APEX Shoulder Mastering Surgical Techniques for Clinical Success-Anterior Instability Repair_ Portals, Anchors, and Suture Passage- Maximizing Your Repair

Anterior Instability Repair_ Portals, Anchors, and Suture Passage- Maximizing Your Repair

Video Transcription

Video Summary

The speaker outlines an arthroscopic strategy to maximize anterior shoulder instability repair by emphasizing portal selection, anchor placement, and restoring labral “bumper” height with appropriate capsular shift. They typically use ~10 lb traction (up to 15), 60° abduction, translate the humeral head depending on whether working anteriorly or posteriorly, and follow principles of “look high, work low.” Preferred portals include a high anterior viewing portal, a low anterior working portal near the subscapularis, and frequent use of a 7 o’clock portal (rarely trans-subscap). Horizontal mattress sutures are favored because they better recreate a bumper and increase labral height; anchors should be placed on the articular surface to preserve this contour. The talk highlights recognizing and repairing bony Bankart fragments, which may hypertrophy after fixation, and introduces adjunct bone grafting during remplissage to potentially increase glenoid bone stock. For Hill-Sachs lesions, remplissage is preferred over Latarjet, citing similar recurrence but higher Latarjet complications.

Asset Caption

John Kelly, MD

Keywords

arthroscopic anterior shoulder instability repair

Bankart repair portal selection (high anterior, low anterior, 7 o’clock)

horizontal mattress sutures for labral bumper restoration

glenoid anchor placement on articular surface

bony Bankart fragment recognition and fixation

Hill-Sachs lesion management with remplissage vs Latarjet