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Capsulolabral Repair with Suture Anchors

For capsulolabral repair with suture anchors, the 30 degree arthroscope should be placed in the posterior viewing portal. It also can be placed in the anterosuperior portal (“bird’s eye” portal) to view the anterior labrum. Working instruments can be then placed in the anteroinferior portal. In some instances, it is helpful to use a 70 degree arthroscope to visualize the glenoid rim while mobilizing the capsulolabral sleeve.

The IGHL complex is mobilized from the glenoid neck as far inferiorly as the six o’clock position using electrocautery or a small elevator. The capsulolabral sleeve must be mobilized until it can be shifted superiorly and laterally onto the glenoid rim. The release should proceed until the muscle fibers of the underlying subscapularis are seen. Next, the glenoid neck is decorticated with a motorized shaver to facilitate healing of the repaired labrum and capsule.

Anchors are placed on the articular rim, or a few millimeters on the articular surface, through the anterior-inferior cannula at an angle that avoids skiving across the articular cartilage. They should not be placed inadvertently along the medial scapular neck. The anchor should be assessed for security and the suture for slideability.

The labrum is repaired and the capsule is shifted superiorly. The authors prefer using a shuttling device [arthrex suture lasso (Arthrex, Naples, FL) or linvatec spectrum (Linvatec, Largo, FL)], and a shuttle relay [linvatec (Linvatec, Largo, FL)] or monofilament suture is placed through the device and retrieved out the superior cannula (while viewing from posterior portal), or the posterior cannula (while viewing from anterosuperior portal).

The suture limb that exits the anterosuperior cannula (while viewing from the posterior portal) is the suture that will ultimately pass through the soft tissue and becomes the “post” suture down which the sliding arthroscopic knot will move. It is advisable to have the knot on the soft tissue capsulolabral side of the repair. Standard arthroscopic sliding knots are then tied. The knot is cut leaving a 3- to 4-mm tail. These steps are repeated for each subsequent anchor.

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