AOSSM/AANA Specialty Day 2020-My Pearls to Successful Arthroscopic Shoulder Stabilization

My Pearls to Successful Arthroscopic Shoulder Stabilization

Pdf Summary

This presentation by Dr. Claude T. Moorman III outlines key "pearls" for successful arthroscopic shoulder stabilization, particularly in the context of collision athletes. The discussion emphasizes understanding the complex pathoanatomy of glenohumeral instability, which includes traumatic Bankart lesions, inferior glenohumeral ligament complex laxity, and SLAP (superior labrum anterior-posterior) lesions. Notably, collision athletes often present with extensive, sometimes 180-degree labral tears involving anterior, posterior, and superior labrum.<br /><br />Key points include the preference for arthroscopic over open techniques unless specific conditions such as collagen disorders, revision surgery, or significant bony deformities are present. Arthroscopy allows capsular shifts and preservation of the subscapularis, resulting in less motion loss, which is critical for throwers who rely on power, speed, and neuromuscular control—thus, overtightening should be avoided in this population.<br /><br />Proper patient positioning is vital, with beach-chair and lateral setups offering different advantages; a "poor man’s lateral" can be achieved with modern shoulder positioning devices. Portal placement is crucial to access all pathological areas; typically, four portals are used (high/low anterior, superolateral, and axillary posterolateral) to address anterior and posterior lesions adequately. Inferior anchor placement through a posterior approach is highlighted as important for a “bomb-proof” repair.<br /><br />Management includes using sufficient anchors (usually 4 to 6) to ensure repair strength while addressing all pathology such as SLAP lesions and inferior capsular laxity. The approach favors individualized treatment based on the athlete’s pathology and functional demands.<br /><br />In summary, successful arthroscopic shoulder stabilization requires thorough understanding of pathology, judicious surgical technique tailored to patient needs, proper positioning and portal use, and comprehensive repair strategies to restore stability while preserving shoulder function.

Keywords

arthroscopic shoulder stabilization

collision athletes

glenohumeral instability

Bankart lesions

SLAP lesions

capsular shift

subscapularis preservation

portal placement

inferior anchor

shoulder positioning