[ Ссылка ]
This is a presentation of a rotator cuff sparing arthroscopic SLAP repair with knotless all-suture anchors. The case begins with a dynamic examination under anesthesia with the arthroscope in the posterior viewing portal to evaluate for instability of the biceps root as well as internal impingement. A standard rotator interval portal has already been established and an auxiliary low anterior working portal is established.
With an oscillating shaver on burner mode, the superior aspect of the glenoid is prepared. A curb drill guide is placed through the high anterior rotator interval portal and is placed just anterior to the biceps root. A single all suture anchor is placed, first manually, and then finished by impacting with a mallet. A straight crescent arthroscopic suture shuttling device is then passed through the mid glenoid portal and around the superior labrum. The working suture anchor is then shuttled through the mid glenoid portal and is then passed back through the working high anterolateral portal. A working blue suture is then passed through the knotless shuttling anchor and tensioned appropriately to fixate the superior labrum. The benefit of this knotless suture device is that it allows for modifiable tension. The anchor is then cut flush with the face of the glenoid.
A high cuff sparing superior lateral rotator portal is then established, first evaluating for the trajectory of the portal utilization of a spinal needle. A curved drill guide is then utilized to place a second anchor just posterior to the bicep root. The anchor is seeded in a sequential fashion similar to that of the anterior anchor. The working suture is then taken out of the high rotator interval portal. The arthroscopic trocar provides superior tension while the spinal needle is placed in position ensuring that the needle pierces the superior capsule and under the surface of the rotator cuff entering the joint and then reengaging the posterior labrum.
Utilizing the PDS suture, this works as a passing suture for the working blue suture through the glenolabral junction, just posterior to the biceps root. The looped end of the shuttling suture, as well as the working suture, is shuttled out of the high anterior interval portal. The working suture is once again placed in the Nautilus shuttling suture in the posterior labral complex can be manually tightened and fixated to the superior glenoid. The working suture is then cut flush with the face of the glenoid and with the use of an arthroscopic probe device the biceps root is reprobed to ensure that the slap tear has been fully stabilized.
