Innovations in Glenohumeral Instability Management Brian J. Cole, - PowerPoint PPT Presentation

Innovations in Glenohumeral Instability Management Brian J. Cole, MD, MBA Professor, Vice-Chairman, and Managing Partner Department of Orthopedics Chairman of Surgery, Rush OPH Section Head, Rush Cartilage Restoration Center Team Physician, Chicago White Sox and Bulls

I (and/or my co-authors) have something to disclose. Detailed disclosure information is available via: Printed Final Agenda Meeting App Meeting Website www.aana.org/annual or AAOS Orthopaedic Disclosure Program on the AAOS website at http://www.aaos.org/disclosure

The Virtues of Knotless Repair AJSM, 2014  No Knots! (and loop failure)  Customized repairs  Low profile Arthroscopy, 2013  Versatile and Consistent  Faster

Joint Friendly

Knotless Labral Repair with Pushlock Anchors - Eliminates suture abrasion on chondral surfaces, synovium and cuff - Restores anatomic meniscoid position of labrum on glenoid - Biomechanically superior construct - Cannulated anchor provides extra channel for marrow elements

Mechanical Superiority Part 1: Biomechanical Testing 200 173.1 167.9 150 Load (N) 100 66.5 SSA KSA 35 50 0 Load 2mm Displacement Ultimate Load Failure Arthroscopy, 2005 AJSM, 2014

Labrum and Capsule Arthroscopy, 2010 Traditional Knotless  Capsular shift (6.8 vs 4.3 mm)  Berg et al, 2002

Versatility Mattress Simple Double Cinch

OR TIME 24.2 Minutes Faster - 721 Patients

The Benefits of Tape Arthroscopy, 2015 Higher Failure Loads for Complex Suture 37% more resistant to tear through Configurations Increased inferential friction

Suture Tape Running Locked Configuration

Basic Pearls

Portal Placement Anterior - Superior Posterior Midglenoid Posterior – Inferior (7 O ’ clock)

7 O’clock Portal

My Go-To Short 2.9mm PushLock with LabralTape

Inverted Mattress SLAP Repair Labral Tape and PushLock

270 Degree Knotless Repair

2.4 mm PL Percutaneous

Bony Bankart Two 3.5 mm SL Medially/Three PL on Rim JBJS 2005  42 shoulders  Average fragment 24.8%  F/U = 34 months  39/42 Good/excellent (93%)  Minimal loss ER

Results Instability: Same as Suture Knots Arthroscopy, 2006 Arthroscopy, 2014 Knee Sp Trauma, 2009

New Alternatives 3 mm Knotless SutureTak - Drill and insert through guide - Pass core suture - Remplissage/PASTA Repair - Controlled Tensioning

Why I use them…versatility, ease and speed Posterior superior Anterior Superior Anterior Posterior Inferior

THANK YOU First Annual AANA/AOSSM/AAOS SKI COURSE January 31-February 3, 2018 Park City, Utah www.BrianColeMD.com