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Dual Posterior Portals For Arthroscopic Posterior Shoulder Stabilization in the Beach Chair Position

Video Author: Seth Gamradt, MD
Published on: 11.05.2013
Associated with: Techniques in Shoulder & Elbow Surgery. 14(4):96-98, December 2013

A posterior labral tear in athletes presents with shoulder pain and recurrent posterior subluxation

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Dual Posterior Portals For Arthroscopic Posterior Shoulder Stabilization in the Beach Chair Position
Creator: Seth Gamradt, MD
Duration: 9:20
A posterior labral tear in athletes presents with shoulder pain and recurrent posterior subluxation
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Black and Tan Technique
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1) Capitellar Chondral Flap 2) Debridement of Capitellar Lesion 3) Osteoarticular Plug Harvest from Lateral Femoral Condyle 4) Osteoarticular Plug Placement 5) Preparing the Defect
Creator: 1 – 5) Joshua S. Gluck MD
Duration: 4:22
1) A freer is used to demonstrate the loose chondral flap on the capitellum that was previously seen during the arthroscopy.

2) A curette is used to sharply debride the loose chondral flap and create a distinct border between normal cartilage and the recipient site for osteoarticular plug transfer.

3) The harvester from the osteoarticular transfer system set is used on the proximal lateral femoral condyle to remove a plug of cartilage and subchondral bone that will exactly match the previously-drilled recipient site.

4) The delivery device is used to place the osteoarticular plug exactly perpendicular to the surface of the capitellum. A smooth tamp is then used for fine tuning to place the plug perfectly flush with the surrounding cartilage. Care is taken to not sink the plug too deep, as there is no way to back it out.

5) A fluted reamer from the osteoarticular transfer system set is used to create a cylindrical void at the site of the defect that is exactly the same diameter and depth as the donor plug. Care should be taken to drill this exactly perpendicular to the articular surface.
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1) Cadaveric examination of the glenohumeral joint 2) Cuff Strength Testing
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1) Cadaveric examination of the glenohumeral joint capsule during maximal ER in abduction shows an abrupt reduction in tension on the anterior aspect of the capsule with even minimal amounts of horizontal adduction

2) In a clinical series of 600 consecutive patients presenting with (non-surgical) shoulder pain over a 5 year period, hand-held dynamometry measurements of internal and external rotation strength were taken in both the uninjured and injured arms on each occasion of service for each patient
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The integrity of the reconstruction is assessed by ranging the shoulder in all planes. We try to achieve a watertight seal between the glenohumeral joint and subacromial space with the graft in order to mimic normal anatomy
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A step-by-step demonstration of a successful arthroscopic repair.
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Creator: Jean Kany
Duration: 3:24
Step 1: Precise identification of the LD pedicle.
Step 2: 5cm mini incision centering around the LD pedicle.
Step 3: Precise control of tension of the transfer.
Step 4: Tenotomy and tubularization.
Step 5: Excursion of tendon.
Step 6: Starting arthroscopy
Step 7: Subdeltoid and posterior to Teres Minor tunnelisation.
Step 8: Selection of the HH site of fixation.
Step 9: ACL guide can be used for a better exit around the bicipital groove.
Step 10: Safe exit of Kwire around the biceps.
Step 11: Maintenance of the maximal pretenotomy tension.
Step 12: Minimal 5cm incision.
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Capitellar Chondral Flap
Creator: Joshua S. Gluck MD
Duration: 0:08
A freer is used to demonstrate the loose chondral flap on the capitellum that was previously seen during the arthroscopy.
Play
Debridement of Capitellar Lesion
Creator: Joshua S. Gluck MD
Duration: 0:12
A curette is used to sharply debride the loose chondral flap and create a distinct border between normal cartilage and the recipient site for osteoarticular plug transfer.
Play
Preparing the Defect
Creator: Joshua S. Gluck MD
Duration: 0:16
A fluted reamer from the osteoarticular transfer system set is used to create a cylindrical void at the site of the defect that is exactly the same diameter and depth as the donor plug. Care should be taken to drill this exactly perpendicular to the articular surface.
Play
Osteoarticular Plug Harvest from Lateral Femoral Condyle
Creator: Joshua S. Gluck MD
Duration: 0:55
The harvester from the osteoarticular transfer system set is used on the proximal lateral femoral condyle to remove a plug of cartilage and subchondral bone that will exactly match the previously-drilled recipient site.
Play
Osteoarticular Plug Placement
Creator: Joshua S. Gluck MD
Duration: 1:16
The delivery device is used to place the osteoarticular plug exactly perpendicular to the surface of the capitellum. A smooth tamp is then used for fine tuning to place the plug perfectly flush with the surrounding cartilage. Care is taken to not sink the plug too deep, as there is no way to back it out.
Play
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Duration: 1:55
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Black and Tan Technique using DJO Monoblock RSP
Play
Mini Invasive Axillary Approach and Arthroscopic Humeral Head Interference Screw Fixation for Latissimus Dorsi Transfer
Creator: Jean Kany
Duration: 3:24
Show More
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Step 1: Precise identification of the LD pedicle.
Step 2: 5cm mini incision centering around the LD pedicle.
Step 3: Precise control of tension of the transfer.
Step 4: Tenotomy and tubularization.
Step 5: Excursion of tendon.
Step 6: Starting arthroscopy
Step 7: Subdeltoid and posterior to Teres Minor tunnelisation.
Step 8: Selection of the HH site of fixation.
Step 9: ACL guide can be used for a better exit around the bicipital groove.
Step 10: Safe exit of Kwire around the biceps.
Step 11: Maintenance of the maximal pretenotomy tension.
Step 12: Minimal 5cm incision.
Play
Osteoarticular Plug Placement
Creator: Joshua S. Gluck MD
Duration: 1:16
Show More
Show Less
The delivery device is used to place the osteoarticular plug exactly perpendicular to the surface of the capitellum. A smooth tamp is then used for fine tuning to place the plug perfectly flush with the surrounding cartilage. Care is taken to not sink the plug too deep, as there is no way to back it out.
Play