Beach Chair Versus Lateral Decubitus Position: Differences in Suture Anchor Position and Number During Arthroscopic Anterior Shoulder Stabilization

Abstract

Background: Arthroscopic shoulder capsulolabral repair using glenoid-based suture anchor fixation provides consistently favorable outcomes for patients with anterior glenohumeral instability. To optimize outcomes, inferior anchor position, especially at the 6-o’clock position, has been emphasized. Proponents of both the beach-chair (BC) and lateral decubitus (LD) positions advocate that this anchor location can be consistently achieved in both positions. Hypothesis: Patient positioning would be associated with the surgeon-reported labral tear length, total number of anchors used, number of anchors in the inferior glenoid, and placement of an anchor at the 6-o’clock position. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study was a cross-sectional analysis of a prospective multicenter cohort of patients undergoing primary arthroscopic anterior capsulolabral repair. Patient positioning in the BC versus LD position was determined by the operating surgeon and was not randomized. At the time of operative intervention, surgeon-reported labral tear length, total anchor number, anchor number in the inferior glenoid, and anchor placement at the 6-o’clock position were evaluated between BC and LD cohorts. Descriptive statistics and between-group differences (continuous: t test [normal distributions], Wilcoxon rank sum test [nonnormal distributions], and chi-square test [categorical]) were assessed. Results: In total, 714 patients underwent arthroscopic anterior capsulolabral repair (BC vs LD, 406 [56.9%] vs 308 [43.1%]). The surgeon-reported labral tear length was greater for patients having surgery in the LD position (BC vs LD [mean ± SD], 123.5°± 49° vs 132.3°± 44°; P = .012). The LD position was associated with more anchors placed in the inferior glenoid and more frequent placement of anchors at the 6-o’clock (BC vs LD, 22.4% vs 51.6%; P < .001). The LD position was more frequently associated with utilization of ≥4 total anchors (BC vs LD, 33.5% vs 46.1%; P < .001). Conclusion: Surgeons utilizing the LD position for arthroscopic capsulolabral repair in patients with anterior shoulder instability more frequently placed anchors in the inferior glenoid and at the 6-o’clock position. Additionally, surgeon-reported labral tear length was longer when utilizing the LD position. These results suggest that patient positioning may influence the total number of anchors used, the number of anchors used in the inferior glenoid, and the frequency of anchor placement at the 6 o’clock position during arthroscopic capsulolabral repair for anterior shoulder instability. How these findings affect clinical outcomes warrants further study. Registration: NCT02075775 (ClinicalTrials.gov identifier)

Beach Chair Versus Lateral Decubitus Surgical Positioning for Arthroscopic Anterior Shoulder Stabilization: A Retrospective Comparison of Clinical and Patient-Reported Outcomes

“…However, beach-chair positioning was associated with a greater number of anchors placed than lateral decubitus in this cohort. Although our data set on number of anchors used is much smaller than the data presented by Baron et al, 1 the drastic difference in results shows that there may be significant surgeon bias when evaluating perioperative factors such as number and location of anchors. A randomized study design would be optimal to clarify perioperative differences between beach-chair and lateral decubitus positioning; however, surgeon preferences and total surgical volume within each position significantly limit the feasibility and validity of such a clinical trial.…”

“…3,6,10 This is supported by the findings of a recent cross-sectional study comparing the number and location of anchors used between beach-chair and lateral decubitus positions for arthroscopic anterior shoulder stabilization. 1 The authors found that anchors were placed in the 6-o’clock portion of the glenoid more than 2 times as frequently when patients were in the lateral decubitus position, and a larger number of anchors were placed with lateral decubitus positioning as well. 1 Despite the differences in anchor utilization, the current study found no differences in redislocation or subjective instability rates between beach-chair and lateral decubitus positions.…”

“…1 The authors found that anchors were placed in the 6-o’clock portion of the glenoid more than 2 times as frequently when patients were in the lateral decubitus position, and a larger number of anchors were placed with lateral decubitus positioning as well. 1 Despite the differences in anchor utilization, the current study found no differences in redislocation or subjective instability rates between beach-chair and lateral decubitus positions. However, beach-chair positioning was associated with a greater number of anchors placed than lateral decubitus in this cohort.…”

Transosseous Equivalent Technique for Bony Bankart Repair

“…We find that performing bony Bankart repair in an arthroscopic fashion permits anatomic positioning of the osseous fragment and accommodates additional intra-articular work, if needed, while avoiding the necessity of large incisions or split/takedown of the subscapularis. We prefer to perform all arthroscopic procedures for instability in the standard lateral decubitus position with a beanbag due to the relative ease of humeral distraction and placement of inferior anchors, 11 although this technique can be applied without any adjustments in the beach chair position. While positioned laterally prior to draping, an exam under anesthesia is performed.…”

Current concepts in chronic traumatic anterior shoulder instability

“…Lateral patient positioning has been reported to be advantageous for the performance and results of BR in a recent systematic review ( 17 ). The MOON shoulder group reported that surgeons using the lateral position for BR more frequently placed anchors in the inferior glenoid and at the 6-o'clock position, which are recognized as important to achieve a satisfactory repair ( 18 ). The MOON shoulder group also reported in their prospective study for anterior shoulder instability that the majority of patients (75.5%, 426 of 564) underwent BR as their surgical treatment ( 19 ).…”