SHOULDER INSTABILITY SURGERY – BANKART REPAIR
When an individual sustains a shoulder dislocation or multiple shoulder dislocations, the labrum (bumper) on the front of the shoulder joint tears. This type of labral tear is called a “Bankart” tear. In addition, the ligaments that surround the shoulder joint – the capsule – stretch and loosen. Also, on occasion, a piece of bone may break off of the humeral head when it “pops out” of the socket during a dislocation. This type of fracture is called a Hill-Sachs lesion.
In those patients who require surgical stabilization for an unstable shoulder, Dr. Keller usually uses a minimally-invasive approach. During surgery, Dr. Keller positions the arthroscope (camera) into the shoulder joint and identifies the torn labrum and stretched capsular tissue. He then uses small instruments to place suture anchors (medical screws with strong sutures) along the border of the front of the socket. Next, Dr. Keller, threads the sutures from the anchors through the stretched tissue and around the torn labrum. He then uses a special device to tie strong knots against the shoulder socket. With this technique, Dr. Keller achieves two goals: he re-tightens the shoulder capsule and repairs the shoulder labrum (bumper) back down to its native position on the shoulder socket.
In those patients with a large Hill-Sachs lesion (divot fracture on the humeral head), Dr. Keller may also perform a Remplissage technique. The goal of this technique is to further stabilize the shoulder. During Remplissage, Dr. Keller positions the arthroscope in the shoulder and places suture anchors inside the divot fracture on the humerus bone. Dr. Keller then harnesses the infraspinatus tendon with the sutures and tensions the tendon by tying knots inside the divot fracture. By filling in the divot fracture with tensioned tendon, Dr. Keller helps stabilize the shoulder further.
Following surgery, patients are given a sling for comfort. Dr. Keller recommends intermittent icing and gentle range of motion following surgery. Dr. Keller also recommends starting physical therapy approximately 2-4 weeks after surgery. Physical therapy focuses on reducing swelling in the shoulder, restoring full range of motion, and maintaining strength in the shoulder. It is also important to avoid certain shoulder positions for 8-12 weeks after surgery.