T-Type Arthroscopic
Capsular Shift for multidirectional Instability
Using standard arthroscopic
maneuvers shoulder surgeons can expect excellent results for arthroscopic
T-shaped cruciate inferior capsular shift to correct multidirectional
instability.
Establish two
portals (1) posterior superior used for 70° scope or (2)
medical anterior superior located in the rotator interval area
just anterior to the biceps tendon.
1.
Make a trough 4 mm
wide along the capsular attachment to the anterior humeral
head.
2.
Using laser or an
arthroscopic pinch forceps a T-shaped incision ismade in the anterior capsule
3.
A chop
catcher passes the suture through the upper flap corner.
4.
The two
limbs are then pulled to the medial anterior superior portal and hold with
a Kocher forceps.
5.
Another chop catcher passes another suture
through the upper corner of the lower flap. Thechop puller is then used to pull one
end through the interval.
6.
One end of the
suture passes below the upper border of the subscapularis and
the other below it.
7.
The knot is tied
to shift the lower flap up to lye on the trough.
8.
The ring forceps suture puller is used to
pull the two limbs laterally. A trochar is placed medially and
one limb is pulled through the trochar.
9.
With the curved
suture catcher the suture limb is passed anteriorly through
the base of the lower flap.
10.
The limbs are then
pulled through an anterior medial portal.
11.
The two limbs are passed through the
trochar and placed in the anterior lateral portal.
12.
Using the concave
knot driver the suture is tied (Niky knot sliding technique)
so to complete shifting the upper flap inferiorly.
