glenoid exposure

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

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

  2. Disclosure • Zimmer-Biomet: Royalties

  3. 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

  4. Positioning

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

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

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

  8. Deltoid Mobilization

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

  10. Marking Stitches

  11. 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

  12. Open the Door

  13. Complete Inferior Release

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

  15. Entry Hole

  16. Ice Pick

  17. Reamer

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

  19. Humeral Guide

  20. Head Cut

  21. Humeral Preparation • Seat broach • Trim away metaphyseal bone

  22. Complete Osteophyte Removal

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

  24. Retractors

  25. Glenoid Exposure

  26. Glenoid Exposure

  27. Glenoid

  28. Glenoid

  29. Glenoid

  30. Glenoid

  31. Glenoid

  32. PSI

  33. PSI

  34. PSI

  35. 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

  36. Thank You

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