superior labral SLAP repair, plus posterior inferior glenohumeral ligament release

If a thrower sustains an injury that does not respond to nonoperative treatment, then surgery is needed if the player wants to return to overhead throwing. The following pictures are from an "arthroscope" which is a joint camera used by a surgeon to view the inside of the shoulder. Long, thin "arthroscopic" instruments are used to remove or repair damaged tissue. Lasers and heat probes are used to cut and vaporize tissue. The photographs below show a typical surgery done to release the tight capsule and repair the torn labrum cartilage in a shoulder damaged by too much overhead throwing.

	This arthroscopic view shows the normal anterior inferior glenohumeral ligament. The surgeon can feel it's consistency with the probe.
	Here we see the normal anterior-inferior labrum. It is not torn or pulled away from the bone.
	This is where the labrum is seen pulled away from the bone. The probe can be inserted between the labrum and the bone.
	Another look at the separation from the bone, after pulling with the probe to show the extent of the tear. This is the superior labrum, right behind the biceps tendon attachment.
	A tool called an elevator prepares the bone for repair.
	A mechanical shaver helps prepare as well.
	Final preparation by a mechanical burr, to expose healthy bleeding bone.
	The bone bed is ready to have the labrum re-attached.
	A needle is passed under the labrum. This needle has a looped suture within it.
	This suture loop is retreived through the other portal.
	This suture loop then is used to pull back the green braided repair suture, also as a loop.
	With the green braided suture looped through/under the labrum, it's other end is pulled back through the same portal as the loop end. Now the "loop" end and the "tail" end are in the same place.
	The tails are simply passed through the loop, and then pulling on the tails brings the loop down, and secures the labrum within the stitch.
	A good view of how the labrum is secured. With the tails passed through the tip of the anchor, the anchor is ready to be driven into the bone which will reattach the labrum to the bone.
	The anchor is placed against the hole that has been drilled in the bone.
	It is tapped into the hole and completely buried in the bone. The insertion handle is removed, and the suture ends are cut off, and this is what the final stitch looks like. Very low profile and no bulky knot near the joint. It is a very secure construct.
	The process is repeated and the repair strength is doubled. This picture shows the second anchor about to be driven into its hole.
	The second step of this surgery is to switch the position of the camera, so that the posterior inferior glenohumeral ligament can be released. This is probably the most important part of the surgery, since this is the primary reason the labrum tore - posterior inferior glenohumeral ligament tightness that would not respond to stretching!
	An instrument similar to a long thin scissors is used to simply cut through this tight, thickened ligament.
	The surgeon knows the entire ligament is released when it retracts, and the overlying rotator cuff muscle is visible.

Arthrex Push-Lock Suture Anchor Animation - an animation done by Arthrex that might clarify the details of placing the sutures in the above surgical procedure. If you watch this animation closely, please note that we at SafeThrow use a technique that is improved over the one depicted in that animation. The technique in the animation shows each suture passed one time around the labrum. The improved technique, demonstrated in the above sequence of photographs, loops the suture and thus passes each suture around the labrum TWICE. This gives greater contact area of the labrum to the bone under the suture, and increases the strength each anchor provides to the repair.