rather than on the edge of the glenoid. Then, I use these push lock anchors, which works well making sure that you give enough tension. And there's this suture as the anchor is inserted, it does pull the labrum up and you can see the labrum coming up on to the front of the glenoid.
BIJAYENDRA SINGH: Again, the assistant lifting the humeral head off the glenoid with one hand while tapping the anchor the other hand helps. Make sure that the line is under the surface and then this handle is removed, and the suture is cut flush. Then a second suture is passed about a centimeter superior to the first one
BIJAYENDRA SINGH: and as it comes superior, the passage of the suture becomes much easier. Again this is achieved through the suture cannula, then brought out through the main working cannula.
BIJAYENDRA SINGH: The trocar and the cannula is inserted followed by drill and the insertion of the second anchor. It's quite critical that the humeral head is pushed back at this level and the assistant comes in handy so that you're not leading with this.
BIJAYENDRA SINGH: And then the third suture, which is just above the subscapularis, will often take the middle glenohumeral joint ligament as well to incorporate in the repair and if required, perhaps consider closing the rotator interval.
BIJAYENDRA SINGH: Again, when you drill here, be careful that the humeral head is gently pushed away by your assistant, especially and also when inserting the anchor as there can be too much pressure onto the inserting handle.
BIJAYENDRA SINGH: Once the third suture is cut, then assess the repair and you can see a good repair of the labrum and a good bumper effect can be seen. And I also try and see what the position of the humeral head, whether I can move it any further away. You can see the surgery,
BIJAYENDRA SINGH: the incursion had produced. Post-operatively the patient is placed in a sling, I start pendulum exercises once the effect of block has worn off, I start assisted movement in two weeks, avoiding external rotation. And then active mobilization
BIJAYENDRA SINGH: at four weeks. They avoid physical contact sports for six months, including martial arts. Generally, 90% of patients have a good, successful outcome following this procedure. I do hope you have enjoyed my video. Please visit the YouTube channel for more videos on upper limb practice.
BIJAYENDRA SINGH: Thank you. [VIDEO ENDS]