Shoulder Arthroscopy: Basic Principles of Positioning, Anesthesia, and Portal Anatomy

Paxton, E. Scott; Backus, Jonathon D.; Keener, Jay D.; Brophy, Robert H.

doi:10.5435/jaaos-21-06-332

Cited by 41 publications

(56 citation statements)

References 52 publications

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“…Several authors have previously detailed the techniques for arthroscopic repair of anterior, posterior, and superior labrum lesions and our approach incorporates previous advances and also includes a few technical points that may be helpful when utilizing an all-suture anchor for labrum repair. [ 3 16 17 18 24 25 26 27 ] For the initial glenohumeral arthroscopy, a low posterolateral portal was utilized that is in line with the lateral border of the acromion and approximately 4 cm inferior to the posterolateral corner of the acromion. [ 16 ] Next, an anterolateral portal (8.25 mm twist in cannula) adjacent to the superolateral edge of the subscapularis tendon is established with spinal needle localization for optimal angle of approach to the glenoid.…”

Section: Methodsmentioning

confidence: 99%

Triple labrum tears repaired with the JuggerKnot™ soft anchor: Technique and results

Agrawal¹,

Pietrzak²

2015

Int J Shoulder Surg

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Purpose:The 2-year outcomes of patients undergoing repair of triple labrum tears using an all-suture anchor device were assessed.Materials and Methods:Eighteen patients (17 male, one female; mean age 36.4 years, range: 14.2-62.3 years) with triple labrum tears underwent arthroscopic repair using the 1.4 mm JuggerKnot Soft Anchor (mean number of anchors 11.5, range: 9-19 anchors). Five patients had prior surgeries performed on their operative shoulder. Patients were followed for a mean of 2.0 years (range: 1.6-3.0 years). Constant–Murley shoulder score (CS) and Flexilevel scale of shoulder function (FLEX-SF) scores were measured, with preoperative and final postoperative mean scores compared with a paired Student's t-test (P < 0.05). Magnetic resonance imaging (MRI) was also performed at final postoperative.Results:Overall total CS and FLEX-SF scores increased from 52.9 ± 20.4 to 84.3 ± 10.7 (P < 0.0001) and from 29.3 ± 4.7 to 42.0 ± 7.3 (P < 0.0001), respectively. When divided into two groups by whether or not glenohumeral arthrosis was present at the time of surgery (n = 9 each group), significant improvements in CS and FLEX-SF were obtained for both groups (P < 0.0015). There were no intraoperative complications. All patients, including contact athletes, returned to their preinjury level of sports activity and were satisfied. MRI evaluation revealed no instances of subchondral cyst formation or tunnel expansion. Anchor tracts appeared to heal with fibrous tissue, complete bony healing, or combined fibro-osseous healing.Conclusion:Our results are encouraging, demonstrating a consistent healing of the anchor tunnels through arthroscopic treatment of complex labrum lesions with a completely suture-based implant. It further demonstrates a meaningful improvement in patient outcomes, a predictable return to activity, and a high rate of patient satisfaction.Level of Evidence:Level IV case series.

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Section: Methodsmentioning

confidence: 99%

Triple labrum tears repaired with the JuggerKnot™ soft anchor: Technique and results

Agrawal¹,

Pietrzak²

2015

Int J Shoulder Surg

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“…Although access to the anterior-inferior labrum has been well described for repair of Bankart lesions, posterior and inferior labral tears have been described less. 7 Access to the inferior glenoid has been described with an accessory posterolateral portal at the 7-o'clock position. 8 For more posterior extension, an additional accessory portal at the 5-o'clock position has been described.…”

Section: Discussionmentioning

confidence: 99%

“…The 5-o'clock trans-subscapularis portal can be used for access to the anterior and anteroinferior glenoid and labrum. 7 Although the 5-o'clock portal has been questioned because of its proximity to the axillary nerve, musculocutaneous nerve, cephalic vein, and humeral articular cartilage, a percutaneous technique without use of a cannula may make this an advantageous portal. It can be used to place anchors from the 3-o'clock to 5:30 clock-face position, with minimal damage to the subscapularis tendon.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Repair of a Circumferential 360° Labral Tear

Rao

Cvetanovich

Zuke

et al. 2017

Arthroscopy Techniques

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Injuries to the glenoid labrum can result in shoulder instability and pain. These lesions may occur anywhere around the glenoid labrum, and thus, the arthroscopist must be prepared to approach all aspects of the glenoid from multiple angles. The pan-labral or circumferential (360°) tear of the glenoid labrum presents a unique challenge to even the experienced arthroscopist. The extent of the lesion requires the use of accessory portals and percutaneous techniques to establish adequate visualization and to facilitate the proper trajectory for anchor placement. The pan-labral tear also demands intraoperative planning throughout the repair to ensure proper tensioning and alignment of the labrum and capsular tissue. The purposes of this article are to report a technique for repairing a pan-labral lesion and to emphasize the use of accessory portals and percutaneous techniques for complete access to the glenoid.

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“…The position could be elected by the surgeon mainly considering the surgery type: open or arthroscopic procedures. Independently of the elected position, both surgeon and anesthesiologist should ensure that the bearings are protected to avoid neurological complications; with special attention to head and neck positioning, considering that severe complications could occur: cervical cutaneous neurapraxias, hypoglossal nerve palsies and spinal cord isquemic complications [ 30 ]. The choice of the BCP represents a challenge for the anesthesiologist, being the main objective to maintain adequate cerebral perfusion [ 18 ].…”

Section: Anesthetic Management Of the Patient With Chronic Shoulder Imentioning

confidence: 99%

“…BCP has been associated with neurologic complications such as stroke, spinal cord ischemia, and blindness. The fact that hypotensive anesthesia is frequently used during shoulder surgery (mainly in arthroscopic procedures) to avoid bleeding, makes the problem more significant [ 30 , 31 ]. The exact neurological complication mechanism is unknown and there is a great controversy in the tools effectiveness to avoid them.…”

Section: Anesthetic Management Of the Patient With Chronic Shoulder Imentioning

confidence: 99%

Anesthesia and Analgesia in the Patient with an Unstable Shoulder

Bambaren¹,

Dominguez²,

Martı́n³

et al. 2017

TOORTHJ

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Introduction:The patient with an unstable shoulder represents a challenge for the anesthesiologist. Most patients will be young individuals in good health but both shoulder dislocation reduction, a procedure that is usually performed under specific analgesia in an urgent setting, and instability surgery anesthesia and postoperative management present certain peculiarities.Material and Methods:For the purpose of the article, 78 references including clinical trials and reviews were included. The review was organized considering the patient that presents an acute shoulder dislocation and the patient with chronic shoulder instability that requires surgery. In both cases the aspects like general or regional anesthesia, surgical positions and postoperative pain management were analyzed.Conclusion:The patient with an acutely dislocated shoulder is usually managed in the emergency room. Although reduction without analgesia is often performed in non-medical settings, an appropriate level of analgesia will ease the reduction procedure avoiding further complications. Intravenous analgesia and sedation is considered the gold standard but requires appropriate monitorization and airway control. Intraarticular local analgesic injection is considered also a safe and effective procedure. General anesthesia or nerve blocks can also be considered. The surgical management of the patient with shoulder instability requires a proper anesthetic management. This should start with an exhaustive preoperative evaluation that should be focused in identifying potential respiratory problems that might be complicated by local nerve blocks. Intraoperative management can be challenging, especially for patients operated in beach chair position, for the relationship with problems related to cerebral hypoperfusion, a situation related to hypotension events directly linked to patient positioning. Different nerve blocks will help attaining excellent analgesia both during and after the surgical procedure. An interescalene nerve block should be considered the best technique, but in certain cases, other blocks can be considered.

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Shoulder Arthroscopy: Basic Principles of Positioning, Anesthesia, and Portal Anatomy

Cited by 41 publications

References 52 publications

Triple labrum tears repaired with the JuggerKnot™ soft anchor: Technique and results

Triple labrum tears repaired with the JuggerKnot™ soft anchor: Technique and results

Arthroscopic Repair of a Circumferential 360° Labral Tear

Anesthesia and Analgesia in the Patient with an Unstable Shoulder

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