AANA Middle East Arthroscopy Master Course (International)-Arthroscopic Treatment of Shoulder Instability

Arthroscopic Treatment of Shoulder Instability

Pdf Summary

This document by Joseph C. Tauro, MD, focuses on the arthroscopic treatment of shoulder instability, emphasizing restoring normal anatomy and joint stability while preserving range of motion (ROM) and function. The ultimate goal is to center the humeral head in the glenoid through soft tissue repair and properly address any bone loss.<br /><br />Key biomechanical principles, including studies on Bankart lesions and the role of the inferior glenohumeral ligament, support the approach. The "Circle Theory" of shoulder stability is referenced to explain the interconnected nature of shoulder structures.<br /><br />SLAP (Superior Labrum Anterior and Posterior) lesions, affecting the superior labrum and the biceps tendon, are categorized into four types, with type 2 characterized by labral detachment. Although SLAP lesions appear in about 5% of cases, repairs are performed more frequently. Indications for SLAP repair include persistent symptoms after conservative treatment and a symptomatic lesion confirmed by imaging. Caution is advised with rotator interval tears, pulley lesions, and especially in older patients with degenerative SLAP lesions, where tenodesis or tenotomy may be better options than repair.<br /><br />Various arthroscopic portals are described for SLAP and labral repairs, including standard posterior, anterior superior, mid-anterior, and posterior inferior portals, with percutaneous portals as needed. Surgical techniques involve capsular splitting and superior shifting to tighten the capsule, lateral anchor placement on the articular margin, and specific approaches for anterior Bankart and posterior labral tears. Posterior lesions are common in certain athletes and treated via specialized portals according to lesion location.<br /><br />Repairs are thoroughly assessed for stability and security before completion. The presentation concludes with appreciation for the audience's attention. Overall, the document outlines a detailed, anatomy-based arthroscopic strategy to effectively manage shoulder instability while minimizing functional loss.

Keywords

arthroscopic shoulder instability treatment

restoring shoulder anatomy

joint stability

range of motion preservation

soft tissue repair

Bankart lesions

inferior glenohumeral ligament

Circle Theory shoulder stability

SLAP lesions types

arthroscopic portals for shoulder repair