Shoulder Instability Surgical Treatment

Surgery may be recommended for patients who have:

• Recurrent dislocations or subluxations: Instability that continues despite rehabilitation.
• A first dislocation in a young contact or collision athlete: Early stabilization substantially reduces recurrence in this group, and it is a conversation worth having before a second episode causes further bone loss.
• Bone loss from the socket or a significant defect in the ball: Measured on CT, these findings change which operation is appropriate.
• Persistent apprehension limiting sport or work: An athlete who cannot put the arm in the at-risk position is functionally unstable even without another dislocation.
• An associated injury requiring treatment: A rotator cuff tear, a large labral tear extending around the socket, or a fracture of the socket rim.

The operation is selected from the pattern of injury, the amount of bone loss, the patient’s sport and position, and the number of prior episodes. Dr. Rynecki Baker discusses the specific rationale with each patient before surgery.

Arthroscopic Bankart Repair

The torn labrum and capsule are reattached to the rim of the socket with suture anchors, restoring the bumper that deepens the joint and re-tensioning the stretched capsule. It is performed arthroscopically through small incisions as an outpatient procedure, and it is the appropriate operation for patients with little or no bone loss. Results are excellent in that group, and considerably less reliable once meaningful bone is missing, which is the reason why you may be required to get a CT scan before surgery.

Remplissage

A defect in the back of the ball, created when it impacted the socket rim during dislocation, can engage on the front of the socket and allow the shoulder to slip out even after a labral repair. Remplissage fills that defect by securing the posterior rotator cuff tendon and capsule into it, preventing engagement. It is performed arthroscopically alongside a Bankart repair and has substantially improved results in patients with moderate bone involvement.

Latarjet Procedure

When bone is missing from the front of the socket, the coracoid process is transferred, with its attached muscles, to the deficient front rim and fixed with screws or suture buttons. The procedure works in three ways: it restores the bony arc of the socket, the transferred muscles act as a sling supporting the joint in the at-risk position, and the attached tissue reinforces the capsule. It is a great operation for significant bone loss, for revision after a failed repair, and in many high-risk collision athletes.

Bone Block and Glenoid Reconstruction

For large socket defects, or in revision cases where the coracoid is unavailable, the socket can be reconstructed with a bone graft, using either the patient’s own bone or donor bone shaped to match the missing rim.

Posterior Stabilization

Posterior instability is addressed by repairing the posterior labrum and tightening the posterior capsule arthroscopically. Patients with posterior bone loss or excessive backward tilt of the socket may require a bone graft or an osteotomy to correct the underlying orientation, and identifying this before surgery is essential.

Capsular Shift and Plication

Patients with multidirectional instability or patulous capsules who have completed a full rehabilitation program without success may be candidates for an open procedure with or without a graft that reduces capsular volume. This is a different operation with a different rationale from a traumatic instability repair.

After an arthroscopic Bankart repair, with or without remplissage

• Sling use: A sling is worn for approximately four to six weeks, with outward rotation limited early to protect the repair.
• Motion: Passive motion begins in the first weeks within protected ranges, with progression to full active motion by around six to eight weeks.
• Strengthening: Rotator cuff and scapular strengthening begin at around six weeks and progress through the third and fourth months.
• Return to sport: Overhead and non-contact sport generally at four to five months, contact and collision sport at approximately six months, guided by objective testing rather than the calendar.

The timeline is broadly similar, with a sling for four weeks, early motion emphasized to avoid stiffness, and strengthening beginning once the transferred bone has begun to heal. A postoperative CT scan may be obtained to confirm healing before return to collision sport, which is generally around five to six months.

Every patient receives a written protocol specific to the procedure performed, and Dr. Rynecki Baker works closely with each patient and their physical therapist throughout recovery. Clearance is based on strength testing, restored motion, and demonstrated confidence in the at-risk position.