Instability occurs most often during an injury, when the shoulder “pops out” of its socket. Then it is necessary to put the shoulder back in place (reposition) and start the rehabilitation process as soon as possible. Unfortunately, what is less well known is the high probability that the shoulder will pop out again, especially in the younger and sports-active population (the percentage of repeated luxations ranges up to 100% depending on the type of activity). This primarily applies to contact sports such as handball, water polo, volleyball, football, rugby, martial arts, skiing, etc.
For each subsequent “popping” of the shoulder, a trauma of decreasing intensity is required – the shoulder “pops” more and more easily, so after multiple luxations it can often pop out even in sleep.
The basic method of treatment is the reconstruction of the joint structures of the shoulder. In our practice, we suggest surgery already after the second luxation in order to avoid major damage to the ligaments and bony structures of the shoulder joint, which significantly complicates the treatment later. We perform the operation arthroscopically through several small approaches, during a one-day stay in the hospital. During the operation, the damaged shoulder structures are returned to their anatomical place with the help of several special anchors with strong threads. The procedure is safe and almost without complications. As long as the surgery does not wait for the shoulder to pop out more than once (often patients talk about 10 or even 20 luxations), the success rate of the procedure is over 90%, i.e. more than 90% of patients will no longer have an unstable shoulder and will return to their previous activities. For normal life activities, such as writing, combing, eating, etc., our patients are ready practically on the second day after surgery. Rehabilitation under the supervision of trained therapists begins immediately. A protective orthosis for the shoulder is worn for the first three weeks after the operation. After removing the orthosis, they begin more active rehabilitation, and within a few months, depending on the type of activity, our patients return to training.
Arthroscopic shoulder surgery
Unfortunately, awareness of the success of shoulder surgeries is still at the level of awareness of orthopedic surgeries from twenty years ago, so patients often do not decide to undergo surgery when it is recommended, and as a result, shoulder “pops” are becoming more numerous. Every “jumping” of the shoulder additionally damages the ligaments of the shoulder, as well as the bone of the joint, so classic arthroscopic surgery can no longer provide sufficient stability to the shoulder. Classic arthroscopic stabilization will not be effective even in the case of recurrence of shoulder dislocation, and after surgery we remind you of the 5-10% possibility of shoulder dislocation even after the stabilization procedure.
This is where a procedure devised by Dr. Latarjet found its place, consisting of an open shoulder surgery, in which one smaller bone in the shoulder area (coracoid process), and to which the tendons of the upper arm muscles are attached, is transferred to the site of the bony defect; in the case of classic operations, this bone is attached to the scapula with two screws. The stability of the reconstructed shoulder is also very good, but there is often a lack of certain movement, which can be a hindrance in some sports activities.
At Aksis Special Hospital, we recently introduced a new method of unstable shoulder surgery – arthroscopic Latarjet procedure. It is an arthroscopic modification of the previously described operation. Only a few centers in France and Italy can boast of the application of this technique, and we can say that we were certainly the first to perform this kind of operation in the whole of Southeast Europe!
What are the advantages?
First of all, the procedure becomes minimally invasive because it is performed through 4 small holes in the shoulder area. In this way, an important shoulder muscle – the deltoid muscle – is not damaged, large scars are not left behind, and the effect on shoulder stability is equal to or even better than that of open surgery.
Postoperative pain is significantly lower, and patients’ immediate postoperative satisfaction higher. The rehabilitation process and return to sports are much faster – for example, with a standard arthroscopic shoulder stabilization surgery, we allow running only after 3 months, and with the arthroscopic Latarjet procedure, the expected return time to contact sports is 3 months.
Small approaches and minimal surgical trauma enable almost complete recovery of mobility of the operated shoulder.
Aksis Special Hospital went one step further – we eliminated the metal or titanium screws used to stabilize the coracoid process. With this, we have removed one of the potential complications – the cracking of the screws. We use special and extremely strong mesh tapes that not only provide less possibility of damage to the coracoid process but also provide even better stability of the reconstruction after the operation. We check the stability of the reconstruction at the end of each performed operation and can confirm that it is exceptional.
We emphasize that these operations are not reserved only for athletes, but for everyone who suffers from an unstable shoulder.
Arthroscopic Latarjet for recurrent shoulder instability is performed in regular practice at our hospital by the head of the Department of Orthopedics, prim. Mladen Miškulin, MD, PhD.