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Anterior portals in shoulder arthroscopy
1Department of Orthopedic Surgery, Children's Hospital, San Francisco, California.
Summary
New anterior superior and anterior inferior portals improve shoulder arthroscopy visualization and access to the glenohumeral ligament labral complex. These portals offer enhanced safety when created using specific techniques and surgeon experience.
Area of Science:
- Orthopedic Surgery
- Arthroscopy
- Anatomy
Background:
- The anterior portal is standard for shoulder arthroscopy but has limitations in accessing anteroinferior structures.
- Improved visualization and access are crucial for treating glenohumeral ligament and labral complex pathologies.
Purpose of the Study:
- To evaluate the safety and effectiveness of anterior superior and anterior inferior portals in shoulder arthroscopy.
- To determine optimal techniques for creating these new portals.
Main Methods:
- Anatomical studies on 78 cadaver specimens.
- Clinical evaluation of 34 operative cases.
- Utilized an "inside out" technique with blunt instrumentation for the anterior inferior portal.
Main Results:
- The anterior inferior portal's safety margin relative to the musculocutaneous nerve is enhanced with arm adduction.
- These portals significantly improved visualization and direct intervention on the glenohumeral ligament labral complex.
- Safe creation is achievable with adherence to guidelines and surgeon expertise.
Conclusions:
- Anterior superior and anterior inferior portals expand arthroscopic capabilities for shoulder joint pathologies.
- Careful technique and experienced surgeons ensure the safe implementation of these portals.