How is a revision shoulder instability surgery performed?
Before proceeding with revision surgery, it is imperative that Dr. Vidal do a thorough evaluation to determine the exact nature of the patient’s shoulder instability. The nature of the recurrences, prognosis and a realistic set of expectations are important for the success of a revision shoulder instability surgery. Dr. Vidal will take into consideration the condition of the labrum, capsule, and surrounding tissues before proceeding with any revision surgery.
Once it has been determined that revision shoulder instability surgery is required, Dr. Vidal may use one or more of the following surgical techniques:
Arthroscopic Revision Surgery – Modern minimally invasive techniques have improved the success of stabilization procedures making arthroscopic revision surgery a viable revision procedure in the case of recurrent instability. The goal is to re-tighten the lost tissues and ligaments that have re-stretched or were not corrected appropriately with the first procedure. Success rates have been reported as high as 90%. Revision Bankart repair, done arthroscopically, is more complicated as a result of prior stabilization procedures making this a highly technical procedure that should be attempted only by a highly skilled surgeon like Dr. Armando Vidal.
Open Revision Bankart Repair – Open surgery utilizes a larger incision on the shoulder than arthroscopic surgery. The open technique allows Dr. Vidal to better visualize the labrum and make necessary repairs. Open revision Bankart repair has been shown to be successful for both collision and contact athletes, returning them to sport activities following a failed primary procedure.
Latarjet Procedure – The size and amount of bone loss or defect plays a major role in determining the best procedure in managing shoulder instability with the Latarjet procedure. During this specialized procedure, Dr. Vidal uses the coracoid (a small bump of bone on the front of the scapula) as a bony bumper in the Latarjet procedure. The bone graft is held in place with screws and prevents further shoulder dislocations.
Glenoid Bone Graft – In cases of bone loss where the socket of the shoulder is compromised, a glenoid bone graft may provide the needed stability by deepening the socket. The bone graft is taken from the iliac crest (top of the hip bone) and secured with screws to the front of the shoulder socket. This is a highly technical procedure and should only be performed by highly skilled surgeons such as Dr. Vidal.
Capsular Reconstruction – This is a very rare procedure and seldom needed. In this procedure an allograft (cadaver graft) is used to recreate the labrum and capsular ligaments. The graft does the job of the damaged labrum and holds the humeral head within the glenoid (shoulder socket).