Operative report Shoulder Arthroscopy
Updated: Jul 18
Operative report 1
Preoperative Diagnosis
1. Right shoulder full-thickness rotator cuff tear involving the supraspinatus tendon.
2. Chronic right shoulder pain.
3. Shoulder impingement syndrome.
Postoperative Diagnosis
1. Right shoulder full-thickness supraspinatus rotator cuff tear measuring approximately 2.5 cm.
2. Subacromial bursitis.
3. Subacromial impingement syndrome.
4. Intact biceps tendon and labrum.
Procedure performed
1. Diagnostic arthroscopy of the right shoulder.
2. Arthroscopic extensive subacromial bursectomy.
3. Arthroscopic subacromial decompression with acromioplasty.
4. Arthroscopic rotator cuff repair utilizing a double-row suture bridge fixation technique.
Indication
The patient is a 56-year-old male with a two-year history of progressively worsening right shoulder pain, night pain, weakness, and inability to perform overhead activities. He had failed an extensive course of conservative management including activity modification, oral anti-inflammatory medications, supervised physical therapy for over six months, corticosteroid injection, and home exercise program. MRI demonstrated a full-thickness tear of the supraspinatus tendon with minimal tendon retraction. Surgical intervention was recommended to restore shoulder function, relieve pain, and prevent further tendon degeneration. Risks, benefits, alternatives, and expected postoperative rehabilitation were discussed in detail with the patient, and informed consent was obtained.
Description of the procedure
The patient was brought to the operating suite and placed supine on the operating table. Following induction of satisfactory general anesthesia, an ultrasound-guided interscalene nerve block was confirmed. Intravenous prophylactic antibiotics were administered prior to skin incision.
The patient was positioned in the **beach-chair position** with the head and neck maintained in neutral alignment. All bony prominences were carefully padded. The right upper extremity was prepared and draped in the usual sterile orthopedic fashion. A final surgical timeout confirmed patient identity, operative site, planned procedure, and availability of implants.
The shoulder joint was insufflated with approximately 30 mL of normal saline through the posterior portal. A standard posterior viewing portal was established, and the arthroscope was introduced into the glenohumeral joint.
A systematic diagnostic arthroscopy was performed.
The articular surfaces of the humeral head and glenoid demonstrated minimal degenerative changes without full-thickness cartilage loss. The anterior, posterior, superior, and inferior labrum were carefully inspected and found to be stable without evidence of detachment or significant tearing.
The long head of the biceps tendon was examined from its origin to the bicipital groove. The tendon appeared intact without subluxation, instability, partial tearing, or significant synovitis.
The superior, middle, and inferior glenohumeral ligaments were intact. The subscapularis tendon insertion was carefully inspected and demonstrated no tearing or degeneration.
Inspection of the superior rotator cuff revealed a full-thickness crescent-shaped tear involving the supraspinatus tendon with mild tendon retraction. The infraspinatus tendon remained intact.The arthroscope was then advanced into the subacromial space. A lateral working portal was established under direct visualization followed by an anterior accessory portal.
Extensive hypertrophic inflamed subacromial bursal tissue was encountered. An arthroscopic shaver and radiofrequency ablation device were utilized to perform an extensive bursectomy until excellent visualization of the rotator cuff and acromion was achieved.
Attention was directed to the undersurface of the acromion where a prominent anterior-inferior acromial spur was identified. Using an arthroscopic burr, an anterior acromioplasty was performed to convert the hooked acromion into a smooth Type I configuration while preserving the coracoacromial ligament. Adequate decompression of the subacromial space was confirmed.
The rotator cuff tear margins were carefully debrided of degenerative tissue using an arthroscopic shaver. Multiple releases were performed with an arthroscopic elevator to mobilize the tendon, allowing an anatomic reduction to the greater tuberosity without excessive tension.The greater tuberosity footprint was meticulously prepared using an arthroscopic burr and curette to remove fibrous tissue and expose healthy bleeding cancellous bone to optimize tendon-to-bone healing.
Attention was then directed toward repair of the rotator cuff.
Two medial-row bio-composite suture anchors were inserted into the prepared greater tuberosity adjacent to the articular margin. Correct anchor placement and fixation strength were confirmed.Using an arthroscopic suture-passing device, each suture limb was sequentially passed through the supraspinatus tendon in a horizontal mattress configuration while maintaining equal tissue distribution. The mattress sutures were securely tied arthroscopically, restoring the medial fixation of the tendon.
The remaining suture limbs were then brought laterally and secured into two knotless lateral-row anchors positioned lateral to the greater tuberosity, creating a transosseous-equivalent double-row suture bridge construct. Excellent compression of the tendon across the prepared footprint was achieved with restoration of the normal tendon footprint.
The repair was carefully inspected from multiple viewing portals. Gentle passive forward elevation, abduction, and external rotation demonstrated excellent repair stability without gapping or undue tension.
The subacromial space was irrigated thoroughly. Hemostasis was achieved using radiofrequency coagulation. No loose bodies or residual debris remained within the joint.
All arthroscopic instruments were removed. Portal sites were closed using interrupted 3-0 nylon sutures. Sterile Xeroform dressing, gauze, and Tegaderm were applied. The arm was placed into a padded shoulder immobilizer with an abduction pillow.
The patient tolerated the procedure well without complications, was awakened from anesthesia, extubated in the operating room, and transferred to the post-anesthesia care unit in stable condition.
Findings
* Full-thickness crescent-shaped supraspinatus tendon tear measuring approximately 2.5 cm.
* Mild tendon retraction with excellent mobility after release.
* Hypertrophic subacromial bursitis.
* Type II acromion with prominent anterior acromial spur.
* Intact infraspinatus tendon.
* Intact subscapularis tendon.
* Intact long head of the biceps tendon.
* Stable superior, anterior, and posterior labrum.
* Minimal glenohumeral chondral degeneration.
* Successful anatomic double-row rotator cuff repair with excellent fixation.
Implants
* Two medial-row bio-composite suture anchors.
* Two lateral-row knotless bio-composite suture anchors.
Check your answer
CPT
29827-RT
29826-RT
Operative report 2
Preoperative Diagnosis
Right shoulder symptomatic partial tear of the long head of the biceps tendon.
Biceps tendinopathy.
Chronic right shoulder pain.
Subacromial impingement syndrome.
Postoperative Diagnosis
Right shoulder high-grade partial tear of the long head of the biceps tendon involving greater than 50% of the tendon.
Severe biceps tendinopathy with tenosynovitis.
Degenerative superior labral fraying.
Subacromial bursitis.
Subacromial impingement syndrome.
Procedure performed
Diagnostic arthroscopy of the right shoulder.
Arthroscopic extensive debridement of the glenohumeral joint.
Arthroscopic biceps tenotomy.
Arthroscopic suprapectoral biceps tenodesis utilizing interference screw fixation.
Arthroscopic extensive subacromial bursectomy.
Arthroscopic subacromial decompression with acromioplasty.
Indication
The patient is a 57-year-old male with a long-standing history of progressively worsening anterior right shoulder pain associated with lifting, overhead activity, weakness, painful clicking, and night pain. Conservative treatment including oral anti-inflammatory medications, activity modification, supervised physical therapy, corticosteroid injection, and home exercise program failed to provide lasting symptomatic improvement over more than six months. MRI demonstrated severe long head of the biceps tendinopathy with a high-grade partial tear, associated superior labral degeneration, and subacromial impingement. Due to persistent symptoms affecting activities of daily living and failure of nonoperative treatment, arthroscopic biceps tenodesis was recommended. Risks, benefits, alternatives, and expected postoperative rehabilitation were discussed in detail, and informed consent was obtained.
Decription of the procedure
The patient was brought to the operating room and placed supine on the operating table. Following successful induction of general endotracheal anesthesia, an ultrasound-guided interscalene regional block was confirmed for postoperative analgesia. Intravenous prophylactic antibiotics were administered prior to incision.
The patient was carefully positioned in the beach-chair position with the head and cervical spine maintained in neutral alignment. All pressure points were adequately padded. The right upper extremity was sterilely prepared and draped in the standard orthopedic fashion. A formal surgical timeout was performed confirming patient identity, operative extremity, planned procedure, and implant availability.
Approximately 30 mL of normal saline was injected into the glenohumeral joint to facilitate portal placement. A standard posterior viewing portal was established, and the arthroscope was introduced into the glenohumeral joint. An anterior working portal was created under spinal needle localization.
A systematic diagnostic arthroscopy was performed.
Inspection of the glenohumeral joint demonstrated minimal degenerative cartilage wear without exposed subchondral bone. The humeral head and glenoid articular surfaces were otherwise well preserved.
The superior, anterior, posterior, and inferior labrum were carefully inspected. Degenerative fraying of the superior labrum adjacent to the biceps anchor was identified without significant instability.
The long head of the biceps tendon demonstrated marked synovitis, longitudinal splitting, tendon hypertrophy, and a high-grade partial-thickness tear involving greater than 50% of the tendon substance. Dynamic probing demonstrated significant instability and pain reproduction. The remaining tendon quality was poor, making primary preservation unsuitable.
The rotator cuff was systematically inspected. The supraspinatus, infraspinatus, teres minor, and subscapularis tendons were intact without evidence of full-thickness tearing.
Using an arthroscopic radiofrequency ablation device, the long head of the biceps tendon was released from its superior labral origin, completing an arthroscopic biceps tenotomy. The remaining superior labral fraying was carefully debrided using an arthroscopic shaver until a stable labral margin was obtained.
Attention was then directed to the bicipital groove. The transverse humeral ligament was released, allowing mobilization of the tendon distally. The inflamed synovial tissue surrounding the tendon within the groove was thoroughly debrided.
A high anterolateral portal was established under direct visualization to facilitate the tenodesis. The bicipital groove was exposed using electrocautery and soft tissue elevators. Remaining inflammatory tissue was removed to clearly identify healthy cortical bone.
The tendon was retrieved into the subacromial space using an arthroscopic grasper. Degenerated proximal tendon tissue was excised while preserving healthy tendon for fixation.
A guide pin was placed into the suprapectoral region of the bicipital groove at the appropriate location while maintaining the physiologic length-tension relationship of the biceps tendon. The guide pin position was confirmed arthroscopically.
A cannulated reamer was advanced over the guide pin to create an appropriately sized socket within the proximal humerus. The socket was irrigated thoroughly to remove bone debris.
The prepared tendon was inserted into the humeral socket under direct arthroscopic visualization. An appropriately sized bio-composite interference screw was inserted, securing the tendon firmly within the socket. Excellent fixation was obtained. The construct was tested through passive elbow flexion, extension, forearm rotation, and gentle shoulder motion, demonstrating stable fixation without tendon slippage.
The arthroscope was redirected into the subacromial space. Extensive hypertrophic inflamed bursal tissue was encountered. An arthroscopic shaver and radiofrequency ablation device were utilized to perform a complete bursectomy, significantly improving visualization.
Inspection of the undersurface of the acromion demonstrated a prominent anterior-inferior acromial spur. Arthroscopic acromioplasty was performed using a motorized burr, converting the hooked acromion into a smooth Type I morphology while preserving the coracoacromial ligament. Adequate subacromial decompression was confirmed.
The entire shoulder was irrigated thoroughly. Final arthroscopic inspection confirmed stable biceps fixation, complete decompression, and excellent hemostasis. No loose bodies or residual debris remained within the joint.
All arthroscopic instruments were removed. Portal sites were closed using interrupted 3-0 nylon sutures. Sterile Xeroform, gauze dressings, and a transparent occlusive dressing were applied. The arm was placed into a padded shoulder immobilizer.
The patient tolerated the procedure well without complications, was awakened from anesthesia, extubated uneventfully, and transferred to the post-anesthesia care unit in stable condition.
Findings
High-grade partial tear (>50%) of the long head of the biceps tendon.
Severe biceps tendinopathy with longitudinal splitting.
Marked biceps tenosynovitis.
Degenerative superior labral fraying.
Intact supraspinatus tendon.
Intact infraspinatus tendon.
Intact subscapularis tendon.
Mild glenohumeral chondral degeneration.
Hypertrophic subacromial bursitis.
Type II acromion with anterior-inferior acromial spur.
Stable suprapectoral biceps tenodesis with excellent fixation following interference screw placement.
Findings
One bio-composite interference screw for suprapectoral biceps tenodesis.
Check your answer
CPT -
29828-RT
29826-RT
Operative report 3
Preoperative Diagnosis
1. Right shoulder chronic proliferative synovitis.
2. Persistent right shoulder pain.
3. Chronic shoulder stiffness refractory to conservative management.
Postoperative Diagnosis
1. Extensive proliferative synovitis involving the glenohumeral joint.
2. Diffuse hypertrophic synovitis of the rotator interval, anterior and posterior capsule, axillary recess, and subscapular recess.
3. Mild degenerative chondral changes of the glenohumeral joint.
4. Intact rotator cuff and biceps tendon.
Procedure performed
1. Diagnostic arthroscopy of the right shoulder.
2. Arthroscopic complete synovectomy of the glenohumeral joint.
3. Arthroscopic debridement of inflamed synovial tissue.
Indication
The patient is a 58-year-old male with a prolonged history of right shoulder pain, swelling, stiffness, and progressive loss of shoulder function despite extensive conservative treatment including oral anti-inflammatory medications, corticosteroid injections, supervised physical therapy, and activity modification for more than six months. MRI demonstrated diffuse synovial proliferation consistent with chronic inflammatory synovitis. Because of persistent pain, recurrent joint inflammation, and functional limitation despite nonoperative management, arthroscopic complete synovectomy was recommended. The risks, benefits, alternatives, expected outcomes, and postoperative rehabilitation were discussed in detail with the patient, and informed consent was obtained.
Description of the procedure
The patient was brought to the operative room and placed supine on the operating table. Following induction of satisfactory general anesthesia, an ultrasound-guided interscalene nerve block was confirmed. Intravenous prophylactic antibiotics were administered prior to skin incision.
The patient was positioned in the beach-chair position with the head and neck maintained in neutral alignment. All bony prominences were carefully padded. The right upper extremity was prepared and draped in the usual sterile orthopedic fashion. A final surgical timeout was performed confirming the patient's identity, operative extremity, planned procedure, and availability of all required arthroscopic equipment.
Approximately 30 mL of sterile normal saline was injected into the glenohumeral joint to facilitate arthroscopic portal placement. A standard posterior viewing portal was established, and the arthroscope was introduced into the glenohumeral joint. Under direct visualization, standard anterior and anterosuperior working portals were established using spinal needle localization.
A systematic diagnostic arthroscopy of the glenohumeral joint was performed. Inspection of the humeral head and glenoid demonstrated mild diffuse chondral softening without full-thickness cartilage defects. The articular surfaces were otherwise well maintained.
The superior, anterior, posterior, and inferior labrum were carefully inspected and found to be stable without significant tearing or detachment. The long head of the biceps tendon was examined from its origin to the bicipital groove and demonstrated no evidence of instability or tearing. The subscapularis, supraspinatus, infraspinatus, and teres minor tendons were carefully inspected and found to be intact.
Extensive hypertrophic inflamed synovium was identified throughout the glenohumeral joint involving the rotator interval, anterior capsule, posterior capsule, superior recess, inferior capsule, axillary recess, and subscapular recess. The synovium appeared markedly hyperemic, thickened, and villous in appearance, consistent with chronic proliferative synovitis.
Attention was directed toward performing a arthroscopic synovectomy. Using an arthroscopic motorized shaver in conjunction with a radiofrequency ablation device, the inflamed synovium was systematically excised from the rotator interval and superior capsule. Care was taken to preserve the surrounding capsulolabral structures while removing all diseased synovial tissue.
The anterior capsule was then completely debrided of hypertrophic synovium from the superior glenoid to the inferior glenohumeral ligament. The arthroscope was redirected posteriorly, and a complete posterior synovectomy was performed by excising all inflamed synovium from the posterior capsule and posterior recess.
Attention was then directed to the inferior glenohumeral pouch and axillary recess. Through alternating viewing and working portals, extensive synovial proliferation was carefully removed using the motorized shaver and radiofrequency device until healthy capsular tissue was encountered. Complete visualization confirmed adequate removal of diseased synovium throughout the inferior recess.
The subscapular recess was entered and thoroughly debrided of all hypertrophic synovial tissue. Remaining inflamed synovium surrounding the biceps origin and superior recess was excised while preserving the integrity of the biceps anchor and surrounding stabilizing structures.
The arthroscope was sequentially advanced into each compartment of the glenohumeral joint to ensure that no residual hypertrophic synovium remained. Multiple viewing angles confirmed complete circumferential synovectomy involving the anterior, posterior, superior, and inferior compartments.
The joint was copiously irrigated with sterile normal saline to remove all synovial debris and inflammatory tissue. Meticulous hemostasis was achieved using the radiofrequency ablation device. Final arthroscopic inspection demonstrated complete removal of proliferative synovium with preservation of the articular cartilage, labrum, biceps tendon, and rotator cuff structures.
All arthroscopic instruments were removed. Portal sites were closed with interrupted 3-0 nylon sutures. Sterile Xeroform dressing, sterile gauze, and transparent occlusive dressings were applied. The extremity was placed in a simple shoulder sling for comfort.
The patient tolerated the procedure well without complications, was awakened from anesthesia, extubated uneventfully, and transferred to the post-anesthesia care unit in stable condition.
Findings
* Extensive hypertrophic proliferative synovitis throughout the glenohumeral joint.
* Diffuse synovitis involving the rotator interval, anterior capsule, posterior capsule, superior recess, inferior capsule, axillary recess, and subscapular recess.
* Hyperemic villous inflammatory synovium.
* Mild grade I-II chondral degeneration of the humeral head and glenoid.
* Intact superior, anterior, posterior, and inferior labrum.
* Intact long head of the biceps tendon.
* Intact supraspinatus, infraspinatus, teres minor, and subscapularis tendons.
* Complete arthroscopic synovectomy successfully performed with preservation of all major intra-articular structures.
Implants : None.
Check your answer
CPT -
29821-RT
Operative report 4
Preoperative Diagnosis
1. Left shoulder degenerative glenohumeral osteoarthritis.
2. Chondral defects involving the humeral head and glenoid.
3. Symptomatic left biceps tendinopathy with partial tearing.
4. Chronic left shoulder pain.
Postoperative Diagnosis
1. Grade III-IV chondral degeneration of the humeral head.
2. Grade III chondral degeneration of the glenoid.
3. Marginal osteophytes and irregular bony prominences of the humeral head and glenoid.
4. High-grade partial tear of the long head of the biceps tendon with severe tendinopathy.
5. Degenerative superior labral fraying.
6. Diffuse synovitis of the glenohumeral joint.
Procedure performed
1. Diagnostic arthroscopy of the left shoulder.
2. Arthroscopic debridement of the humeral head bone.
3. Arthroscopic chondroplasty and debridement of the humeral head cartilage.
4. Arthroscopic debridement of the glenoid bone.
5. Arthroscopic chondroplasty and debridement of the glenoid cartilage.
6. Arthroscopic extensive glenohumeral debridement.
7. Arthroscopic biceps tenotomy.
8. Arthroscopic suprapectoral biceps tenodesis utilizing interference screw fixation.
Indication
The patient is a 59-year-old male with a long-standing history of progressively worsening left shoulder pain associated with painful range of motion, mechanical catching, weakness, and limitation of daily activities. The patient had failed extensive conservative treatment including activity modification, oral anti-inflammatory medications, corticosteroid injections, and supervised physical therapy over several months. MRI demonstrated advanced chondral degeneration of the glenohumeral joint with irregular articular surfaces and significant pathology of the long head of the biceps tendon. Because of persistent pain and functional limitation despite appropriate conservative management, arthroscopic debridement of the glenohumeral joint with biceps tenodesis was recommended. The risks, benefits, alternatives, and expected postoperative rehabilitation were discussed in detail with the patient, and informed consent was obtained.
Description of the procedure
The patient was brought to the operative room and placed supine on the operating table. Following induction of satisfactory general anesthesia, an ultrasound-guiduided interscalene nerve block was confirmed. Intravenous prophylactic antibiotics were administered prior to skin incision.
The patient was positioned in the beach-chair position with the head and neck maintained in neutral alignment. All bony prominences were carefully padded. The left upper extremity was prepared and draped in the usual sterile orthopedic fashion. A final surgical timeout was performed confirming the patient's identity, operative extremity, planned procedure, and availability of all required arthroscopic equipment.
Approximately 30 mL of sterile normal saline was injected into the glenohumeral joint to facilitate portal placement. A standard posterior viewing portal was established, and the arthroscope was introduced into the glenohumeral joint. An anterior working portal was established under spinal needle localization.
A systematic diagnostic arthroscopy was performed.
Inspection of the glenohumeral joint demonstrated diffuse synovitis with advanced degenerative changes involving both the humeral head and glenoid articular surfaces. Multiple unstable cartilage flaps, fibrillated cartilage, exposed subchondral bone, and loose chondral fragments were identified throughout the joint.
The superior labrum demonstrated degenerative fraying without significant detachment. The anterior and posterior labrum remained stable. The long head of the biceps tendon demonstrated severe tendinosis with longitudinal splitting, synovitis, and a high-grade partial-thickness tear involving greater than 50% of the tendon substance. Dynamic probing confirmed significant degeneration of the tendon, making preservation unsuitable.
Attention was first directed to the humeral head. Extensive unstable articular cartilage was debrided using an arthroscopic shaver until stable cartilage margins were obtained. A motorized burr was then utilized to remove irregular bony prominences and marginal osteophytes from the humeral head. Loose osteochondral fragments were completely removed, and the articular surface was contoured to a smooth and stable margin while preserving as much healthy cartilage as possible.
Attention was then directed to the glenoid. Extensive unstable glenoid cartilage was debrided using an arthroscopic shaver and curette. Chondroplasty was performed circumferentially until all unstable cartilage flaps had been removed and stable cartilage margins were achieved. Arthroscopic burrs were then utilized to debride irregular glenoid osteophytes and exposed subchondral bone, creating a smooth congruent glenoid surface. The glenohumeral joint was repeatedly irrigated to remove all cartilaginous and osseous debris.
Additional inflamed synovium and degenerative soft tissue throughout the glenohumeral joint were removed using a combination of an arthroscopic shaver and radiofrequency ablation device. Complete debridement of loose tissue and unstable degenerative material was performed until healthy tissue remained throughout the joint.
Attention was then directed toward the long head of the biceps tendon. Using an arthroscopic radiofrequency ablation device, the tendon was released from its attachment at the superior labrum, completing an arthroscopic biceps tenotomy. The remaining superior labral fraying was carefully debrided to a stable margin.
The transverse humeral ligament was released, exposing the bicipital groove. Inflamed synovium surrounding the tendon was completely excised. The tendon was mobilized distally and retrieved through the anterior portal. Degenerated proximal tendon tissue was excised while preserving healthy tendon for fixation.
The bicipital groove was prepared by removing remaining soft tissue and exposing healthy cortical bone. A guide pin was inserted into the suprapectoral region of the proximal humerus while maintaining the normal physiologic length-tension relationship of the biceps tendon. A cannulated reamer was advanced over the guide pin to prepare the humeral socket.
The prepared tendon was secured within the humeral socket using an appropriately sized bio-composite interference screw. Excellent fixation was obtained. The repair construct was tested through passive shoulder motion as well as elbow flexion, extension, and forearm rotation and remained stable without evidence of loosening or tendon slippage.
Final arthroscopic inspection demonstrated stable debridement of the humeral head and glenoid, removal of all unstable cartilage and bony prominences, excellent contouring of the articular surfaces, stable biceps tenodesis fixation, and no remaining loose bodies within the joint.The glenohumeral joint was copiously irrigated with sterile normal saline. Meticulous hemostasis was achieved using the radiofrequency device.
All arthroscopic instruments were removed. Portal sites were closed using interrupted 3-0 nylon sutures. Sterile Xeroform dressing, sterile gauze, and transparent occlusive dressings were applied. The left upper extremity was placed into a padded shoulder immobilizer.
The patient tolerated the procedure well without complications, was awakened from anesthesia, extubated uneventfully, and transferred to the post-anesthesia care unit in stable condition.
Findings
* Grade III-IV chondral degeneration of the humeral head.
* Grade III chondral degeneration of the glenoid.
* Extensive unstable articular cartilage flaps involving the humeral head and glenoid.
* Marginal osteophytes of the humeral head and glenoid.
* Multiple loose osteochondral fragments.
* High-grade partial tear of the long head of the biceps tendon with severe tendinopathy.
* Degenerative superior labral fraying.
* Diffuse hypertrophic glenohumeral synovitis.
* Intact subscapularis tendon.
* Intact supraspinatus tendon.
* Intact infraspinatus tendon.
* Stable arthroscopic suprapectoral biceps tenodesis with excellent fixation.
Implants
* One bio-composite interference screw for suprapectoral biceps tenodesis.
Operative report 5
Preoperative Diagnosis
Left shoulder full-thickness supraspinatus rotator cuff tear.
Symptomatic biceps tendinopathy.
Chronic subacromial bursitis.
Glenohumeral osteoarthritis with glenoid osteophytes.
Chronic left shoulder pain.
Postoperative Diagnosis
Full-thickness supraspinatus tendon tear measuring approximately 2.8 cm.
Partial-thickness degeneration of the long head of the biceps tendon with tenosynovitis.
Degenerative fraying of the rotator cuff tendon margins.
Glenoid marginal osteophytes with degenerative bony irregularity.
Hypertrophic subacromial bursitis.
Mild degenerative superior labral fraying.
Procedure performed
Diagnostic arthroscopy of the left shoulder.
Arthroscopic debridement of the long head of the biceps tendon.
Arthroscopic debridement of the rotator cuff tendon.
Arthroscopic debridement of the glenoid bone.
Arthroscopic extensive subacromial bursectomy.
Arthroscopic rotator cuff repair utilizing a double-row suture bridge fixation technique.
Indication
The patient is a 58-year-old male with a long-standing history of progressively worsening left shoulder pain associated with weakness, painful overhead activity, night pain, and limitation of activities of daily living. The patient failed an extensive course of conservative treatment including activity modification, oral anti-inflammatory medications, supervised physical therapy, corticosteroid injections, and home exercise program for more than six months. MRI demonstrated a full-thickness supraspinatus tendon tear with associated biceps tendinopathy, chronic subacromial bursitis, and degenerative glenoid changes. Due to persistent pain and functional impairment despite conservative management, arthroscopic debridement and rotator cuff repair were recommended. Risks, benefits, alternatives, and expected postoperative rehabilitation were discussed in detail with the patient, and informed consent was obtained.
Description of the procedure
The patient was brought to the operative room and placed supine on the operating table. Following induction of satisfactory general anesthesia, an ultrasound-guided interscalene nerve block was confirmed. Intravenous prophylactic antibiotics were administered prior to skin incision.
The patient was positioned in the beach-chair position with the head and neck maintained in neutral alignment. All bony prominences were carefully padded. The left upper extremity was prepared and draped in the usual sterile orthopedic fashion. A final surgical timeout was performed confirming the patient's identity, operative extremity, planned procedure, and availability of all required arthroscopic equipment.
Approximately 30 mL of sterile normal saline was injected into the glenohumeral joint to facilitate portal placement. A standard posterior viewing portal was established, and the arthroscope was introduced into the glenohumeral joint. Under direct visualization, standard anterior and lateral working portals were established.
A systematic diagnostic arthroscopy was performed.
Inspection of the glenohumeral joint demonstrated mild degenerative chondral changes without full-thickness cartilage loss. The superior labrum demonstrated mild degenerative fraying while the remaining labrum was stable without detachment.
The long head of the biceps tendon demonstrated moderate tendinosis with synovitis and superficial longitudinal fraying. Using an arthroscopic shaver and radiofrequency ablation device, the degenerative tendon fibers and inflamed synovium were carefully debrided until healthy stable tendon remained. The remaining biceps tendon was stable within the bicipital groove.
Inspection of the rotator cuff demonstrated a full-thickness crescent-shaped tear involving the supraspinatus tendon with frayed degenerative tendon margins. The torn tendon edges were debrided using an arthroscopic shaver to remove nonviable tissue while preserving healthy tendon suitable for repair. The remaining supraspinatus tendon was mobilized using an arthroscopic elevator until a tension-free reduction to the greater tuberosity was achieved.
Attention was directed to the glenoid where marginal osteophytes and irregular degenerative bone along the anterior and superior glenoid rim were identified. A motorized arthroscopic burr was utilized to carefully debride the prominent bony irregularities and contour the glenoid rim while preserving the articular surface. Loose osteochondral debris was removed from the joint.
The arthroscope was then advanced into the subacromial space. Extensive hypertrophic inflamed bursal tissue was encountered throughout the subacromial space, significantly limiting visualization. A complete subacromial bursectomy was performed using an arthroscopic shaver and radiofrequency ablation device until excellent visualization of the rotator cuff and greater tuberosity was obtained.
The greater tuberosity footprint was prepared using an arthroscopic burr to remove residual soft tissue and expose healthy bleeding cancellous bone to optimize tendon-to-bone healing.
Attention was then directed toward repair of the rotator cuff. Two medial-row bio-composite suture anchors were inserted into the prepared greater tuberosity adjacent to the articular margin. Anchor fixation was confirmed to be secure.
Using an arthroscopic suture-passing device, the sutures were sequentially passed through the supraspinatus tendon in a horizontal mattress configuration. The sutures were securely tied arthroscopically, restoring the medial fixation of the tendon.
The remaining suture limbs were then secured laterally into two knotless lateral-row anchors positioned distal to the greater tuberosity, creating a transosseous-equivalent double-row suture bridge construct. Excellent compression of the tendon onto the prepared footprint was achieved with complete restoration of the anatomic insertion.
The repair was carefully inspected from multiple viewing portals. Passive forward elevation, external rotation, and abduction demonstrated excellent stability of the repair without gap formation or excessive tension.
The shoulder joint and subacromial space were copiously irrigated with sterile normal saline. Meticulous hemostasis was achieved using the radiofrequency ablation device. Final arthroscopic inspection demonstrated complete debridement of the biceps tendon, rotator cuff tendon, glenoid bone, and subacromial bursa with a stable anatomic rotator cuff repair.
All arthroscopic instruments were removed. Portal sites were closed using interrupted 3-0 nylon sutures. Sterile Xeroform dressing, sterile gauze, and transparent occlusive dressings were applied. The left upper extremity was placed into a padded shoulder immobilizer with an abduction pillow.
The patient tolerated the procedure well without complications, was awakened from anesthesia, extubated uneventfully, and transferred to the post-anesthesia care unit in stable condition.
Findings
Full-thickness supraspinatus tendon tear measuring approximately 2.8 cm.
Degenerative fraying of the rotator cuff tendon margins.
Moderate biceps tendinosis with superficial longitudinal fraying.
Glenoid marginal osteophytes with irregular degenerative bone.
Mild degenerative superior labral fraying.
Extensive hypertrophic subacromial bursitis.
Mild glenohumeral chondral degeneration.
Intact subscapularis tendon.
Intact infraspinatus tendon.
Successful anatomic double-row rotator cuff repair with excellent fixation.
Implants
Two medial-row bio-composite suture anchors.
Two lateral-row knotless bio-composite suture anchors.
Operative report 6
Preoperative Diagnosis
1. Right shoulder superior labral tear with degenerative labral fraying.
2. Symptomatic biceps anchor complex degeneration.
3. Partial-thickness bursal-sided supraspinatus rotator cuff tear.
4. Acromioclavicular joint osteoarthritis.
5. Chronic right shoulder pain.
Postoperative Diagnosis
1. Degenerative superior labral tear with extensive anterior and superior labral fraying.
2. Degeneration of the biceps anchor complex without complete detachment.
3. Partial-thickness bursal-sided supraspinatus tendon tear involving approximately 30% of tendon thickness.
4. Advanced acromioclavicular joint osteoarthritis with inferior osteophyte formation.
5. Chronic subacromial bursitis.
6. Mild glenohumeral synovitis.
Procedure performed
1. Diagnostic arthroscopy of the right shoulder.
2. Arthroscopic debridement of the superior labrum.
3. Arthroscopic debridement of the biceps anchor complex.
4. Arthroscopic debridement of the bursal side of the rotator cuff.
5. Arthroscopic distal clavicle excision (Mumford procedure).
6. Arthroscopic extensive subacromial bursectomy.
Indication
The patient is a 56-year-old male with a prolonged history of right shoulder pain localized over the superior and anterior aspect of the shoulder associated with painful overhead activity, weakness, and tenderness over the acromioclavicular joint. The patient had failed extensive conservative treatment including activity modification, oral anti-inflammatory medications, corticosteroid injections, and supervised physical therapy for more than six months. MRI demonstrated degenerative superior labral pathology, partial bursal-sided rotator cuff tearing, degeneration of the biceps anchor complex, and advanced acromioclavicular joint osteoarthritis. Due to persistent symptoms and functional limitation despite conservative management, arthroscopic debridement and distal clavicle excision were recommended. Risks, benefits, alternatives, and expected postoperative rehabilitation were discussed in detail with the patient, and informed consent was obtained.
Description of the procedure
The patient was brought to the operative room and placed supine on the operating table. Following induction of satisfactory general anesthesia, an ultrasound-guided interscalene nerve block was confirmed. Intravenous prophylactic antibiotics were administered prior to skin incision.
The patient was positioned in the beach-chair position with the head and neck maintained in neutral alignment. All bony prominences were carefully padded. The right upper extremity was prepared and draped in the usual sterile orthopedic fashion. A final surgical timeout was performed confirming the patient's identity, operative extremity, planned procedure, and availability of all required arthroscopic equipment.
Approximately 30 mL of sterile normal saline was injected into the glenohumeral joint to facilitate portal placement. A standard posterior viewing portal was established, and the arthroscope was introduced into the glenohumeral joint. An anterior working portal was established under spinal needle localization.
A systematic diagnostic arthroscopy was performed.
Inspection of the humeral head and glenoid demonstrated mild diffuse chondral wear without full-thickness cartilage defects. The anterior and posterior labrum were stable. The superior labrum demonstrated extensive degenerative fraying extending adjacent to the biceps anchor. The biceps anchor complex was carefully probed and found to be stable without complete detachment; however, significant degenerative tissue and synovitis were present.
Using an arthroscopic motorized shaver and radiofrequency ablation device, the unstable superior labral tissue was carefully debrided until stable labral margins were obtained. The degenerative tissue surrounding the biceps anchor complex was then meticulously debrided while preserving the integrity and stability of the biceps attachment. Inflamed synovial tissue within the superior recess was also excised.
The subscapularis tendon, infraspinatus tendon, and long head of the biceps tendon were inspected and found to be intact without significant tearing.
The arthroscope was then advanced into the subacromial space through the posterior portal. A lateral working portal was established under direct visualization. Extensive hypertrophic inflamed subacromial bursal tissue was encountered, limiting visualization. An extensive bursectomy was performed utilizing an arthroscopic shaver and radiofrequency ablation device until excellent visualization of the rotator cuff and acromioclavicular joint was achieved.
Inspection of the rotator cuff demonstrated a partial-thickness bursal-sided tear of the supraspinatus tendon with degenerative frayed tendon fibers. The unstable tendon edges and devitalized tissue were carefully debrided using an arthroscopic shaver until healthy stable tendon margins were obtained. The remaining rotator cuff demonstrated satisfactory integrity without evidence of a full-thickness tear.
Attention was then directed to the acromioclavicular joint. Soft tissues overlying the distal clavicle were elevated using a radiofrequency ablation device to expose the distal clavicle and medial acromion. Significant degenerative arthritic changes with inferior osteophyte formation and joint narrowing were identified.
An arthroscopic burr was introduced through the anterior portal, and arthroscopic distal clavicle excision was performed. Approximately 8 to 10 mm of the distal clavicle was resected while carefully preserving the superior and posterior acromioclavicular ligaments. The resection was carried circumferentially until an adequate decompression of the acromioclavicular joint was achieved. The resection site was inspected from multiple viewing portals confirming complete removal of the distal clavicle with preservation of joint stability and a satisfactory decompression.
The shoulder was thoroughly irrigated with sterile normal saline. Meticulous hemostasis was achieved using the radiofrequency device. Final arthroscopic inspection confirmed complete debridement of the superior labrum, biceps anchor complex, and bursal-sided rotator cuff with successful arthroscopic distal clavicle excision. No loose bodies or residual debris remained within the joint or subacromial space.
All arthroscopic instruments were removed. Portal sites were closed using interrupted 3-0 nylon sutures. Sterile Xeroform dressing, sterile gauze, and transparent occlusive dressings were applied. The right upper extremity was placed into a padded shoulder sling.
The patient tolerated the procedure well without complications, was awakened from anesthesia, extubated uneventfully, and transferred to the post-anesthesia care unit in stable condition.
Findings
* Degenerative superior labral tear with unstable frayed tissue.
* Degenerative biceps anchor complex with synovitis.
* Partial-thickness bursal-sided supraspinatus tendon tear involving approximately 30% of tendon thickness.
* Extensive hypertrophic subacromial bursitis.
* Advanced acromioclavicular joint osteoarthritis with inferior osteophytes.
* Mild glenohumeral synovitis.
* Intact long head of the biceps tendon.
* Intact subscapularis tendon.
* Intact infraspinatus tendon.
* Successful arthroscopic distal clavicle excision with adequate preservation of acromioclavicular joint stability.
Implants
* None.
Operative report 7
Preoperative Diagnosis
Left shoulder Type II SLAP tear.
Partial-thickness rotator cuff tear.
Glenohumeral osteoarthritis with degenerative humeral head and glenoid changes.
Chronic left shoulder pain.
Postoperative Diagnosis
Type II superior labrum anterior-to-posterior (SLAP) tear.
Grade III chondral degeneration of the humeral head.
Grade III chondral degeneration of the glenoid.
Partial-thickness articular-sided supraspinatus tendon tear with degenerative fraying.
Mild glenohumeral synovitis.
Procedure performed
Diagnostic arthroscopy of the left shoulder.
Arthroscopic SLAP repair.
Arthroscopic debridement of the humeral head bone.
Arthroscopic debridement of the glenoid bone.
Arthroscopic debridement of the rotator cuff.
Arthroscopic extensive glenohumeral debridement.
Indication
The patient is a 55-year-old male with a prolonged history of left shoulder pain associated with painful overhead activity, mechanical catching, weakness, and limitation of activities of daily living. The patient had failed extensive conservative treatment including activity modification, oral anti-inflammatory medications, corticosteroid injections, supervised physical therapy, and home exercise program over more than six months. MRI demonstrated a Type II SLAP lesion with associated degenerative changes of the glenohumeral joint and a partial-thickness rotator cuff tear. Due to persistent pain and functional limitation despite conservative management, arthroscopic SLAP repair with debridement of the degenerative intra-articular pathology was recommended. The risks, benefits, alternatives, expected outcomes, and postoperative rehabilitation were discussed in detail with the patient, and informed consent was obtained.
Description of the procedure
The patient was brought to the operative room and placed supine on the operating table. Following induction of satisfactory general anesthesia, an ultrasound-guided interscalene nerve block was confirmed. Intravenous prophylactic antibiotics were administered prior to skin incision.
The patient was positioned in the beach-chair position with the head and neck maintained in neutral alignment. All bony prominences were carefully padded. The left upper extremity was prepared and draped in the usual sterile orthopedic fashion. A final surgical timeout was performed confirming the patient's identity, operative extremity, planned procedure, and availability of all required arthroscopic equipment.
Approximately 30 mL of sterile normal saline was injected into the glenohumeral joint to facilitate portal placement. A standard posterior viewing portal was established, and the arthroscope was introduced into the glenohumeral joint. Standard anterior and anterosuperior working portals were established under direct visualization.
A systematic diagnostic arthroscopy was performed.
Inspection of the humeral head demonstrated Grade III chondral degeneration with unstable cartilage margins and marginal osteophytes. The glenoid demonstrated corresponding Grade III chondral degeneration with irregular bony prominences and unstable chondral flaps. The superior labrum was detached from the superior glenoid consistent with a Type II SLAP lesion. The anterior and posterior labrum remained stable. The long head of the biceps tendon was intact and firmly attached to the detached superior labrum. The subscapularis tendon and infraspinatus tendon were intact.
Attention was first directed toward the humeral head. Using an arthroscopic shaver and motorized burr, unstable cartilage, loose osteochondral fragments, and irregular bony prominences were carefully debrided until smooth stable margins were obtained. Loose debris was removed from the joint.
Attention was then directed toward the glenoid. Arthroscopic shaver, curettes, and a motorized burr were utilized to remove unstable cartilage flaps, marginal osteophytes, and irregular glenoid bone while preserving the remaining healthy articular surface. The glenoid was contoured to create a stable and congruent articular surface.
Inspection of the rotator cuff demonstrated a partial-thickness articular-sided supraspinatus tear with degenerative fraying. Using an arthroscopic shaver and radiofrequency ablation device, the frayed tendon fibers and unstable degenerative tissue were carefully debrided until healthy tendon margins were obtained while preserving the intact tendon substance.
Attention was then directed toward the superior labrum. The superior glenoid rim was prepared using an arthroscopic shaver and burr to remove residual soft tissue and create a healthy bleeding bony surface for healing. The detached superior labrum was mobilized using an arthroscopic elevator until an anatomic reduction could be achieved without excessive tension.
A drill guide was positioned on the superior glenoid rim, and two bio-composite suture anchors were inserted at the 11 o'clock and 1 o'clock positions. Proper anchor fixation was confirmed. Sutures were passed through the superior labrum using an arthroscopic suture-passing device while carefully avoiding injury to the biceps tendon. Arthroscopic sliding knots with alternating half-hitches were tied, securely reattaching the superior labrum to the glenoid rim. The repair restored the normal anatomy of the superior labrum and biceps anchor complex.
The repair construct was carefully probed and demonstrated excellent fixation without displacement. Passive shoulder range of motion confirmed maintenance of repair stability without excessive tension.
The glenohumeral joint was thoroughly irrigated with sterile normal saline. Final arthroscopic inspection confirmed stable SLAP repair, satisfactory debridement of the humeral head, glenoid, and rotator cuff, and complete removal of loose cartilage and osseous debris. Meticulous hemostasis was achieved using the radiofrequency ablation device.
All arthroscopic instruments were removed. Portal sites were closed using interrupted 3-0 nylon sutures. Sterile Xeroform dressing, sterile gauze, and transparent occlusive dressings were applied. The left upper extremity was placed into a padded shoulder immobilizer.
The patient tolerated the procedure well without complications, was awakened from anesthesia, extubated uneventfully, and transferred to the post-anesthesia care unit in stable condition.
Findings
Type II SLAP tear with detachment of the superior labrum from the superior glenoid.
Intact long head of the biceps tendon.
Grade III chondral degeneration of the humeral head.
Grade III chondral degeneration of the glenoid.
Marginal osteophytes involving the humeral head and glenoid.
Partial-thickness articular-sided supraspinatus tendon tear with degenerative fraying.
Mild glenohumeral synovitis.
Intact subscapularis tendon.
Intact infraspinatus tendon.
Stable arthroscopic SLAP repair with anatomic restoration of the superior labrum.
Implants
Two bio-composite suture anchors for arthroscopic SLAP repair.
Operative report 8
Preoperative Diagnosis
1. Right shoulder subacromial impingement syndrome.
2. Chronic subacromial bursitis.
3. Chronic right shoulder pain.
Postoperative Diagnosis
1. Right shoulder subacromial impingement syndrome.
2. Extensive hypertrophic subacromial bursitis.
3. Mild rotator cuff tendinosis without full-thickness tear.
4. Intact glenohumeral articular surfaces.
Procedure performed
1. Diagnostic arthroscopy of the right shoulder.
2. Arthroscopic extensive subacromial bursectomy.
3. Arthroscopic subacromial decompression without acromioplasty.
Indication
The patient is a 56-year-old male with a prolonged history of right shoulder pain associated with painful overhead activities, night pain, and functional limitation despite extensive conservative treatment including activity modification, oral anti-inflammatory medications, corticosteroid injections, and supervised physical therapy for greater than six months. Clinical examination and MRI findings were consistent with chronic subacromial impingement syndrome and subacromial bursitis without evidence of a full-thickness rotator cuff tear. Due to persistent symptoms despite appropriate nonoperative management, arthroscopic subacromial decompression was recommended. The risks, benefits, alternatives, expected outcomes, and postoperative rehabilitation were discussed in detail with the patient, and informed consent was obtained.
Description of the procedure
The patient was brought to the operative room and placed supine on the operating table. Following induction of satisfactory general anesthesia, an ultrasound-guided interscalene nerve block was confirmed. Intravenous prophylactic antibiotics were administered prior to skin incision.
The patient was positioned in the beach-chair position with the head and neck maintained in neutral alignment. All bony prominences were carefully padded. The right upper extremity was prepared and draped in the usual sterile orthopedic fashion. A final surgical timeout was performed confirming the patient's identity, operative extremity, planned procedure, and availability of all required arthroscopic equipment.
Approximately 30 mL of sterile normal saline was injected into the glenohumeral joint to facilitate portal placement. A standard posterior viewing portal was established, and the arthroscope was introduced into the glenohumeral joint. An anterior working portal was established under direct visualization.
A systematic diagnostic arthroscopy was performed.
Inspection of the humeral head and glenoid demonstrated well-preserved articular cartilage with only minimal degenerative changes. The superior, anterior, posterior, and inferior labrum were intact without evidence of instability or tearing. The long head of the biceps tendon was intact with no significant tendinosis or instability. The subscapularis, supraspinatus, infraspinatus, and teres minor tendons were carefully inspected from the articular side and demonstrated no evidence of full-thickness tearing. Mild tendinosis of the supraspinatus tendon was noted.
The arthroscope was then advanced into the subacromial space through the posterior portal. A lateral working portal was established under direct visualization.
Extensive hypertrophic inflamed bursal tissue was identified throughout the subacromial space, significantly limiting visualization. An arthroscopic motorized shaver was utilized to perform an extensive bursectomy, removing the inflamed bursal tissue from the anterior, lateral, and posterior aspects of the subacromial space. A radiofrequency ablation device was subsequently used to complete the bursectomy and achieve meticulous hemostasis.
Following complete bursectomy, the undersurface of the acromion and the coracoacromial ligament were carefully inspected. No significant anterior-inferior acromial spur or bony prominence requiring acromioplasty was identified. Therefore, no acromial bone resection was performed.
Attention was directed toward decompression of the subacromial space. Dense inflammatory fibrous tissue beneath the coracoacromial ligament and within the subacromial interval was carefully released and debrided using the radiofrequency ablation device and arthroscopic shaver. Adhesions between the deltoid fascia, subacromial bursa, and rotator cuff were released, restoring adequate subacromial space and allowing unrestricted gliding of the rotator cuff beneath the acromion. Care was taken to preserve the integrity of the coracoacromial ligament and acromial undersurface throughout the procedure.
The bursal surface of the rotator cuff was then thoroughly inspected. Mild bursal-sided fraying of the supraspinatus tendon was present and was gently debrided using the arthroscopic shaver until stable tendon fibers remained. No full-thickness rotator cuff tear was identified, and no repair was indicated.
Final arthroscopic inspection demonstrated an adequately decompressed subacromial space with complete removal of inflamed bursal tissue and fibrous adhesions. The rotator cuff moved freely beneath the acromion without evidence of mechanical impingement. Excellent hemostasis was confirmed throughout the operative field.
The shoulder was copiously irrigated with sterile normal saline. All arthroscopic instruments were removed. Portal sites were closed using interrupted 3-0 nylon sutures. Sterile Xeroform dressing, sterile gauze, and transparent occlusive dressings were applied. The right upper extremity was placed into a shoulder sling for comfort.
The patient tolerated the procedure well without complications, was awakened from anesthesia, extubated uneventfully, and transferred to the post-anesthesia care unit in stable condition.
Findings
* Extensive hypertrophic subacromial bursitis.
* Dense inflammatory fibrous tissue within the subacromial space.
* Mild bursal-sided supraspinatus tendinosis.
* Intact supraspinatus tendon without full-thickness tear.
* Intact infraspinatus tendon.
* Intact subscapularis tendon.
* Intact long head of the biceps tendon.
* Intact glenoid and humeral head articular cartilage with minimal degenerative change.
* No significant acromial spur requiring acromioplasty.
* Successful arthroscopic subacromial decompression achieved without acromial bone resection.
Implants
* None.
Operative report 9
Preoperative Diagnosis
Right shoulder Type II superior labrum anterior-to-posterior (SLAP) lesion.
Chronic right shoulder pain.
Shoulder instability with painful mechanical symptoms.
Postoperative Diagnosis
Right shoulder Type II SLAP lesion with detachment of the superior labrum from the superior glenoid.
Mild degenerative superior labral fraying.
Intact long head of the biceps tendon.
Mild glenohumeral synovitis.
Procedure performed
Diagnostic arthroscopy of the right shoulder.
Arthroscopic Type II SLAP lesion repair.
Arthroscopic debridement of the superior labrum.
Arthroscopic glenohumeral synovectomy.
Indication
The patient is a 42-year-old male with a prolonged history of right shoulder pain associated with painful overhead activity, mechanical catching, intermittent popping, and decreased athletic performance. The patient had failed extensive conservative treatment including activity modification, oral anti-inflammatory medications, supervised physical therapy, corticosteroid injection, and home exercise program for more than six months. Magnetic resonance imaging demonstrated a Type II superior labrum anterior-to-posterior lesion involving the biceps anchor complex. Due to persistent pain, mechanical symptoms, and failure of conservative management, arthroscopic SLAP repair was recommended. The risks, benefits, alternatives, expected outcomes, and postoperative rehabilitation were discussed in detail with the patient, and informed consent was obtained.
Description of the procedure
The patient was brought to the operative room and placed supine on the operating table. Following induction of satisfactory general anesthesia, an ultrasound-guided interscalene nerve block was confirmed. Intravenous prophylactic antibiotics were administered prior to skin incision.
The patient was positioned in the beach-chair position with the head and neck maintained in neutral alignment. All bony prominences were carefully padded. The right upper extremity was prepared and draped in the usual sterile orthopedic fashion. A final surgical timeout was performed confirming the patient's identity, operative extremity, planned procedure, and availability of all required arthroscopic equipment.
Approximately 30 mL of sterile normal saline was injected into the glenohumeral joint to facilitate portal placement. A standard posterior viewing portal was established, and the arthroscope was introduced into the glenohumeral joint. Standard anterior and anterosuperior working portals were established under spinal needle localization.
A systematic diagnostic arthroscopy was performed.
Inspection of the humeral head and glenoid demonstrated well-preserved articular cartilage without significant degenerative changes. The anterior and posterior labrum were intact and stable. Examination of the superior labrum demonstrated a Type II SLAP lesion with detachment of the superior labrum and biceps anchor from the superior glenoid. The detached labrum was mobile upon probing and demonstrated instability consistent with a reparable lesion. Mild degenerative fraying was present along the free edge of the superior labrum.
The long head of the biceps tendon was carefully inspected from its origin to the entrance of the bicipital groove. The tendon demonstrated excellent structural integrity without longitudinal tearing, tendinosis, or instability. The subscapularis, supraspinatus, infraspinatus, and teres minor tendons were carefully inspected and found to be intact.
Attention was first directed toward preparation of the superior glenoid. Using an arthroscopic shaver, unstable frayed labral tissue was minimally debrided while preserving healthy labral substance. A motorized burr and arthroscopic rasp were then utilized to prepare the superior glenoid neck by removing the remaining soft tissue and creating a healthy bleeding bony surface to promote biological healing.
The detached superior labrum was carefully mobilized using an arthroscopic elevator until an anatomic reduction to the superior glenoid could be achieved without excessive tension. Mobility of the labrum and biceps anchor complex was confirmed throughout the superior glenoid.
A drill guide was positioned on the superior glenoid rim at approximately the 11 o'clock position. A pilot hole was created, and a bio-composite suture anchor was inserted with excellent fixation. A second anchor was placed at approximately the 1 o'clock position to restore the entire superior labral attachment.
Using an arthroscopic suture-passing device, sutures were sequentially passed through the superior labrum adjacent to the biceps anchor while carefully avoiding injury to the long head of the biceps tendon. Arthroscopic sliding knots followed by multiple alternating half-hitches were tied securely. The superior labrum was anatomically reduced against the prepared superior glenoid with excellent restoration of the biceps anchor complex.
The repair was thoroughly probed and demonstrated excellent stability without residual displacement or gapping. Passive forward elevation, abduction, and external rotation were performed, confirming maintenance of repair stability throughout shoulder motion.
Mild inflammatory synovitis surrounding the superior recess was debrided using an arthroscopic shaver and radiofrequency ablation device. Final arthroscopic inspection demonstrated anatomic restoration of the superior labrum, secure fixation of the repair, preservation of the long head of the biceps tendon, and no remaining loose bodies within the joint.
The glenohumeral joint was copiously irrigated with sterile normal saline. Meticulous hemostasis was achieved using the radiofrequency ablation device.
All arthroscopic instruments were removed. Portal sites were closed using interrupted 3-0 nylon sutures. Sterile Xeroform dressing, sterile gauze, and transparent occlusive dressings were applied. The right upper extremity was placed into a padded shoulder immobilizer with an abduction pillow.
The patient tolerated the procedure well without complications, was awakened from anesthesia, extubated uneventfully, and transferred to the post-anesthesia care unit in stable condition.
Findings
Type II SLAP lesion with complete detachment of the superior labrum from the superior glenoid.
Mild degenerative fraying of the superior labrum.
Stable anterior and posterior labrum.
Intact long head of the biceps tendon without instability.
Intact supraspinatus tendon.
Intact infraspinatus tendon.
Intact subscapularis tendon.
Mild glenohumeral synovitis.
Well-preserved humeral head and glenoid articular cartilage.
Stable anatomic arthroscopic SLAP repair with excellent fixation.
Implants
Two bio-composite suture anchors for superior labral repair.
Operative report 10
Preoperative Diagnosis
1. Right shoulder recurrent anterior instability.
2. Bankart lesion of the anterior-inferior glenoid labrum.
3. Recurrent anterior shoulder dislocations.
4. Chronic right shoulder pain.
Postoperative Diagnosis
1. Right shoulder Bankart lesion involving the anterior-inferior labrum from the 3 o'clock to 6 o'clock position.
2. Anterior capsular insufficiency with capsular redundancy.
3. Mild Hill-Sachs lesion without significant engagement.
4. Intact rotator cuff and biceps tendon.
Procedure performed
1. Diagnostic arthroscopy of the right shoulder.
2. Arthroscopic Bankart repair.
3. Arthroscopic anterior capsulorrhaphy of the shoulder.
4. Arthroscopic debridement of the anterior glenoid rim.
Indication
The patient is a 27-year-old male with a history of recurrent traumatic anterior dislocations of the right shoulder resulting in persistent instability, pain, apprehension during overhead activities, and limitation of athletic and daily activities. The patient had failed extensive conservative treatment including activity modification, supervised physical therapy, strengthening exercises, and bracing. MRI arthrogram demonstrated an anterior-inferior labral detachment consistent with a Bankart lesion associated with capsular laxity. Due to recurrent instability and failure of nonoperative management, arthroscopic Bankart repair with anterior capsulorrhaphy was recommended. The risks, benefits, alternatives, expected outcomes, and postoperative rehabilitation were discussed in detail with the patient, and informed consent was obtained.
Description of the procedure
The patient was brought to the operative room and placed supine on the operating table. Following induction of satisfactory general anesthesia, an ultrasound-guided interscalene nerve block was confirmed. Intravenous prophylactic antibiotics were administered prior to skin incision.
The patient was positioned in the beach-chair position with the head and neck maintained in neutral alignment. All bony prominences were carefully padded. The right upper extremity was prepared and draped in the usual sterile orthopedic fashion. A final surgical timeout was performed confirming the patient's identity, operative extremity, planned procedure, and availability of all required arthroscopic equipment.
Approximately 30 mL of sterile normal saline was injected into the glenohumeral joint to facilitate portal placement. A standard posterior viewing portal was established, and the arthroscope was introduced into the glenohumeral joint. Standard anterior and anterosuperior working portals were established under spinal needle localization.
A systematic diagnostic arthroscopy was performed.
Inspection of the humeral head demonstrated a small non-engaging Hill-Sachs lesion involving the posterolateral aspect of the humeral head. The glenoid articular surface demonstrated no significant cartilage loss or appreciable glenoid bone deficiency. The superior and posterior labrum were intact. The anterior-inferior labrum was detached from the glenoid rim extending from approximately the 3 o'clock to the 6 o'clock position, consistent with a Bankart lesion. The anterior capsule demonstrated redundancy and laxity with medial displacement of the capsulolabral complex.
The long head of the biceps tendon was intact and stable at its origin. The superior labrum remained firmly attached. The subscapularis, supraspinatus, infraspinatus, and teres minor tendons were carefully inspected and found to be intact.
Attention was directed toward mobilization of the Bankart lesion. Using an arthroscopic periosteal elevator, the detached anterior-inferior labrum and capsule were carefully elevated from the anterior glenoid neck until complete mobilization was achieved. Adequate mobility of the capsulolabral complex was confirmed, allowing an anatomic reduction to the glenoid rim without excessive tension.
The anterior glenoid neck was prepared using an arthroscopic shaver and motorized burr to remove fibrous tissue and lightly decorticate the glenoid rim, exposing a healthy bleeding bony surface to optimize healing. Loose soft tissue and debris were removed from the joint.
Attention was then directed toward the capsulorrhaphy and Bankart repair. A drill guide was positioned at the inferior anterior glenoid, and the first bio-composite suture anchor was inserted at approximately the 5:30 o'clock position. Excellent anchor fixation was obtained.
Using an arthroscopic suture-passing device, the anterior capsule and detached labrum were captured in a capsular shift fashion, advancing the capsule superiorly and laterally while restoring the normal tension of the inferior glenohumeral ligament complex. Arthroscopic sliding knots followed by alternating half-hitches were securely tied, reducing the capsulolabral complex to the prepared glenoid rim.
Additional bio-composite suture anchors were sequentially inserted at approximately the 4 o'clock and 3 o'clock positions. Sutures were passed through progressively more superior portions of the anterior capsule and labrum, completing a stepwise capsular plication and anatomic Bankart repair. The capsular redundancy was completely eliminated, restoring the normal bumper effect of the anterior-inferior labrum and appropriate tension of the anterior capsule.
The completed repair was thoroughly inspected and probed. The labrum was firmly attached to the anterior glenoid rim with excellent restoration of the capsulolabral complex. The humeral head remained concentrically reduced within the glenoid throughout passive forward elevation, abduction, and external rotation. No residual anterior translation or instability was appreciated.
The glenohumeral joint was copiously irrigated with sterile normal saline. Meticulous hemostasis was achieved using the radiofrequency ablation device. Final arthroscopic inspection demonstrated a stable Bankart repair, successful anterior capsulorrhaphy, restoration of the anterior labral bumper, and elimination of capsular redundancy.
All arthroscopic instruments were removed. Portal sites were closed using interrupted 3-0 nylon sutures. Sterile Xeroform dressing, sterile gauze, and transparent occlusive dressings were applied. The right upper extremity was placed into a shoulder immobilizer in slight abduction and internal rotation.
The patient tolerated the procedure well without complications, was awakened from anesthesia, extubated uneventfully, and transferred to the post-anesthesia care unit in stable condition.
Findings
* Bankart lesion involving the anterior-inferior labrum from the 3 o'clock to the 6 o'clock position.
* Anterior capsular redundancy and insufficiency.
* Mild non-engaging Hill-Sachs lesion.
* Intact superior labrum and biceps anchor.
* Intact long head of the biceps tendon.
* Intact supraspinatus tendon.
* Intact infraspinatus tendon.
* Intact subscapularis tendon.
* No significant glenoid bone loss.
* Stable arthroscopic Bankart repair with successful anterior capsulorrhaphy and restoration of glenohumeral stability.
Implants
* Three bio-composite suture anchors for Bankart repair and anterior capsulorrhaphy.
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