Subjects enrolled in the study have consulted with a participating surgeon and have decided to treat their shoulder instability surgically using one of the following standard procedures:
Arthroscopic Bankart with Remplissage of a Hill-Sachs lesion, Open Bankart, or Latarjet.
While one of these techniques is less invasive and is performed arthroscopically, both open and arthroscopic procedures restore shoulder stability. All three of the procedures have a long history of success and are used routinely in clinical practice.
The Arthroscopic Bankart with Remplissage of a Hill-Sachs lesion is a procedure that involves the use of several small incisions and a small camera, known as an arthroscope, to examine the shoulder joint prior to repair. Instruments are then inserted into these small incisions to repair the shoulder capsule and labrum (cartilage). This prevents the humerus, or upper arm bone, from subluxating forward from the joint cavity. A Hill-Sachs lesion is a compression fracture that usually occurs due to a traumatic dislocation and this repair aims to recenter the humeral head so that it no longer is compressed against the rim of the glenoid cavity. Remplissage means "to fill in" and is performed by filling the Hill-Sachs lesion with the shoulder capsule in the back of the shoulder and the infraspinatus (one of the rotator cuff muscles in the back of the shoulder). Small anchors are placed in the humeral head and the labrum is sutured to strengthen the repair.
An Open Bankart repair is similar to the Arthroscopic Bankart, however, an incision is made in order to perform the shoulder stabilization procedure. The incision is made over the front of the shoulder joint and the surgeon repairs the shoulder capsule and labrum, while also repositioning any ligaments that may have shifted due to the shoulder dislocation.
The Latarjet is also an open shoulder stabilization procedure but involves a bone transfer to the front of the joint cavity to restore bone loss. The bone graft is taken from a small structure on the shoulder blade, known as the coracoid, and provides a barrier to prevent further dislocations. After the bone graft is completed, the surgeon then takes the tendon attached to the coracoid and repositions it in front of the shoulder joint to provide extra support. Finally, the labrum is repaired, and the shoulder capsule is tightened.