This document provides information on posterior instability of the shoulder. It discusses the mechanism of injury, incidence, diagnosis through x-rays, keys to success including portal placement and fixation options. Positioning for repair in beach chair position is described along with portals for posterior stabilization and techniques for suture passing and fixation using suture anchors, suture lassos, and knots. Additional stabilization techniques and potential complications are briefly touched upon.

1. Posterior Instability
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. Mechanism of Injury
• Epilespy
• Electrical Shock
• Direct Blow
• FOOSH
• Axial load on
adducted, IR
arm

3. Incidence of Posterior Dislocation
Diagnosis missed in 60 - 79% of cases

4. X-rays

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

6. Fixation Options

7. Positioning – Beach Chair
• Advantages • Disadvantages
– Orthostatic hypotension
– Allows for anatomic
– Requires special table or
positioning
attachment
– Fewer portals required
– Can use arm holder (ie
Trimano)
– Easy positioning
– Reposition tear to portals

8. 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

9. Suture Passing
• Birdbeak
 Suture Lasso SD
 1.8mm Tip Diameter
 Multiple Configurations

10. Posterior Stabilization: SutureTak

11. Inferior Stabilization: Perc ST
Posterior Stabilization: PushLock

12. BONUS CONTENT

13. Deleted Scene: Lost Suture

14. Deleted Scene: Damaged Suture

15. Deleted Scene: Lost Wire

16. Deleted Scene: Tangled Suture

17. Pan Stabilization – 360 degrees

18. Thank You!