Glenoid Exposure Tips and Tricks to Achieve Reproducible Glenoid - PowerPoint PPT Presentation

Glenoid Exposure Tips and Tricks to Achieve Reproducible Glenoid Access John W. Sperling, MD, MBA Mayo Clinic

Disclosure • Zimmer-Biomet: Royalties

Positioning • Beach chair position –Waist 45 ° , knees 30 ° –Slightly roll the body away from the operative shoulder –Place a rolled up towel under the medial border of the scapula

Positioning

Approach • Landmarks –Posterior spine of the scapula –Lateral/Anterior border of the acromion –Clavicle –Coracoid

Approach • Incision –Begins at the anterior portion of the clavicle –Passes approximately ½ cm lateral to the coracoid

Approach • Incision –Develop the deltopectoral interval proximally – Small triangle of fat is usually present identifying the infraclavicular triangle –Vein is left medially

Deltoid Mobilization

Incise Interval-Subscapularis • Identify the rotator interval • Significant surgeon variability in technique of releasing the subscapularis – Intra-tendinous – Off bone – Osteotomy

Marking Stitches

Inferior Capsule • Inferior capsule release: stay on bone and directly visualize the capsule • Arm externally rotated and adducted, continue the release to the 4 o’clock position

Open the Door

Complete Inferior Release

Humeral Head Cut • Use a drill to gain access to humeral canal • Prepare humeral canal with hand reaming

Entry Hole

Ice Pick

Reamer

Humeral Head Cut • Cutting block is 1 mm above RC insertion • 30-35 ° retroversion is average

Humeral Guide

Head Cut

Humeral Preparation • Seat broach • Trim away metaphyseal bone

Complete Osteophyte Removal

Glenoid Exposure • Common reasons for difficult exposure –Lack of deltoid mobilization –Insufficient capsular release –Too high a head cut –Insufficient humeral osteophyte removal

Retractors

Glenoid Exposure

Glenoid Exposure

Glenoid

Glenoid

Glenoid

Glenoid

Glenoid

PSI

PSI

PSI

Summary • Key to glenoid exposure is the humeral side • When in doubt-repeat the 4 key steps – Aggressive humeral head cut – Humeral osteophyte removal – Inferior capsule – Deltoid mobilization

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