The posterior-medial portal.
Repair of the posterior superior labrum usually involves placing an anchor posterior to the biceps attachment through an anterior-superior or Wilmington portal. Access to the posterior-superior labrum can be accomplished by establishing a portal medial to the posterior viewing portal. The initial posterior arthroscopic viewing portal is established slightly lateral to a traditional position to allow viewing of the posterior labrum and maintain separation from the posterior-medial portal. The suture anchor can be placed behind the biceps attachment through an anterior portal. The posterior-medial portal is started approximately 3 cm medial to the viewing portal with an 18-gauge needle. The needle is directed anterolateral into the intra-articular space under arthroscopic visualization to determine the appropriate course of the suture retriever. The needle is replaced with a sharp suture retrieval device. The suture from the anchor is pulled through the labrum to achieve a simple or mattress type repair. The suture is retrieved through the anterior-superior portal by finding it medial to the labrum. The sutures can be tied through the anterior-superior portal. The posterior-medial portal can be safely established with attention to technical considerations.
Hoenecke
Heinz
H
Scripps Clinic, La Jolla, California, USA. bhoeneck@san.rr.com
Fronek
Jan
J
D001182:Arthroscopy / Q000379:methods*; D006801:Humans; D012785:Shoulder Joint / Q000601:surgery*; D013536:Suture Techniques