Four-Quadrant Approach to Capsulolabral Repair: An Arthroscopic Road Map to the Glenoid

Advancing technology, improved instrumentation, and a desire to address intra-articular pathology with a minimally invasive approach have driven the expansion of arthroscopic shoulder surgery in the past 2 decades. Proponents cite greatly improved visualization, lack of the need to perform a capsulo...

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Bibliographic Details
Main Authors: Seroyer, Shane T, Nho, Shane J, Provencher, Matthew T, Romeo, Anthony A
Format: Report
Language:English
Subjects:
Anatomy and Physiology
ARTHROSCOPIC SHOULDER SURGERY
CAPSULOLABRAL RECONSTRUCTIONS
GLENOHUMERAL JOINTS
GLENOID
LATERAL DECUBITUS POSITION
Medicine and Medical Research
PORTAL PLACEMENT
POSITION(LOCATION)
REPRINTS
SHOULDERS(ANATOMY)
SLAP(SUPERIOR LABRUM ANTERIOR TO POSTERIOR) LESIONS
SOFT TISSUES
SURGERY
SURGICAL INSTRUMENTS
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Summary:Advancing technology, improved instrumentation, and a desire to address intra-articular pathology with a minimally invasive approach have driven the expansion of arthroscopic shoulder surgery in the past 2 decades. Proponents cite greatly improved visualization, lack of the need to perform a capsulotomy, fewer subscapularis issues postoperatively, and improved access to the entire glenohumeral joint. Our understanding and recognition of glenohumeral joint pathology have improved, and our ability to appropriately treat it has also improved. Aside from the anteroinferior and superior capsulolabral injury, orthopaedic surgeons have encountered and are able to address combined lesions, posterior labral tears, 270 degree to 360 degree labral tears, capsular laxity, humeral avulsion of the glenohumeral ligaments, associated glenoid or humeral bone loss, and partial-thickness rotator cuff tears. To adequately address the extent of pathology encountered in a shoulder instability case, access to the inferior, posteroinferior, and posterior aspects is necessary. In this technical article we present a simplified approach using safe access points by dividing the glenohumeral joint into 4 quadrants that allows for ease of instrumentation and implant placement. This will provide a blueprint for the treatment of capsulolabral injuries. In addition to portal selection and location, we will discuss several instruments we believe are advantageous in tissue manipulation and suture management. Published in Arthroscopy: The Journal of Arthroscopic and Related Surgery, v26 n4 p555-562, Apr 2010. Prepared in collaboration with Department of Orthopaedic Surgery, Division of Sports Surgery, Naval Medical Center San Diego, San Diego, CA. The original document contains color images. All DTIC reproductions will be in black and white.