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Arthroscopic Cuff-Sparing Percutaneous (CUSP) Technique for Posterior Instability Repair in the Beach-Chair Position

Bhatia, Deepak N. MS(Orth), DNB(Orth)

Techniques in Hand & Upper Extremity Surgery: September 2012 - Volume 16 - Issue 3 - p 173–179
doi: 10.1097/BTH.0b013e31825fd6f8
Techniques

Arthroscopic posterior labral repair and capsular shift procedures are technically difficult in the beach-chair position as compared with the lateral decubitus position. Optimal visualization in the beach-chair position, and anchor placement in the posterior glenoid rim, necessitate various lateral trans-cuff portals, and these may result in damage to the rotator cuff tendons. The author has devised a new technique for posterior labral repair in the beach-chair position; the technique involves visualization of the posterior capsulolabral complex through a 70-degree arthroscope placed in the posterior axillary pouch portal, and labral repair is performed through percutaneous medial portals. The cuff-sparing and percutaneous (CUSP) nature of the technique utilizes safe anatomic zones for visualization and percutaneous repair of the entire posterior labrum, and lateral portals that may potentially damage the rotator cuff tendons are avoided. Technical variants of the procedure include: (1) a “CUSP shift” technique (combined labral repair and capsular shift); (2) a “CUSP-stitch” technique (isolated labral repair without a capsular shift); and (3) a “posterior labroplasty” technique for reconstruction of deficient posterior labral tissue. Technical tips to avoid neurological injury, and a detailed rehabilitation protocol are presented.

Department of Orthopaedic Surgery, Seth GS Medical College, King Edward VII Memorial Hospital, Mumbai, India

Conflict of Interest and Source of Funding: The author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest and no source of funding in connection with the submitted article.

Address correspondence and reprint requests to Deepak N. Bhatia, MS(Orth), DNB(Orth), Department of Orthopaedic Surgery, Seth GS Medical College, King Edward VII Memorial Hospital, Parel, Mumbai 400012, India. E-mail: thebonesmith@gmail.com.

© 2012 Lippincott Williams & Wilkins, Inc.