Arthroscopic Management of Shoulder Instability: Triad Technique

Abstract

The techniques and results of arthroscopic techniques in the treatment of shoulder instability have evolved considerably over the past 15 years. The first arthroscopic stabilization technique was introduced by Johnson¹ in the early 1980s. He used a staple to secure the detached labrum to an abraded glenoid rim. The arthroscopic insertion of a staple posed the same problems as the use of hardware in the shoulder that had been previously reported by Zuckerman and Matsen,² namely hardware loosening and arthritic changes. Under ideal conditions, the staple could be used to repair a Bankart lesion, but malleting or driving a staple into the bone just below the glenoid rim was a difficult and delicate task. The staple might be insufficiently inserted, thus providing inadequate capture of the ligament labral complex, or overdriven into the relatively hard glenoid bone, thereby cutting through the ligament labral complex. The angle of approach of the staple and driver combined with the tapering contour of the scapular neck led to skiving of staples that were left in soft tissues when they were thought to be in bone. Probably the biggest deficiency of the staple was that it was not able to address the problem of capsular laxity that is likely to coexist with labral lesions.