AANA Lab Course 915 - Foundations in Arthroscopy-Arthroscopic Portals-John Orwin, M.D.

Arthroscopic Portals-John Orwin, M.D.

Pdf Summary

This presentation provides a comprehensive guide to establishing shoulder arthroscopy portals, emphasizing patient positioning, anatomical landmarks, and portal placement techniques.<br /><br />Key points include: <br />- Proper patient positioning and marking of anatomical landmarks and portal sites with a sterile pen before the procedure.<br />- Identification of common portals: posterior, anterior, anterior-inferior, superior, and lateral (subacromial).<br />- The posterior portal is placed using an outside-in technique by palpating the “soft spot” of the joint, aiming the cannula toward the coracoid process, and ensuring placement is not too medial, low, or close to the acromion.<br />- The anterior portal is typically created with an inside-out technique, visualizing the biceps tendon and rotator interval, and using a switching stick to guide cannula placement through the subcutaneous tissue.<br />- The anterior-inferior portal requires needle localization to avoid placing it too inferior, medial, or close to the anterior portal, aiming to enter just superior to the subscapularis tendon.<br />- The lateral (subacromial) portal is crucial for subacromial decompression and rotator cuff repairs. It is placed approximately 2 cm lateral to the acromion's edge to safely enter the subacromial space without risking axillary nerve damage.<br />- Use of blunt obturators and cannulas directed under the acromion into the bursa ensures safe access.<br />- The use of switching sticks helps confirm anatomical landmarks such as the acromioclavicular ligament and acromion during portal creation.<br /><br />Overall, the presentation stresses the importance of careful planning, anatomical knowledge, and technique to establish safe and effective arthroscopy portals for shoulder surgery.

Keywords

shoulder arthroscopy

portal placement

patient positioning

anatomical landmarks

posterior portal

anterior portal

anterior-inferior portal

lateral subacromial portal

subacromial decompression

rotator cuff repair