By Dev Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
I wrote last week about improvements in ACL surgery over the last 25 years and this week I’d like to explore improved results from another commonly performed sports medicine surgery- stabilization surgery for the dislocating shoulder. The results here mirror those of ACL surgery in many ways.
Many young athletes dislocate a shoulder from trauma, typically a dive with the arm outstretched overhead. This can happen in any sport involving that kind of motion, and any contact sport.
Most surgeries were performed through a large “open” incision 25 years ago, but nowadays can be performed arthroscopically in most cases. For uncomplicated stabilization of shoulders that have had a small number of dislocations from trauma, we should expect 90% of shoulders to remain stable and satisfaction rates upwards of 80% out to about 5 years with current methods, for recreational athletes.
Early Open Surgery Methods- Very Good At Stabilizing, Not So Good At Retaining Motion
Historically, the open surgery was for an unstable shoulder was reported in the early 1900s. A surgeon named “Bankart” first described the essential anatomy of the torn ligament and labrum stabilizing the shoulder in 1923, and for the most part we still generically refer to a shoulder stabilization as a “Bankart repair”.
Over the decades as additional knowledge was gained, modifications to the original procedures were developed. A key component surrounded understanding why surgeries on shoulders with many dislocations tended to do poorly compared to ones with only a few dislocations. While there are many factors, restoring bone loss that resulted from the dislocations was a major advancement.
As it turned out, open stabilization was extremely effective at providing excellent stabilization, with low re-dislocation rates. But it came at a price. The rehabilitation was difficult and often resulted in permanent motion loss. Some techniques had unacceptably high rates of early arthrits. The end result was that many folks ended up with a stable shoulder but were unhappy about the result.
Arthroscopic Stabilization- Much Better At Retaining Motion With Excellent Stability
“Arthroscopy” involves small incisions, with the surgeon visualizing and performing repairs through the small incisions. There are numerous advantages over open surgery. Arthroscopy avoids some complications of open incisions, is generally faster, has minimal blood loss, is more comfortable after surgery, and generally leads to a faster return to sports with excllent joint motion.
And yet, in its earliest years, arthroscopic stabilization had a higher dislocation rate than open surgery. As it has been with ACL reconstruction surgery, arthroscopic shoulder stabilization has improved substantially over the years. Better surgical technique, improved surgical implants, and cutting-edge rehabilitation all play a role.
Measuring the ultimate outcome from arthroscopic shoulder stabilization surgery can involve many factors. Is there another dislocation after surgery? How is the range of motion? What’s the patient’s level of sport activity? How does the patient feel about their result?
If you’re a young athlete with an unstable shoulder, and you have a strong desire to resume a contact or collision sport you’ll likely want to consider shoulder stabilization surgery. Find an experienced shoulder surgeon and have a thorough discussion. You’ll have to work hard on your rehab and be patient but you should generally end up with an excellent result.