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Portals-Anterior Instability

Two anterior portals (superior and inferior) are established using an “outside-in” technique with a spinal needle. These portals function as utility portals for instrument passage, glenoid preparation, suture management, and knot tying. It is important to separate these anterior cannulas widely so cannula crowding in the joint is not a problem.

The second cannula is placed as low as possible in the rotator interval typically entering just superior to the subscapularis tendon and usually placed a centimeter inferior and lateral to the palpable coracoid process so that it enters the joint aiming slightly lateral to medial.

The first anchor is placed at the five o’clock position with the proper medial orientation. The anchor must be placed at the corner of the anterior glenoid rim or even a couple of millimeters onto the articular face of the glenoid to incorporate the labrocapsuloligametous sleeve as a prolongation of the glenoid cavity. It is imperative to ensure the avoidance of medial placement of the anchors on the scapular neck. Alternately, a trans-subscapularis approach can be used to improve inferior access if needed.

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