The 7-o'clock Posteroinferior Portal for Shoulder Arthroscopy

The Bankart lesion, in which the anteroinferior labrum is detached from the glenoid, is the critical anatomic lesion in the majority of patients with anterior glenohumeral instability. Some patients with anterior glenohumeral instability will have Bankart lesions with posterior extension beyond the 6-o'clock position, and achieving anatomic labral repair in these cases can present a technical challenge. In our experience, the lateral decubitus position and use of accessory portals allow superior visualization of the inferior half of the glenohumeral joint for glenoid and labral preparation, anchor placement, and suture management. The use of double-loaded suture anchors at the inferior glenoid provides multiple points of fixation at this challenging location while limiting the number of anchors required. The purpose of this article is to present a simple and reproducible technique for arthroscopic repair of Bankart lesions with posterior extension, emphasizing the use of accessory 5-o'clock trans-subscapularis and 7-o'clock portals.

Section: Discussionmentioning

confidence: 99%

The Use of Accessory Portals in Bankart Repair With Posterior Extension in the Lateral Decubitus Position

Cvetanovich

Hamamoto

Campbell

et al. 2016

“…The posteroinferior portal for shoulder arthroscopy has been shown to be safe and effective for accessing the inferior aspect of the glenohumeral joint in cadaveric models, with mean distances of 39 AE 4 mm from the circumflex artery and 29 AE 3 mm from the axillary nerve and suprascapular nerve. 8 The lateral decubitus position facilitates improved visualization and workflow through this portal. It is important to localize the posteroinferior portal with the use of a spinal needle, ensuring that the needle is oriented to allow for the proper screw trajectory.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, a portion of the intact labrum may need to be debrided to allow for complete visualization, mobilization, and reduction of the fracture fragment. A posteroinferior portal at the 7-o'clock position, approximately 2 to 3 cm inferior and distal to the standard posterior viewing portal, 8 can be helpful for fracture release and manipulation and will be needed for hardware insertion later in the procedure. This posteroinferior portal is localized using a spinal needle to assess the position and trajectory in planning for screw fixation through this portal.…”

Section: Techniquementioning

confidence: 99%

Arthroscopic Reduction and Internal Fixation of an Inferior Glenoid Fracture With Scapular Extension (Ideberg V)

Tuman

Bishop

Abrams

2015

Arthroscopic reduction and internal fixation of glenoid fractures have been well described, especially for glenoid rim (Bankart) fractures, as well as for scapular body fractures with extensions into the articular surface. This approach has the advantage of decreasing comorbidities associated with a standard open approach, but it can be technically challenging and may not be amenable to all fracture patterns. Arthroscopic fixation of scapular fractures incorporating a transverse pattern along the inferior aspect of the glenoid is particularly challenging because of difficulty in accessing this space. We detail the use of a posteroinferior arthroscopic portal for fracture reduction and hardware placement in a scapular fracture with inferior glenoid involvement.

“…Structures at potential risk from use of the posteroinferior portal include the branches of the suprascapular nerve and its artery; the axillary nerve, which courses with the posterior circumflex humeral artery; and the articular surfaces of the humerus and glenoid. 18 Difelice et al 17 measured the distance of the axillary and suprascapular nerves from the API portal with patients both in the beach-chair position and in the lateral position. They found it to be a safe portal, measuring 2 cm, on average, from the axillary nerve at the 8-or 4-o'clock position.…”

Section: Discussionmentioning

confidence: 99%

“…The use of this portal facilitates manipulation of the IGHL and suture passage at the most inferior part of the capsule. [17][18][19] Table 1 shows the advantages and challenges of using the API portal for arthroscopic Bankart repair.…”

mentioning

confidence: 99%

Arthroscopic Bankart Repair: Accessory Posterior Portal With Slotted Cannula for Lowest Capsulolabral Access

Tsvieli

Atoun

Amar

et al. 2014

We present a novel technique for safe establishment of the accessory posterior portal using a slotted cannula. Arthroscopic Bankart repair is a common procedure. A variety of arthroscopic techniques have been described in the literature, commonly using the posterior portal for visualization and the anterior portal with a working cannula. The accessory posterior portal enables elegant access to the lower part of the capsulolabral junction, a firmer grasp and mobilization of the tissue, quick and easy tool exchange using a slotted cannula, and clearer suture placement because of the flat, direct working angle. The skin incision is made small without the need for an arthroscopic cannula, and the portal location is in a relatively safe zone. The use of the accessory posterior portal along with a slotted cannula shortens the duration of the operative procedure and improves safety and performance.