Shoulder Instability: Bony Defect Repair With Soft Tissue Animation

Shoulder Instability: Bony Defect Repair With Soft Tissue Animation

This animation 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, at the back of the shoulder.

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 inside the shoulder. You can see the top of the upper arm bone with an area of missing bone. Two soft-body anchors have already been inserted into the upper arm bone through the shoulder capsule and infraspinatus tendon. 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, and the procedure is complete.