Question:Our daughter tore the cartilage in her shoulder playing volleyball. We watched a short video that showed us how the surgeon is going to repair the problem. I didn't really understand what the portals are that they talked about. It seems like these are important, but I didn't really get it.
Answer:It sounds like your daughter is going to have arthroscopic surgery. This means the surgeon uses a long, thin needle inserted through the skin into the joint. There's a tiny TV camera on the end of the needle that projects a picture up on a screen for the surgeon to watch.
This enables the surgeon to see inside the joint. It helps him or her move the surgical tools needed to make the repair. The portals are the places where the needle is inserted. It's important to find clear channels where the needle can slide into the joint without puncturing or damaging other tissues.
Where the surgeon inserts the scope depends on the suspected location of the tear. The first step in the repair process is to look inside the joint and find the tear. The surgeon examines the location and extent of the damage. This allows him or her to plan the next step in the repair process.
The scope must be inserted in a direction that allows the surgeon to see the opposite side of the joint. So, if the scope is inserted through an anterior approach (front of the shoulder), then the back or posterior portion of the joint can be seen.
Sometimes the surgeon uses one portal to identify the problem but a different portal to fix it. Again, this is based on the information gathered during the diagnostic exam. Some places are harder to reach than others. The surgeon must choose the portal that will give the best access to the damaged area without causing further damage getting there.Matthew T. Provencher, MD, LCDR, MC, USNR, et al. Arthroscopic Preparation of the Posterior and Posteroinferior Glenoid Labrum. In Orthopedics. November 2007. Vol. 30. No. 11. Pp. 904-905.
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