Course Lecture Pearls: Foundations in Arthroscopy-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.

Video Transcription

Video Summary

The presentation focuses on arthroscopic shoulder instability surgery, emphasizing the importance of understanding capsular injury patterns from anterior/inferior dislocations. Key concepts include careful patient positioning—preferably in the lateral decubitus position with balanced arm suspension—and meticulous portal placement to maximize access and minimize complications. Successful repair hinges not just on labral reattachment but crucially on capsular mobilization and shifting to remove laxity and reduce joint volume. Various labral lesion types are discussed, including Bankart, ALPSA, and SLAP lesions, with caution against over-treating normal anatomical variants. Techniques for anchor placement, suturing, and knot tying are outlined, stressing that initial anchor tension sets repair success. The remplissage procedure addresses Hill-Sachs lesions by tethering posterior capsule/infraspinatus into defects to enhance stability. Posterior instability repairs follow similar principles but are less common. Overall, comprehensive mobilization and proper tensioning of the capsule-labral complex are essential to optimize surgical outcomes in shoulder instability cases.

Keywords

arthroscopic shoulder instability surgery

capsular injury patterns

lateral decubitus position

labral lesion types

anchor placement techniques

remplissage procedure