Table 1.

Key Points for Arthroscopic Repair of Posterior Bony HAGL Lesion With Teres Minor Avulsion

Perform a thorough preoperative examination with the patient under anesthesia to evaluate the extent of posterior instability.

Perform a thorough arthroscopic evaluation of the shoulder to identify other concurrent lesions.

Use standard anterosuperior and posterolateral shoulder arthroscopy portals, but the addition of a posterosuperior port-of-Wilmington portal aids in visualization and fixation of posterolateral lesions.

Placement of multiple cannulas to create a sheathless approach allows for interchanging the arthroscope and instrumentation from portal to portal with ease.

When attempting to visualize the posterior HAGL lesion, use of a 70° arthroscope placed through the posterosuperior port of Wilmington provides the best visualization.

Use a shaver and curette to prepare the bony bed of the humerus and create a good healing surface.

Use of a small (3.0-mm) SutureTak preloaded with 2 sutures (1 No. 2 FiberWire and 1 No. 2 TigerWire) allows for ease of management of the tissue with adequate strength of fixation.

Drill a hole in the previously prepared bony bed with a 2.9-mm drill, and use a mallet to place the SutureTak into position.

Pass the sutures through the tissue and around the bony avulsion fragment using a curved SutureLasso.

Tie both the FiberWire and TigerWire with a locking knot (we use a Tuckahoe knot), backed up by 3 alternating half-hitches.

Visually ensure that there is good bony apposition of the bony avulsion to its site of origin on the humerus.