Good afternoon, it is my pleasure and big honor to be here, thinking atrophic shoulder destabilization in 360 degrees. This is my disclosure. The circuit concept described by Pagnani and Warren explains that anterior shoulder dislocation creates anterior barcapsular injury with circle forces shifting the tissues and creating a lesion in the opposite side. The repair direction should be to shift the structures from the inferior to superior and repairing first the posterior secondary injury limits the global shift repair. The repairing should be start for the main lesion and then the secondary injury. Repair balancing the inferior glenohumeral ligament in anterior and posterior. The lesion could be progressed to a circumferential 360 degree tear that the influential factor and the laxity of the patient ligament capsule, the intensity of the mechanism is the recurrence of the episode. The dislocation is relaxation in main direction, secondary lesion on the opposite side, either in the superior or inferior structures. The lateral decubitus position is the best option, I think is the only option, to first in examination with anesthesia before surgical procedure, switching the portal view for anterior and posterior is switching the working portal for anterior and posterior. The surgical position in this meta-analysis has significant lower long-term recurrence rate in lateral decubitus and the outcomes of the modern VARCA repair in the athletic population at five year follow-up showed less than 10% of recurrence frail and an anatomical repair restore biomechanics. Even in the multidirectional instability, the capsule application is successful to reduce the volume capsular. This is a posterior instability, a correct diagnosis of the main direction of the instability, simplify the associated injuries, a release and the remand of the structures generating a good healing scenario, precise location and enough number of anchors. Capsular application in between 5 to 15 millimeters with capsular shift effect, adequate reduction and tension of the capsular labral complex and I show in this case, adequate balance of the inferior glenohumeral ligament at the end of the surgery, in this case, in the anterior part of the capsule. At the end of the surgery, if we have a big laxity, we can close the posterior portal adding a shifting of the posterior capsule. In 360 injury with slab, in this case, the instability, we always fix, we repair the slab. Generally, at the end of the procedure, in some cases, in the beginning, like a complete detachment that obstruct vision, it's very important to observe the complete repair by the interlateral portal, evaluating the balancing of the repair. In extended laryngeal detachment beyond the 6 o'clock hour, primarily or after the release, we place an anchor in 6 o'clock position. We done that with a posterior percutaneous accessory portal that gives a fixed inferior point to the repair. Even more, if we have a bone fragment, a posterior percutaneous accessory portal is very useful to place this anchor and lateral portal view, it will retrieve the suture for the anterior portal. The combination of biocomposite anchors and only suture anchor will decrease a residual weakness area of the glenoid without decreasing the biological effect of the perforations. Double-loaded anchors combine capsule lateral vertical and mattress-shutter stitches, increasing the contact area and the labrum volume. The application reduces the capsular volume with capsular shift effect. In conclusion, examination with anesthesia corroborates the main direction of instability. The lateral decubit position is the best option, simplifying the injury and start the repair by its main direction with 360-degree repair concept, anchoring at 6 o'clock in lesions that exceed the lower limit of the glen. Combine double-loaded suture anchors in biocomposite and only suture in different areas to decrease the residual glenoid weakness. Combine vertical and mattress-shutter to improve the contact and volume of the repair. Application with angulator-suited patient, one hour distance for the position of the anchor and between 5 to 15 mm lateral to the labrum, depending on the laxity and type of injury. Balance the inferior glenohumeral ligament at the end of the surgery and close the rotator interval of posterior portal at the end of the repair only in large capsular laxities.

atrophic shoulder destabilization

360 degrees

anterior shoulder dislocation

repair direction

lateral decubitus position