Burcu ERÇAKMAK, Alp BAYRAMOĞLU, M. Hakan ÖZSOY, K. Mutlu HAYRAN, M. Deniz DEMİRYÜREK, Ceren GÜNENÇ BEŞER

Soft spot: the important zone at the standard posterior portal of shoulder arthroscopy

Background/aim: The localization of the standard posterior portal of shoulder arthroscopy and landmarks mentioned in the literatureare unclear. The purpose of this prospective cadaveric study was to determine the localization of the standard posterior portal and itsdistance to the neural structures.Materials and methods: One fresh frozen and 10 formalin-fixed adult cadaveric shoulders were dissected. In the beach chair position, a5-mm trocar was placed anteroposteriorly from the superior edge of the subscapularis muscle, superior to the tip of the coracoid processand tangent to the glenoid. The relevant distances of the posterior exit point were measured.Results: In all specimens, the exit point was a triangular fibrous area, between the posterior and lateral parts of the deltoid. Medial andinferior distances of the trocar to the posterolateral tip of the acromion were 1.88 ± 0.53 cm and 1.35 ± 0.34 cm and distances to theaxillary and suprascapular nerves were 4.54 ± 1.08 cm and 2.54 ± 0.85 cm, respectively.Conclusion: The most important finding of this study was the superficial localization of the soft spot between the posterior and lateralparts of deltoid.

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Di Giacomo G, Costantini A. Arthroscopic shoulder surgery anatomy: basic to advanced portal placement. Oper Tech Sports Med 2004; 12: 64-74.
DiFelice GS, Williams RJ, Cohen MS, Warren RF. The accessory posterior portal for shoulder arthroscopy. Arthroscopy 2001; 17: 888-891.
Espinosa-Uribe AG, Morales-Avalos R, Gutierrez-de la J, Garcia-de Leon OR, Torres-Garcia JK, Guzman-Avilan K, Vilchez-Cavazos F, de la Garza-Castro O, Guzman-Lopez S, Elizondo-Omana RE. Safe areas for the placement of standard shoulder arthroscopy portals. An anatomical study. Int J Morphol 2015; 33: 1386-1392.
Farmer KW, Wright TW. Shoulder arthroscopy: the basics. J Hand Surg Am 2015; 40: 817-821.
Lo IKY, Lind CC, Burkhart SS. Glenohumeral arthroscopy portals established using an outside–in technique: neurovascular anatomy at risk. Arthroscopy 2004; 20: 596-602.
Paxton ES, Backus J, Keener J, Brophy RH Shoulder arthroscopy: basic principles of positioning, anesthesia, and portal anatomy. J Am Acad Orthop Surg 2013; 21: 332-342.
Bozkurt M, Simsek ME, Açar Hİ. Arthroscopic anatomy of shoulder. In: Bozkurt M, Açar Hİ, editors. Clinical Anatomy of the Shoulder. An Atlas. Berlin, Germany: Springer; 2017. pp. 17-23.
Caborn DNM, Fu FH. Arthroscopic approach and anatomy of the shoulder. Oper Tech Orthop 1991; 1: 126-133.
Meyer M, Graveleau N, Hardy P, Landreau P. Anatomic risks of shoulder arthroscopy portals: anatomic cadaveric study of 12 portals. Arthroscopy 2007; 23: 529-536.
Davidson PA, Tibone JE. Anterior-inferior (5 o’clock) portal for shoulder arthroscopy. Arthroscopy 1995; 11: 519-525.
Imhoff AB, Ansah P, Tischer T, Reiter C, Bartl C, Hench M, Spang JT, Vogt S. Arthroscopic repair of anterior-inferior glenohumeral instability using a portal at the 5:30-o’clock position: analysis of the effects of age, fixation method, and concomitant shoulder injury on surgical outcomes. Am J Sports Med 2010; 38: 1795-1803.
Goubier JN, Iserin A, Augereau B. The posterolateral portal: a new approach for shoulder arthroscopy. Arthroscopy 2001; 17: 1000-1002.
Nord KD, Brady PC, Yazdani RS, Burkhart SS. The anatomy and function of the low posterolateral portal in addressing posterior labral pathology. Arthroscopy 2007; 23: 999-1005.
Andrews JR, Carson WG Jr, Ortega K. Arthroscopy of the shoulder: technique and normal anatomy. Am J Sports Med 1984; 12: 1-7.
Mirouse G, Nourissat G. The split portal: description of a new accessory posterior portal for arthroscopic shoulder instability procedures. Knee Surg Sports Traumatol Arthrosc 2016; 24: 625-629.
Wolf EM. Anterior portals in shoulder arthroscopy. Arthroscopy 1989; 5: 201-208.
Iamsumang C, Chernchujit B. The supine position for shoulder arthroscopy. Arthrosc Tech 2016; 5: e1117-e1120.