SPORTS MEDICINE
A shoulder dislocation is a very common injury seen in young athletes. Even if the shoulder is "popped back in" without too much issue, studies have shown anywhere from a 70 to 100% chance of subsequent dislocations in individuals under 20 years old. In addition to the obvious pain and dysfunction these dislocations cause, individuals can experience significant trauma to the joint leading to severe arthritis at a young age. For that reason, operative intervention has increasingly become the standard of care for young athletes who sustain a shoulder dislocation.
When the shoulder dislocates, the labrum (soft tissue which surrounds the socket) will often tear. Surgeons generally will try to repair this tissue back to the socket. This procedure is most commonly performed arthroscopically (through tiny incisions using a camera). Generally patients are able to return to sports approximately 6 months after the surgery. While the results of this procedure are good, there does still remain a risk of approximately 10% to 25% of further dislocations. For this reason, surgeons continue to look for ways to limit further dislocations following surgery.
When a shoulder dislocates, the posterior (back) part of the humeral head often gets dented by the glenoid (socket). This is called a Hill-Sachs defect. This defect can place the shoulder at greater risk for further dislocations in the future as it can engage the edge of the glenoid during certain movements. Remplissage is a French word that means "filling the defect." It involves filling the defect in the humeral head with the overlying portion of the rotator cuff. This is typically performed arthroscopically and in conjunction with the repair to the ligaments and labrum.
Suture anchors are placed into the Hill-Sachs defect in the humeral head. The overlying rotator cuff is then secured down to the defect using the sutures. This creates a harness that simultaneously fills the defect and also prevents the humeral head from engaging with the glenoid rim during movement. This can significantly reduce shoulder instability and lower the risk of future dislocations. The main potential drawback of this procedure is that some patients experience limitations with the ability to externally rotate the arm. While this is generally only a few degrees, certain athletes such as throwers may find this problematic as they attempt to return to their sport.
Adding this procedure to a standard labral repair does not affect recovery time. Patients go home the day of surgery and typically remain in the sling for approximately 6 weeks. Most patients begin moderate exercise within 2 or 3 months to help regain strength. Typically, patients return to sports 6 months following the surgery.
Learn more about our state-of-the-art shoulder care at Ortho Rhode Island.
