Arthroscopic Shoulder Stabilisation (Bankart Repair)
Description:
Dislocations of the Shoulder (Gleno-Humeral) Joint are common. During the dislocation structural damage may occur to the joint. This damage may involve damage to the fibrous lip (labrum) of the socket (glenoid) or the bony socket (glenoid) itself. This damage may need to be repaired or reconstructed to stabilise the Gleno-Humeral Joint.
The soft tissue damage can usually be repaired or reconstructed as a keyhole (arthroscopic) procedure. The torn labrum is released and secured back to the to the edge of the socket (glenoid) with anchors which are fixed to the bone and to which sutures are attached that allow the labrum to be secured.
If the damage is more extensive with significant loss of bone this void is typically best addressed with a procedure that transfers bone from elsewhere to repair the socket (glenoid). This procedure is typically in the form of a Coracoid transfer or Latarjet procedure although alternative bone grafts can be used. This procedure is most reliably undertaken under direct vision as an open procedure.
There may be associated injuries to the Rotator Cuff or Superior Labrum (SLAP) that can be addressed at the same time.
The purpose of the surgery:
The aim of the surgery is to stabilise an unstable Gleno-Humeral Joint.
Alternative Treatment options:
Shoulder instability may be managed with rehabilitation to optimise muscle function in an attempt to satisfactorily improve stability. Activities can be modified to avoid those during which the Gleno-Humeral Joint feels unstable.
Anaesthetic:
The surgery is typically undertaken with the patient asleep with a nerve block to provide additional pain relief.
Incision and Dressings:
The majority of stabilisations can be performed as a keyhole (arthroscopic) procedure and are usually carried out through two or three small (5mm) incisions. These incisions are closed either with paper Butterfly sutures (SteriStripsTM) with or without dissolvable sutures which do not need to be removed. The wounds are then covered with a splash-proof OpsiteTM dressing. These dressings may in turn be covered by a large padded dressing immediately following the operation. This padded dressing is removed prior to being discharged home.
If there is bone damage then a larger incision is required (open technique) an incision approximately 5cm long is made over the front of the shoulder. This is typically closed with an absorbable suture under the skin. Paper Butterfly Stitches (SteriStripsTM) are usually used and the wound covered with padding and a splash proof OpsiteTM dressing.
Procedure:
The labrum (lip) of the socket is often detached and scarred down. This tissue is released and the damaged edge of the Glenoid (socket) is prepared. The labrum is then reattached to the Glenoid using sutures (stitches) attached to small anchors drilled into the bone of the Glenoid.
Rehbailitation:
Following the surgery immobilisation is required in a polysling. The sling should be worn as instructed in the post-operative guidance. The sling is usually worn for three weeks day and night and three weeks at night. The arm should be exercised as detailed in the post-operative rehabilitation guidelines. This typically involves avoiding movements that stress the repair too soon.
Please see the stabilisation rehabilitation guidelines.
Admission and Discharge:
You will normally be admitted the day of surgery and go home the same day. It may be necessary for you to stay in overnight particularly if you do not have a responsible adult to keep an eye on you overnight or if your operation is late on in the day.
Risks associated with the operation:
All operations are associated with a degree of risk but significant complications associated with a an arthroscopic stabilisation are uncommon. The following risks are those which are serious or most commonly reported in the literature.
Infection (<1%). Infection in shoulder surgery is uncommon, particularly in keyhole (arthroscopic) surgery. If an infection were to develop it is typically a superficial infection, which can be treated with oral antibiotics. Rarely does an infection develop that requires re-admission to hospital and surgery to wash the infection out.
Anaesthetic Risks (Anaestheic complications are rare but include Heart Attack (Myocardial Infarction, MI), Stroke (Cerbero-Vascular Accident, CVA) and a clot in the leg (Deep Vein Thrombosis, DVT) or lungs (Pulmonary Embolus, PE).
Damage to nerve or blood vessels (Neuro-Vascular Damage) (<1%). Damage to nerves or blood vessels are rare. Damage to the axillary nerve may occur as it passes close to the joint. Damage to this nerve may result in weakness and difficulty brining the arm out to the side (abduction).
Stiffness. After the surgery and a period of immobilization the shoulder is likely to be stiff. This stiffness should improve with time and graduated rehabilitation. Initial stiffness may be protective of the repair. Initial stiffness may be protective of the repair. Rarely persistent stiffness or a frozen shoulder (Intrinsic Capsular Stiffness) develops and may require treatment.
Recurrence (5%). The aim of the surgery is to stabilise the shoulder (Gleno-Humeral) Joint. Despite a successful repair or reconstruction there is a small risk of recurrent instability. Typically this follows a further injury.
Further surgery (Re-operation)
Arthritis. While the surgery itself is unlikely to significantly predispose the shoulder to arthritis, a dislocation itself increases the probability of arthritis.
