My plant story was an arthroscopy last day. Here as you can see we have an outside view, I'm visualizing from an anterolateral portal which is located midway between the anterolateral edge of the acromion and the multi-pterodactyl pectoral crease, and you can see from here, this is my subscap, this is the rotator interval I already opened completely, this is my humeral head, I'm visualizing from the rotator interval I have my guide already into the joint, as you can see from here the guide has been inserted from the posterior of the joint to a conventional posterior portal, and what we did is that we already prepared the coracoid process, the CA ligament has been detached, as we can see from here, this is my CA ligament, this is the coracoid process tip, congenital tendon here, subscap, we already completed the split of the subscapularis, and we already passed the suture with the bottom through the coracoid process here. Of course, the pec minor, as you can see here, has been released from the medial aspect of the coracoid here, and down there should be the plexus, okay? So we don't need to go to the plexus, of course, so now it's time to, we've already drilled the tunnel through the coracoid process using this guide, and we'll show it later on, this is my split of the subscapularis, and if we go through the split, we will find that we prepared already the anterior edge of the coracoid, and we have already passed the drills with the guide to bring the graft anterior to the anterior glenorim, okay, through the subscapularis here. So now it's time to complete the coracoid osteotomy, so again, let's go out to the coracoid here, this is my coracoid, and this is the osteotomy that will be completed now. So I, for this purpose, I will insert this saw from this anterolateral portal located right anterior and lateral to the acromion, so now let's start, and we'll complete the coracoid osteotomy, sorry about this, okay. I'm sorry for this tissue which is in here, I will clean it a little bit for you, wait, wait a minute, okay, sorry about it, there we are. So now it's completed, the osteotomy as you can see, here we need to release a bit more the base of the coracoid here, so there we are, just to make sure that it's completely released, there's some soft tissue here, this is preventing to mobilising the coracoid process, okay, almost done, okay, this is my coracoid now, still some ligament here, alright, so it's released now, okay, so this is my coracoid, now it's time to bring the coracoid into the joint through the suprascapular split, and for that purpose, I have a switching stick, I will open the split of the suprascapular from here, now the coracoid part is completely released, this is my suprascapular here, okay, so now Angela will bring the monofilament suture through the, okay, here we are, I will grab the monofilament suture, okay, so monofilament suture, let me hold the clip here, and remove the cannula, okay, now it's time to bring together with the monofilament the sutures of the, that will bring the coracoid process into the joint, yes please, so now Angela is taking the pin out, okay, now we have both sutures and monofilament out from the same portal here, now I want to make sure we are exiting through the same portal, both of them, okay, I have a switching stick please, I will use this racing rod to retract a little bit there, okay, so now the, I will have here the sutures and the monofilament that will be brought together through the anterior portal, would you mind pulling up the monofilament, release this please, take it out, take the clip out, pull, pull a bit more, a bit more, stop, stop, okay, pull it more, a bit more, a little bit more, more, more, more, okay, now let's bring it out, okay, so now we need to bring together the monofilament with the sutures, thank you, okay, and now pull the way posteriorly, let me show you, may I have the switching stick please, let's make sure we don't have anything difficult in the passage of the graft, this is my graft, okay, let's try to elevate a little bit the anterior fold of the subscapularis here, wait a minute, okay, keep on pulling please, keep on pulling, keep on pulling, keep on pulling, there we are, a little bit more please, okay, let's try to bring it through the subscap, yes, hang on a minute, pull, okay, just a sec, now this driver, this forceps, we will use this forceps just to rotate a little bit the graft and to bring it into the joint, okay, pull please, all right, so we are right in front of the colloquial process, so now we want to make sure that we are that the superior fold of the subscapularis is above, it's over the graft, there we are, and now we make sure that the graft is in contact with the colloquial person, we can now remove this guide and we want to see, to have a nice view of the anterior, of the anterior aspect of the, okay, there we are, this is my congen tendon, this is the inferior fold of the subscapularis, this is the capsule, and this is the superior subscapularis here, and we are bringing the graft into the joint, okay, there we are, okay, there we are, so now we need, all we need to do is to reposition it to make sure that it's vertical, so for that purpose we need, we can remove this rod and we can visualize from this anterolateral portal now, okay, here we are, this is my subscap, this is the, sorry, okay, let's go into the joint now, here we are, so this rod please, so I'm going to retrieve a little bit the subscap here, okay, that's my graft here, so here we are with a graft, this is my humeral head, linoid, and this is my graft, so what we need now is to tighten it, and I want to try to rotate it a little bit more, okay, would you mind pulling, wait a minute, wait, wait, wait, don't pull anymore, pull now please, okay, so there we are, what we need to do is just to bring the graft in contact with the anterior vena rim, just tensioning the graft, would you mind holding the camera for me, okay, so for this purpose we can go back, this is my, okay, so now we will bring the tensioner, here's the tensioner, thank you, so this is, oh yeah, thank you, we have here the posterior bottom here, we'll bring the tensioner through, a suture passage through this tensioner, and we'll use this to bring the two sutures through it, we need to have the bottom, yeah, sorry about it, okay, we are now, this is the bottom that will be used, this is one suture, we will use the other one now, oops, okay, so this is the bottom that will be used to fix and to compress, to provide compression to the anterior bottom, to the anterior vena rim, okay, all right, so now we use the tensioner, okay, so this is my knees knot, and now it's time to pass all together through the tensioner, okay, all right, so here we are, now, can I have a clip please, thank you, so now we have to do two things, first is to tension from posterior, and for that purpose, we'll use one, two to one handed, one more, to one handed, okay, I want to make sure that the position of the graft is adequate, watch it from the front, or from in particular, so here we are, this is my bottom here, and this is my superior fold of the surcapillary here, so it's tight, and now we want to take it from inside, okay, this is the inner part of the joint, I will take it from here, could you hold this for me, again, hold this, you hold this, and you hold this please, and let's try to tie, okay, can we have a knot pusher please, so now it's time to finalize the posterior fixation here, okay, so we have this knot pusher for that purpose, okay, and now we'll bring the, all the tissue down, okay, so you will see, so now we would, okay, all right, so now we need to check the final position of the graft, so David, this is quite tight, is there any question from the room, David?

surgeon

arthroscopy

anterolateral portal

coracoid process

subscapularis