Posterior Capsular Repair – Dr. Hawkins
Positioning: Lateral decubitus on the beanbag.
Prepping and Draping:
Shave the area. 10×10 steri-drape across the neck. Mark off the tip of the acromion. The incision is vertically down from the posterior tip to the axillary fold.
Vertical skin incision. Cautery through the dermis. Mets through the subcutaneous tissue to reach the deltoid fascia. Undermine the subcutaneous tissue so as to expose the fascia (but, like in the rotator cuff repairs, don’t go through it).
Once adequately mobilized, incise the deltoid fascia and split the fibers. The location for where you “go for it” is based on palpating the posterior glenoid. Use mets to split the fibers until you come across the fascia overlying the infraspinatus tendon. Galpis are inserted. Undermine deltoid so that you get a good look at the infraspinatus tendon. He does not attempt to separate infraspinatus from teres minor.
Use cautery to get through the tendon, and use a Howarth to develop the interval between the tendon and the capsule. Start superiorly. The dissection is then carried both horizontally along the superior border of the tendon and vertically through the tendon to expose the capsule. The capsule is THIN and easy to perforate.
Then use a knife to incise the capsule – a horizontal incision, then vertically along the labral edge. Look for a Bankhart equivalent – rare. Then plicate the capsule by reefing up on the inferior limb.