Technique
1. Establish portals
A. Posterior portal for viewing
B. Anterior portal
- need to keep low and away from biceps, otherwise difficult to get around biceps
- for suture passage, if in combination with bankart repair often use AI portal instead of AS
C. Anterosuperolateral portal / Wilminton for insertion of anchors
- insert spinal needle first
- anterolateral border acromion
- needs to be close to acromion to get angle over humeral head
- check with needle
- need best angle to insert anchors to anterior and posterior aspect of biceps
- passes through supraspinatous
- use knife to cut in line with fibres
- insert portal
2. Prepare insertion
- shaver via anterior portal
- debride frayed labrum
- mobilise biceps tendon
- debride bony base to create ledge and bleeding bone
3. Anchors
Drill and insert via Wilminton portal
Usually 3 anchors is a minimum
Technique
- insert anchor
- suture through each cannula
- limb through W portal will be the suture limb that is passed
- suture passer through anterior portal (right angled for left shoulder)
Anterior anchor
- best to pass the suture passer above the biceps to get good bite
- retrieve sutures and tie from port of Wilmington
Posterior 2 anchors
- pass suture passer under biceps
Can suture Portal of Wilminton if desired
4. Dfficult posterior anchors
Camera through anterior / anterosuperiorlateral portal
A. Place anchor through posterior portal
- does not always give good angle
B. Trans infraspinatous Portal
