Shoulder Instability: Labral Repair Using Knotless Soft Anchors Animation

Shoulder Instability: Labral Repair Using Knotless Soft Anchors Animation

This video demonstrates a labral repair to the front of the shoulder using a knotless, soft-bodied anchor. Here, we see a right shoulder with a labral tear at the front of the shoulder. The camera or arthroscope is in the incision or portal at the back of the shoulder, and there are 2 portals for instruments in the front of the shoulder with cannulas in place. These hard cannulas help the surgeon with managing sutures from the anchors.

After the surgeon has evaluated the shoulder joint with the arthroscope and the bony socket has been prepared for repair, the surgeon will bring in a drill guide. They will orient the drill guide into the proper position on the socket. A flexible drill is introduced through the drill guide and advanced into the bone to prepare a spot for the anchor.

Next, the knotless soft-bodied anchor is introduced through the drill guide. Once the anchor contacts bone, the surgeon will mallet the back of the anchor inserter to help drive the anchor into position. The anchor inserter and drill guide are then removed. Here, you can see there are 3 different suture strands coming out of the anchor. The blue and white suture is called the repair suture. This suture will wrap around the labrum and help complete the repair.

The black and white sutures are one continuous strand of suture that will act as a shuttle for the repair suture. When utilized later, the shuttle suture will help secure the repair suture into the soft anchor body. After a series of steps, the repair suture has now been passed around the labral tissue. Now, the surgeon will secure the repair suture using the black and white shuttle suture.

The shuttle suture will bring the repair suture through a finger trap-like mechanism within the soft anchor body. This step allows for a knotless repair where previously knots were required to be tied by the surgeon in order to secure the suture. Now, the surgeon will bring the labral tissue back down to the glenoid bone and tension the repair as needed. Finally, the surgeon will cut the free end of the suture. This process is then repeated multiple times until the entirety of the labral tear has been repaired.