This document provides an overview of shoulder labral repair and stabilization procedures. It discusses key steps like portal placement, suture management and fixation options. Specific techniques are demonstrated for SLAP repairs, anterior stabilizations using suture anchors and pushlocks, and posterior stabilizations. Potential complications like a lost suture or wire are also briefly covered. The document serves as a reference for orthopedic surgeons on the technical aspects of arthroscopic shoulder stabilization and labral repair surgeries.

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!