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Punch Chop Needle Technique

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 TACS-Repair
  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 is made 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. The chop 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.    
             
GOC Clinic Bonn, Germany  1990 - 2006