Our Summary

This research paper discusses the treatment of a certain type of shoulder instability, specifically multidirectional instability (MDI). When traditional non-surgical treatments fail, a type of minimally invasive surgery called arthroscopic surgical stabilization is often used. This surgery allows doctors to easily reach all parts of the shoulder joint. As this surgical technique has advanced, we’ve learned more about what leads to successful recovery after the operation.

The best way to use arthroscopic surgery for MDI currently involves fixing the labrum (a ring of cartilage in the shoulder joint), reducing the size of the joint capsule in a way that’s specific to each patient, and properly treating any potential injuries to the biceps anchor (a part of the shoulder that helps keep the arm stable).

The authors of this paper also provide a video guide to their method for this surgery, which involves repairing the entire labrum and shifting the joint capsule using a specific type of anchor that doesn’t require knots, in cases where the patient also has a specific type of injury to the labrum known as a type II SLAP lesion.

FAQs

  1. What is the preferred treatment option for multidirectional type of shoulder instability (MDI) after failed conservative therapy regimens?
  2. What is the optimal arthroscopic treatment of MDI as per the current techniques?
  3. What is the technique presented in the article for arthroscopic circumferential labral repair and pancapsular shift in the setting of MDI with a concurrent type II SLAP lesion?

Doctor’s Tip

One helpful tip a doctor might tell a patient about labral repair is to follow post-operative rehabilitation guidelines closely to ensure proper healing and optimize recovery. This may include physical therapy exercises to strengthen the shoulder muscles, as well as avoiding certain activities or movements that could put strain on the repaired labrum. It is important to communicate with your healthcare team throughout the recovery process and report any changes or concerns promptly.

Suitable For

Patients who are typically recommended for labral repair include those with multidirectional type of shoulder instability who have failed conservative therapy regimens. This may include patients with recurrent dislocations or subluxations, as well as those with a concurrent type II SLAP lesion. Arthroscopic surgical stabilization is often preferred for these patients, as it allows for easy access to all aspects of the capsule with one surgical procedure. Factors critical to postoperative success include restoring labral integrity, reducing capsular volume, and addressing potential lesions of the biceps anchor. Overall, patients who are recommended for labral repair are those who would benefit from stabilizing the shoulder joint and addressing any associated pathologies.

Timeline

Before Labral Repair:

  1. Patient experiences shoulder pain and instability
  2. Patient undergoes imaging studies such as MRI to diagnose labral tear
  3. Patient undergoes conservative therapy such as physical therapy and corticosteroid injections
  4. Patient continues to experience symptoms and decides to undergo arthroscopic labral repair surgery

After Labral Repair:

  1. Patient undergoes arthroscopic labral repair and pancapsular shift using knotless all-suture anchors
  2. Patient is placed in a sling for a period of time to protect the repaired labrum
  3. Patient undergoes physical therapy to regain shoulder strength and range of motion
  4. Patient gradually returns to activities and sports as recommended by their surgeon
  5. Patient experiences improved shoulder stability and decreased pain postoperatively

What to Ask Your Doctor

  1. What is the success rate of labral repair in patients with my specific type of shoulder instability?
  2. What are the potential risks and complications associated with labral repair surgery?
  3. How long is the recovery process after labral repair surgery, and what can I expect in terms of pain and rehabilitation?
  4. Will I need physical therapy after the surgery, and if so, for how long?
  5. Are there any specific precautions or restrictions I should follow post-surgery to ensure the best possible outcome?
  6. How soon can I return to my normal daily activities and sports or physical activities after labral repair surgery?
  7. Are there any alternative treatment options to consider before proceeding with labral repair surgery?
  8. How often will I need follow-up appointments or imaging to monitor the success of the surgery?
  9. What is the long-term outlook for my shoulder after undergoing labral repair surgery?
  10. Are there any specific lifestyle changes or modifications I should make to prevent re-injury to my shoulder in the future?

Reference

Authors: Rupp MC, Rutledge JC, Dey Hazra RO, Dey Hazra ME, Haskel J, Millett PJ. Journal: Arthrosc Tech. 2023 Jul 3;12(8):e1289-e1295. doi: 10.1016/j.eats.2023.03.020. eCollection 2023 Aug. PMID: 37654880