Shoulder Instability: Bone Defect Repair Using Soft Tissue

Shoulder Instability: Bone Defect Repair Using Soft Tissue

This surgical video demonstrates a bony defect repair with soft tissue for the treatment of shoulder instability. This procedure uses the shoulder capsule, the connective tissue that surrounds the shoulder joint, and the tendon of the infraspinatus, one of the rotator cuff muscles, to fill in a gap of missing bone in the top of the upper arm bone, or humerus.

This helps improve the shape of the top of the upper arm bone, which can help it stay in contact with the shoulder socket to reduce instability. This surgery is referred to as a Remplissage procedure, which means “to fill in” in French.

Here, we see a left shoulder, with the patient lying on their right side. The front of the shoulder is on the right side of the screen, and the back of the shoulder is on the left side of the screen.

The surgeon has already made small incisions into the shoulder, called portals, and inserted plastic tubes, called cannulas, that will be used to pass surgical instruments in and out of the shoulder.

The surgeon begins by placing two soft-body anchors through the infraspinatus tendon and shoulder capsule into the gap of missing bone in the top of the upper arm bone. These anchors are already threaded with sutures.

The free blue suture from one anchor is threaded through the black and white striped suture loop of the other anchor. Tension is applied to the free end of the black and white striped suture to pass the blue suture into the anchor without having to tie a knot.

The same steps are completed for the other sutures and second anchor. Both blue sutures are pulled, forming a bridge across the two anchors that pulls the tendon and shoulder capsule down toward the bone to fill in the missing gap.

The sutures are then cut off, the cannulas will be removed, and the skin incisions will be closed with sutures. The procedure is complete.