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Easy Arthroscopic Access to the Shoulder Labrum

Tears of the glenoid labrum of the shoulder are common in athletes with traumatic shoulder injuries. The glenoid The glenoid is the portion of the shoulder blade that forms the shoulder socket. The labrum is a dense fibrocartilage ring that is firmly attached to the glenoid. It provides depth and stability to the shoulder joint.

When the labrum is torn along the posterior (back) or posteroinferior area, access to repair it can be difficult. Using an arthroscope to fix the tear often causes more damage to the labral tissue. In this article, a new technique is described that allows easy, safe access to this area.

The patient is positioned on his or her side. An arm traction device is used to give the surgeon a better view and better access to the area. A diagnostic exam of the shoulder is done using a standard posterior portal. Portal refers to the place where the arthroscopic needle is inserted through the skin into the joint.

In the standard arthroscopic labral repair, the surgeon makes a second portal just above the subscapularis tendon. This view makes it possible to see if the posterior labrum can be reached. The scope is then placed in the posterosuperior portal. This gives a good view of the posteroinferior quadrant.

Although the view is good, getting to the labrum where it attaches to the bone is not a straight shot. Angling the scope in to that area can cause additional tearing and damage to the labral tissue.

An alternate method is proposed here. The surgeon doesn't use the posterior portals. Instead, a mid-glenoid or anteroinferior portal is used to find the tear. This portal allows the surgeon to slide the arthroscopic tools directly across the glenoid.

From there, the labrum can be lifted off the glenoid. A special tool called the arthroscopic elevator can reach under the posterior labral tissue. This allows the surgeon to get under the chondrolabral junction where the labrum attaches to the bone. The bone is shaved to smooth it. The rest of the repair can be done using the standard posterior portals.

The surgeon must watch for incomplete tears or cracks in the posterior labrum. These can also be repaired using the elevator device through the anterior portal.

The authors conclude that the anterior portal can be used to reach the chondrolabral junction. This makes preparation of the area for repair easier to perform compared to the standard posterior approach.

References: Matthew T. Provencher, MD, LCDR, MC, USNR, et al. Arthroscopic Preparation of the Posterior and Posteroinferior Glenoid Labrum. In Orthopedics. November 2007. Vol. 30. No. 11. Pp. 904-905.

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