PROCEDURE PERFORMED: Left shoulder arthroscopy decompression paralabral cyst, superior labral repair with posterior superior labral repair, and debridement of anterior and inferior labral tear.
Appropriate antibiotics were given intravenously prior to starting the case. He was carefully placed and allowed to keep his position with left shoulder facing upwards. Examination under anesthesia demonstrated full range of motion of the left shoulder, which was stable throughout the testing. All bony prominences were well padded. The left shoulder and upper extremity were prepped and draped in a regular sterile fashion. A standard posterior and anterior and superior portal was created. Diagnostic arthroscopy demonstrated some mild fraying of the rotator cuff tendon from the articular side. This represents approximately 5% to 10% thickness of the rotator cuff tendon. This was debrided with 4.0 full-radius resector. There was also fraying of the anterior and inferior labral structures. This was debrided with a 4.0 full-radius resector as well. The articular surfaces were well preserved. The anterior and inferior labral structures were intact after debriding it. However, there was a complete avulsion of the superior labrum of the superior glenoid extending posteriorly to approximately the 2 o'clock position. Being careful with the location of neurovascular structures, the paralabral cyst was decompressed in its entirety with using 4.0 full-radius resector. Next, the superior glenoid and labral structures were debrided with a 4.0 full-radius resector. Next, two Smith & Nephew 2.9 mm BIORAPTOR anchors were implanted into the superior glenoid rim, one posterior to the biceps tendon at approximately the 1:30 position and the one anterior to the biceps tendon. Each suture line was passed through healthy portions of labral tissue and then tied down using Slide-N-Lock followed by 2.5 inches. The repair was (inaudible) and found to be stable. The scope was placed in the anterior and superior portal viewing the posterior labral structures, which were intact after the end of the repair. The scope was then placed in the subacromial position. Diagnostic bursoscopy demonstrated normal rotator cuff tendon and the coracoacromial ligament was also intact without any fraying. The arthroscopic equipment was removed from the joint. Portals were then closed using 3-0 Vicryl buried interrupted sutures followed by Steri-Strips to the skin, 30 cc of 0.5% Marcaine plain was injected into the portal sites in the joint. Sterile bulky dressing was placed on the shoulder. The patient was then placed on a sling. The patient was then extubated, transferred to the recovery room, then awakened, neurovascularly intact. Sponge and needle counts were accurate.
