AANA Lab Course 1001 - Foundations in Arthroscopy (Resident/Fellow)-Arthroscopic Labral, SLAP, and Instability Repairs, Capsular Plication-Wesley M. Nottage, M.D

Arthroscopic Labral, SLAP, and Instability Repairs, Capsular Plication-Wesley M. Nottage, M.D

Pdf Summary

This lecture by Dr. Wesley M. Nottage focuses on arthroscopic repair of shoulder labral injuries, particularly SLAP 2 lesions, instability repairs, and capsular plication. It emphasizes the complexity of diagnosing and treating these injuries arthroscopically, highlighting detailed procedural steps as defined in the AANA Copernicus Project, which identifies 14 stages and 45 steps to a "standard" Bankart repair with numerous possible errors.<br /><br />Patient positioning—either lateral decubitus or beach chair—is crucial, with the lateral position preferred for instability repairs due to ease and lower recurrence rates. Portals are created carefully under direct visualization, especially anterior portals which must be spaced widely and placed lateral to the coracoid to optimize access.<br /><br />Arthroscopic evaluation begins posteriorly and moves anteriorly, assessing the labrum and associated structures for pathology versus normal variants such as the Buford complex or sublabral foramen, which should not be repaired to prevent motion restriction. SLAP lesions are uncommon (about 6% incidence overall, 1% isolated SLAP 2), and overdiagnosis is frequent; diagnosis requires confirmatory arthroscopy and clinical testing.<br /><br />Repair principles include thorough labral mobilization, restoring the capsulolabral complex with anchors placed preferably posterior to the glenoid midline to avoid stiffness, and careful knot tying. Capsular volume reduction through arthroscopic capsular plication is done by sequentially advancing and tensioning capsular folds without overtightening.<br /><br />The Remplissage technique is used adjunctively before anterior work to address Hill-Sachs lesions. Posterior instability, less common but often unrecognized, is managed with arthroscopic or open repair, frequently involving "reverse Bankart" lesions.<br /><br />SLAP lesion classification is complex, with 10 recognized types and some involving extensive labral tears. MRI has limited diagnostic accuracy; arthroscopy remains the gold standard. The key clinical takeaway is to accurately distinguish normal anatomy from pathology and avoid unnecessary repair of normal variants, as well as to recognize that SLAP lesions should represent a small fraction of shoulder cases treated arthroscopically.

Keywords

arthroscopic shoulder repair

SLAP 2 lesions

Bankart repair

capsular plication

shoulder instability

patient positioning lateral decubitus

anterior portals placement

Buford complex

Remplissage technique

posterior instability repair