Single-portal SLAP lesion repair

SLAP lesions are increasingly being recognized as a common cause of shoulder pain. Because an intact superior labral complex is required for peak performance of the shoulder, it is critical that all arthroscopic surgeons are able to recognize and repair these injuries. The most common method of repair involves at least 2 additional portals. The area of repair can become quite crowded, and the method can be challenging at times. A simple and highly reproducible technique is described. This technique requires only an anterior portal for suture management and no special instrumentation. A 5-mm anterior portal is established along with a standard posterior portal. A spinal needle is inserted from the anterior-lateral aspect of the acromion to identify the most desirable location for the suture anchor. After placement of the suture anchor, a second spinal needle is placed in the area of the subclavian portal. This needle is passed through the base of the biceps origin. PDS suture (Ethicon, Somerville, NJ) is placed through the needle and captured with a standard grasper. Before the needle is removed, a loop grasper or crochet hook is used to locate the needle. This prevents the suture from getting caught in hypertrophic tissue. A standard switching technique is then performed, and both sutures are brought out of the anterior portal and tied. This technique is simple and reproducible and requires no special instrumentation.