Advantages and techniques of utilizing anterolateral portal in delaminated rotator cuff repair.

Typically, rotator cuff repair is performed two-dimensionally while visualizing the subacromial space. To achieve a more complete repair, sutures can be retrieved from inside the joint utilizing a penetrating suture device through the anterolateral portal, which permits visualization of the articular side and bursal side of the rotator cuff tear. Utilizing other portals can leave the sutures out of sight and reach. The anterolateral portal helps capture both leaves of a delaminated tear and places the sutures in the center of the field for retrieval and tying. The anterolateral portal is located with a spinal needle just off the anterolateral corner of the acromion, and the suture anchor is inserted into the greater tuberosity through this portal. The sutures are passed into the joint through the tear in the rotator cuff with a suture grasper. The scope is redirected intraarticularly, and the suture is visualized. The sutures are positioned, and the penetrator is passed through the tendon. The scope is placed back in the bursa for tying sutures and capturing both leaves of a delaminated tear. It works equally well for simple complete tears and partial articular-sided supraspinatus tendon avulsion lesions.

A novel technique for advancing the inferior labrum in a bankart repair.

Passing suture during a Bankart repair can be a difficult task. A key component of a Bankart repair involves shifting the anteroinferior capsule and labrum superiorly. This technical note describes a new technique of reaching the inferior aspect of the Bankart lesion from posterior. Typical suture passers push the tissue further away. Using a SutureLasso through the low posterolateral portal allows one to push the tissue from inferior toward the suture anchor, making it simpler to advance the capsulolabral complex. Three suture anchors are used in the anteroinferior quadrant. The lowest suture anchor is the critical anchor for advancing the capsule and labrum. The SutureLasso is placed into the axillary recess through the low posterolateral portal, and the nitinol wire is advanced through the capsule and labrum, retrieving the suture and pulling it back through the tissue for tying with a sliding locking knot. This ensures good superior advancement of the tissue and helps obtain an optimal arthroscopic result in Bankart repair. Additional anchors are placed, and suture passage for the middle and superior anchors is then completed from anterior. The advancement and restoration of the tissue tightness provide the optimal components for an excellent result.