Fig 2.

(A) Once the position of the needle is satisfactory, it is removed. A 0.5-cm nick is made in the skin, and the 1.1-mm guidewire is inserted in the same direction as the spinal needle and tapped into the Hill-Sachs defect. (B) A 4-mm cannula with a sharp obturator is passed over the wire and into the joint. The guidewire and obturator are then removed. (C) A hole for the anchor is created with an awl or drill (depending on the system being used). The anchor is then inserted and its introducer removed. (D) The tip of the cannula is carefully withdrawn. It is important to visualize this step arthroscopically. Once the cannula has been withdrawn beyond the rotator cuff tendon, it must not be withdrawn any further. The guidewire is inserted, the cannula (containing the guidewire and the sutures from the first anchor) is redirected, and the guidewire is used to pierce the rotator cuff tendon again, leaving a sufficient bridge of infraspinatus tendon between the exiting sutures and the guidewire. (E) The cannula must now be completely withdrawn while the surgeon ensures the guidewire stays in place. This is done so that the sutures from the first anchor can be extricated from the cannula. (F) Arthroscopic view showing a generous sleeve of rotator cuff tissue between the sutures from the first anchor and the guidewire, which will guide the insertion of the second anchor. (G) The sharp obturator together with the cannula can now be advanced over the guidewire, through the infraspinatus tendon, and into the joint. (H) A hole is created using the awl, and another anchor is inserted. (I) The surgeon now has 2 anchors inserted into the Hill-Sachs lesion with their respective sutures piercing the infraspinatus tendon at separate points (leaving a bridge of intervening tendon). The sutures exit the deltoid muscle and skin through a single portal.