Treatment of soft tissue injuries

Soft tissue injuries play a central role in shoulder instability, especially in primary dislocations or recurrent subluxations. The goal of surgical treatment is to restore the anatomical integrity of the stabilizing structures.

Arthroscopic Bankart repair

The arthroscopic Bankart repair is considered the standard procedure for treating labral injuries. This technique involves attaching the torn labrum to the glenoid using special anchors. This technique is particularly commonly used in young, active patients who have developed anterior instability after a primary dislocation.

The advantages of this procedure lie in its minimally invasive technique, which allows for less postoperative pain and a shorter rehabilitation period compared to open surgery. Furthermore, many patients report high levels of satisfaction and the ability to return to their previous level of activity. However, the method also has disadvantages: The risk of recurrent dislocations is increased, particularly in patients with additional bone loss or risk factors such as young age, athletic activity, and hyperlaxity.

Treatment of the SLAP lesion

A SLAP (Superior Labrum Anterior to Posterior) lesion affects the superior aspect of the labrum and is commonly found in overhead athletes such as volleyball or tennis players. Arthroscopic labral reattachment is the primary treatment procedure, particularly in young patients with high athletic demands. In older patients, biceps tenodesis, which relocates the long head of the biceps tendon to reduce stress on the labrum, is often performed.

Arthroscopic refixation offers the advantage of anatomical restoration and can lead to significant long-term stabilization of the shoulder. However, it requires prolonged postoperative rehabilitation, and the risk of failure is higher in older patients, especially if degenerative changes are present.

Rotator cuff repair

The rotator cuff plays a central role in actively stabilizing the shoulder. Injuries to this area, such as trauma or degenerative processes, can lead to instability. Surgical treatment is usually performed arthroscopically, by reattaching the torn tendons to the humeral head.

This procedure allows for functional restoration and symptom relief. However, there is a risk of recurrence of tears in older patients or those with poor tissue quality. Furthermore, postoperative shoulder mobility may be limited.

Treatment of bony lesions

Bone defects play a crucial role, especially in chronic shoulder instability. They often arise as a result of repeated dislocations and require specific surgical interventions to restore shoulder stability.

Latarjet operation

The Latarjet procedure is a proven procedure for treating large glenoid defects. In this procedure, a piece of the coracoid, including the attached muscle tendons, is transplanted to the anterior aspect of the glenoid. This not only enlarges the joint surface but also increases the passive and dynamic stability of the shoulder.

The advantages of the Latarjet procedure include its high effectiveness in patients with significant bone defects. The procedure also has a low recurrence rate and is particularly popular among athletes with demanding physical demands. However, the procedure also carries risks: These include nerve damage, infection, and technical challenges that require an experienced surgeon. In the long term, it can also lead to biomechanical changes that increase the risk of osteoarthritis.

Remplissage

This procedure is used for Hill-Sachs lesions, a dent in the humeral head caused by repeated dislocations. The remplissage technique fills the lesion by suturing the posterior capsule and infraspinatus tendon into the defect. This prevents the defect from snapping into the glenoid when moving the arm.

Remplissage can be performed arthroscopically and provides effective shoulder stabilization. However, it has the disadvantage of limiting external rotation in overhead athletes. Therefore, this procedure is primarily recommended for patients with medium to large Hill-Sachs lesions.

Autologous and allogeneic bone block procedures

For very large glenoid defects, bone blocks from the iliac bone (autologous) or from a donor (allogeneic) can be used to compensate for the defect. The goal is to anatomically restore the original shape of the glenoid cavity.

The advantages of these procedures lie in the precise reconstruction of the joint, which is particularly important in cases of severe defects. However, the procedures are technically demanding and involve a longer rehabilitation period. There is also a risk of resorption of the transplanted bone or the development of non-unions.

Risks and complications of surgical procedures

As with any surgery, procedures to treat shoulder instability carry risks. The most common complications include infection, nerve damage, and postoperative mobility restrictions. Especially in complex procedures such as the Latarjet procedure or bone block grafts, the surgeon's experience is crucial to minimize the risk of complications.

In the long term, patients who have suffered repeated dislocations may develop osteoarthritis. This risk is influenced by the number of dislocations and the degree of biomechanical changes after surgery.

Conclusion

Surgical treatment of shoulder instability offers a variety of options that can be individually tailored to the patient and the type of injury. While minimally invasive procedures such as the arthroscopic Bankart repair produce good results for isolated soft tissue injuries, more complex interventions such as the Latarjet procedure or bone block procedures are required for bony defects. Careful diagnosis and the selection of the appropriate method are crucial for restoring long-term shoulder function and stability and minimizing the risk of complications.