Stephen J. Snyder, M.D.

Arthroscopic techniques for stabilization of the shoulder have continued to evolve over the past decade. Initially staples, rivets, screw-washer combinations, and plates were developed for securing soft tissues. Unfortunately, numerous complications were experienced with these devices, such as migration, breakage, irritation/infection, need for removal, and/or anatomic placement limitations. In the worst of scenarios, significant articular surface damage and/or synovial fistulae were the result of such complications.

Further advances have lead to arthroscopic intra-articular suture techniques in which "hardware" devices are not needed. Although complications are rare with suture techniques, these procedures are difficult to master and are again subject to anatomic placement limitations as well as suture cutout and/or pullout. A further advancement is the introduction of suture anchors. These devices potentially avoid the anatomic placement limitations, irritation, and need for subsequent removal with "hardware" fixation devices. In addition, because these devices can be precisely placed where needed, the problems of cutout and/or pullout are dramatically reduced.

Over the coming year, the VJO will provide an in-depth review of the latest intra-articular suture techniques and suture-anchor device techniques for soft tissue fixation in the shoulder. In this featured VJO segment, Dr. Stephen J. Snyder of the Southern California Orthopedic Institute surgically demonstrates an arthroscopic intra-articular suture-anchor repair technique for a Bankart lesion. Dr. Snyder demonstrates the use of a device called a shuttle-relay, which allows the surgeon to employ either permanent or absorbable sutures with a mattress stitch, if desired. Such sutures are stronger and duplicate the repair obtained with open Bankart techniques. They also allow plication of the anterior capsule.

References
1. Snyder SJ, Strafford BB Arthroscopic management of instability of the shoulder Orthopedics 1993;16(9):993-1002
2. Maki NJ Soft tissue fixation in the shoulder - Part I: suture technique MVP Video J Ortho 1993;8(6):Seg 3

• Total Run Time: 30:16 minutes
• Catalog Number: 7022
• Publication Date: February 1994

• DVD/iPod: $95.00
• VHS (NTSC): $95.00
• VHS (PAL): $95.00