Arthroscopic Stabilisation (Labral Repair) Surgery
An arthroscopic stabilisation labral repair is an operation performed to prevent further instability of the shoulder. When a patient suffers a traumatic dislocation of the shoulder then the labrum (ring of soft tissue around the rim of the shoulder socket) is often torn from its attachment at the front of the shoulder socket (glenoid). There is often damage to the ligaments in the shoulder which lose their tension. As a consequence of the damage to the soft tissue structures young patients can often continue to have symptoms of instability including further dislocation as there is now a structural weakness in the shoulder. Previously the labrum and capsular ligaments were repaired via an open surgical procedure with a scar at the front of the shoulder. In more recent years there have been advances in technology with regards to arthroscopy and modern arthroscopic anchors, sutures and instrumentation which have allowed repair of the labrum and soft tissue structures to be performed by arthroscopic keyhole techniques.
An arthroscopic stabilisation labral repair is performed under a general anaesthetic. An interscalene block to temporarily numb the nerves supplying the shoulder and arm is also usually performed to provide good post operative pain relief. A number of port sites are used to insert the instruments and these lead to a small 1cm incision at the back of the shoulder and two small 1cm incisions over the front of the shoulder. The damaged labrum tissue is mobilised, the rim of the socket (glenoid) is prepared and the labrum is re-attached in its normal position with the use of arthroscopic anchors and sutures. When the patient wakes up from surgery the arm will feel numb with little movement possible due to the nerve block and this will last for a number of hours (on average eight to twelve hours) following the surgery. The patient will wake up with their arm in a sling and they will usually stay in hospital overnight.The day following the surgery the nerve block should have worn off and the patient’s pain controlled well with simple oral painkillers. Regular simple anti-inflammatory painkillers are advisable for the first few weeks and the use of an ice pack on the shoulder may be helpful to keep the shoulder comfortable over the first week. Before discharge the patient is reviewed by a ward physiotherapist and they are usually allowed home the following day after surgery.
Arthroscopic stabilisation surgery is usually very successful in preventing further episodes of instability. The risk of suffering a further dislocation after an arthroscopic stabilisation is approximately one in ten, with young patients participating in contact sporting activity at the highest risk of this. Other risks of surgery include general anaesthetic, infection, nerve damage, leg or lung clots (DVT deep vein thrombosis, PE pulmonary emboss) and stiffness.
The arm is usually immobilised in a sling for four weeks and then the patient gradually discontinues using the sling over the following two weeks. Following surgery it often takes patients approximately two months before they can return to driving. Patients can normally return to breaststroke swimming at approximately eight weeks and front crawl after three months. Returning to playing golf often takes three months and it is an absolute minimum of three months before a patient can return to contact sporting activities. A patient can only return to contact sporting activities once they have regained symmetrical movement and power in the shoulder and have completed sports specific physiotherapy with their therapist.