Presentation for Pacific Medical PA Lab, Tracy CA, July 2012

1. Instability / Labral Repair
Alan M. Hirahara, M.D., FRCS(C)
Board Certified in Orthopaedic Surgery & Orthopaedic Sports Medicine
Specializing in arthroscopic shoulder surgery
Medical Director Team Physician Consultant
Sacramento State Athletics Sacramento River Cats Oakland A’s
MiLB - AAA

2. Keys to Success
• Plan your Repair!!!
• Portal Placement
• Suture Management

3. Fixation Options

4. Suture Passing
• Birdbeak
2.3 mm O.D.
1.8 mm O.D.
 Suture Lasso SD

5. SLAP LESIONS

6. Portals: SLAP Repair
• Posterior portal
– Stay at superior glenoid in case of partial
cuff tear
• Anterior portal
– More lateral and superior for better angle on
anterosuperior glenoid
• Supra & Infraspinatous portals
– Stay medial in muscle
– Plan for potential RCR

7. Beware the Buford Complex
• 58 yo female with anterior shoulder pain since
8/08, without trauma. Surgeon took her to
surgery 2/09 and performed “debridement of
pRCT and Bankart repair.”
• Presented with 6/10 with significantly
increased pain and limited Abd-ER

8. Beware the MGHL Band

9. SLAP Repair: PushLock

10. ANTERIOR STABILIZATIONS

11. Portals: Anterior Stabilization
• Posterior portal
– Low
• Anterior portal
– Low & Lateral
• Just above subscap
• Wissinger rod
• Accessory portal, if nec
– Anterosuperior portal
– Supraspinatous portal

12. Anterior Stabilization: SutureTak

13. Anterior Stabilization – PushLock

14. POSTERIOR STABILIZATIONS

15. Portals: Posterior Stabilization
• Anterior viewing portal
– Low
• Posterior lateral portal
– Low & Lateral
– Use to place anchors
• Supraspinatous portal
– Suture passing & tying
• Posterior portal
– Suture passing
– Management

16. Posterior Stabilization: SutureTak

17. Inferior Stabilization: Perc ST
Posterior Stabilization: PushLock

18. BONUS CONTENT

19. Deleted Scene – Lost Suture

20. Deleted Scene – Damaged Suture

21. Deleted Scene: Lost Wire

22. Deleted Scene: Tangled Suture

23. Pan Stabilization – 360 degrees

24. Thank You!