Emilio Calvo on Arthroscopic Latter-Jay. Here's all that's needed. Good morning. Thanks for having me here. Can I have a presentation? Because I'll share with you the technique I follow for the Arthroscopic Latter-Jay. It's only a video with a technique. I will try to do an Arthroscopic Latter-Jay plus a Banker Repair at the same time. Can you please play the video? This is the position of the portals. Most of the portals are located anteriorly because we'll work the majority of the procedure in the anterior aspect of the shoulder. You will see how, along the procedure, we will move from the posterior aspect of the joint to the anterior aspect. This is the first step in joint evaluation and capsular liberate dissection. You can see here the helix axillations in this case, which is a revision procedure. It's very important to fully open the rotator interval to have a good access to the glenohumeral joint and also to dissect the lateral aspect of the coracoid, removing the insertion of the coracoid acromial ligament. You can see here how we are cleaning the lateral aspect of the coracoid. Now it's time to dissect the capsular labral tissue, trying to remove it and to retract it inferiorly to the inferior axillary pouch to later reattach it to its original position. Now we will move anteriorly to the deep portal, which is an interlateral portal, and we start to dissect the congenital tendon and to harbor the coracoid. It's important for that purpose to release the medial and lateral aspects of the congenital tendon. This is the portal located medially, about 6 cm medial to the most inferior deltoid pectoral crease. We are detaching the pectoralis minor from its insertion. And now it's time to complete the release of the pec minor, and we will clean the upper aspect of the coracoid process and establish a superior portal aimed to drill the holes through the coracoid process and also to carry out the osteotomy. I'm using this device with this technique, using screws, not sutures or buttons, and I prefer to use these tappers as a kind of washers to provide compression with the screws. And now it's time to do the coracoid osteotomy. For that purpose I use a conventional osteotome. And once the coracoid is completely osteotomized, I start with the suprascapular preparation split, which is, to me, the most difficult part of the procedure. So trying to establish the split level of the suprascapularis, I insert the curved visceral rod from posterior that exits anterior lateral to the congenital tendon, and I define the level of the split of the suprascapularis. So we open the suprascapularis from anteriorly. The larger the split, the better. And it's very important to localize and to identify the axillary nerve, which is quite close. And once you identify the axillary nerve, you feel safe because there is all the way to go into the joint. Then you prepare the glenal rim, and it's time yet to do the coracoid transfer and fixation, which is an easy part of the procedure. I use a technique using these long screws to hold the graft and to bring it into the joint. It's very important to carefully prepare the undersurface of the coracoid to obtain a breathing surface, to obtain a nice healing. And then we put the graft into the joint anterior to the anterior glenal rim, pass the long K-wires, drill the tunnels through the coracoid glenal neck, and then just fix the coracoid with screws. So this is our inferior screw. We'll then insert the superior screw. So we don't need to close the suprascapularis split. And now it's time to make sure that everything is okay, and there's no impeachment between the suprascapularis and the coracoid graft. Very stable. You can see the plexus over there. Stable fixation, and it's always under control, the brachial plexus. So now it's time to go back to the glenohumeral joint, trying to reattach the capsule and the labrum. And in this way, we will go to the posterior portal as a viewing portal again, and we'll try to reattach the capsule. You see here the labrum and the capsule. We're going to use the conventional old suture anchors to reattach the capsule to its original position. You can see there. It's very important to first fix the superior part of the capsule labral complex to reattach it on its original anatomic position. There we are, our first anchor, which is the superior anchor. So this is a conventional labor repair, as you can see. You can see both do the suture for the previous procedure that failed. Second anchor, usually two or at least three anchors is good enough to reattach the capsule labral complex. And in this way, we keep the graft out of the joint, preventing any impingement or any risk of arthritis. Now we visualize from the anterior portal, you will check the final position of the capsule labral complex, and we will see that the graft stays completely extraticular. So this is my technique. Thank you very much.

video

Emilio Calvo

arthroscopic procedure

shoulder joint

coracoid transfer