07. Juni 2016

A More Sophisticated Approach to Shoulder Instability

The soft tissue surgery traditionally used to treat shoulder instability, named the Bankart Repair after the surgeon who first described it, is not always the ideal solution. A more sophisticated approach and a thorough analysis of risk factors is essential in ensuring that individual patients receive the treatment best suited to their symptoms.

 

An anterior shoulder dislocation can often result in trauma-related instability in the front of the shoulder, which can significantly impair quality of life, especially in young patients. As the stabilizing structures of the shoulder joint suffer cumulative damage with each dislocation, surgery is advisable if symptoms of instability persist.

When dealing with a stabilization, it is important to weigh up all the treatment options. Alongside the traditional soft tissue surgery, University Hospital Basel also performs bone block surgery such as the Latarjet Procedure – also named after the surgeon who originated it. New literature shows how essential it is to carry out a differentiated assessment when dealing with patients in risk groups, as dislocation can recur relatively frequently (in 6–19% of cases). Risk groups include young people (under 20), people involved in contact sports, and patients with bone loss to the glenoid or the head of the humerus, which articulate with each other on the shoulder blade. At our Department of Orthopedic Surgery, a Latarjet bone block procedure is advised if the risk factors suggest that soft tissue surgery alone would leave the patient unacceptably likely to suffer another dislocation. At University Hospital Basel, the Latarjet is a combined open and arthroscopic (keyhole) procedure so that ancillary injuries can be dealt with at the same time. This involves attaching the coracoid and conjoined tendon (where part of the biceps attaches) to the lower front part of the glenoid, by dividing the subscapularis muscle horizontally using two parallel screws. A number of clinical studies have shown that the Latarjet Procedure results in a low recurrence of dislocation (5–8% of cases) and has low complication rates. And after both the open and arthroscopic procedures, even professional sports people have been able to return to training quickly and without adverse consequences.

For further information and appointments at University Hospital Basel, please contact our International Service Team.