Shoulder Instability Surgery
What are the Surgical Options for Anterior Shoulder Instability? Exploring Advanced Techniques.
When conservative management fails to adequately stabilize the shoulder or when there are significant structural abnormalities, surgical intervention becomes necessary for the treatment of anterior shoulder instability. Orthopedic surgeons employ various advanced techniques tailored to the individual patient’s condition and needs. Below, we delve into the details of four prominent surgical options: Arthroscopic Bankart Repair, Remplissage, Latarjet Procedure, and Distal Tibia Allograft.
- Procedure: Arthroscopic Bankart repair is a minimally invasive procedure aimed at addressing anterior shoulder instability by repairing a detached or torn labrum (a ring of cartilage surrounding the glenoid) and reattaching it to the glenoid rim.
- Advantages:
- Minimally invasive approach with smaller incisions, leading to less postoperative pain and faster recovery.
- Preservation of healthy tissue and surrounding structures.
- High success rates in restoring shoulder stability, particularly in cases of isolated labral tears without significant bone loss.
- Considerations:
- May not be suitable for cases with significant bone loss or capsular deficiency.
- Rehabilitation and recovery may still be lengthy, requiring dedicated physical therapy.
- Procedure: Remplissage, which means “to fill in” in French, is a procedure often performed in conjunction with Bankart repair for cases of shoulder instability with concomitant Hill-Sachs lesions (indentations in the humeral head resulting from dislocations). It involves filling the defect with soft tissue (usually the posterior capsule and infraspinatus tendon) to prevent engagement of the Hill-Sachs lesion on the glenoid rim during shoulder movement.
- Advantages:
- Addresses both the labral pathology (Bankart lesion) and the engaging Hill-Sachs lesion, providing additional stability.
- Can be performed arthroscopically in combination with Bankart repair, minimizing surgical trauma.
- Considerations:
- Potential risk of loss of external rotation due to the posterior capsular shift.
- May not be suitable for all cases of shoulder instability, particularly those without significant engaging Hill-Sachs lesions.
- Procedure: The Latarjet procedure involves transferring a portion of the coracoid process of the scapula, along with the attached conjoint tendon, to the anterior aspect of the glenoid to create a bony block. This provides additional stability to the shoulder joint, particularly in cases of significant bone loss or recurrent instability.
- Advantages:
- Creates a bony block, addressing both soft tissue and bony deficiencies.
- Provides excellent stability, even in cases of significant bone loss or glenoid defects.
- Low recurrence rates and high success rates in restoring shoulder function, even in high-risk patients.
- Considerations:
- Involves an open surgical approach, which may result in longer recovery times and increased risk of complications compared to arthroscopic procedures.
- Potential risk of non-union or malunion of the coracoid graft.
- Procedure: In cases of severe glenoid bone loss, where conventional techniques may not provide adequate stability, a distal tibia allograft can be used to reconstruct the glenoid surface. The allograft is shaped to match the anatomy of the glenoid and fixed in place with screws.
- Advantages:
- Provides a large, structurally sound graft to reconstruct the glenoid surface, restoring stability.
- Offers an alternative for cases with extensive bone loss or failed previous surgeries.
- Considerations:
- Requires meticulous surgical technique to accurately shape and position the allograft.
- Potential risk of graft resorption or non-union.
- Long-term outcomes and complications are still being studied, and further research is needed to establish the efficacy of this technique.
Why choose Dr. Christian Cruz?
For patients requiring surgery to correct shoulder instability, Dr. Christian Cruz provides expert care across Alexandria, Arlington, and Lanham. Using advanced surgical techniques, Dr. Cruz aims to restore stability and strength to the shoulder joint. Schedule your consultation today.
At a Glance
Dr. Christian Cruz
- Fellowship trained in Sports Medicine and Shoulder Surgery
- Expertise in complex knee and shoulder reconstruction
- Assistant Professor of Orthopaedic Surgery at Uniformed Services University School of Health Sciences
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