Michael Fu, MD - HSS Shoulder Surgery

Michael Fu, MD - HSS Orthopedic Surgeon and Shoulder Specialist

Arthroscopic Shoulder Stabilization: Labral Repair and Remplissage

Arthroscopic shoulder stabilization surgery for shoulder instability is a procedure that we commonly perform in our practice. When we treat a patient with shoulder instability, our goal is to prevent the shoulder from further dislocations or subluxations, as each instability injury causes cumulative damage to the shoulder. However, there is a huge difference in instability risk between a high school wrestling athlete who has had multiple dislocations, and a thirty year-old patient who dislocates their shoulder for the first time in a skiing injury. Concurrently, there is a variety of surgical procedures that can be performed to stabilize a shoulder, with different degrees of technical difficulty, morbidity, invasiveness, and tightening of the shoulder. Therefore, an individualized treatment plan is critical for each patient to achieve the goal of a stable and functional shoulder.

As a shoulder-focused practice at Hospital for Special Surgery (HSS), the top-ranked hospital for orthopedics by the US News & World Report, we have treated numerous patients with shoulder instability with successful outcomes.

Understanding Shoulder Instability and Labral Tears

Shoulder instability occurs when the shoulder joint is too loose, and the humeral head (ball) is able to translate excessively in the glenoid (socket). This condition can lead to dislocations and a variety of injuries, including tears to the labrum, which is a cuff of cartilage that deepens the shoulder socket and stabilizes the joint. Labral tears can cause pain, a feeling of the shoulder instability, and a decrease in strength or range of motion.

The Role of Arthroscopic Labral Repair

Arthroscopic labral repair, or shoulder stabilization, is a surgical technique designed to repair tears in the labrum, restoring stability to the shoulder joint. This procedure is particularly beneficial for patients who experience recurrent shoulder dislocations or those with labral tears resulting from acute injury or chronic shoulder instability.

Procedure Overview

Performed under a nerve block (regional anesthesia), arthroscopic labral repair involves making small incisions around the shoulder through which an arthroscope (a small camera) and surgical instruments are inserted. The surgeon views the shoulder joint on a monitor, identifying the tear and using suture anchors to reattach the torn labrum to the bone, thereby restoring the normal anatomy and stability of the shoulder joint.

Remplissage: An Adjunct to Labral Repair

The remplissage procedure is an innovative technique sometimes used in conjunction with labral repair for patients with more severe instability or those with a specific type of bone defect in the humerus known as a Hill-Sachs lesion. Remplissage, French for "filling", involves filling the defect with tendon tissue to prevent the humeral head defect from engaging with the glenoid rim, thereby reducing the risk of recurrent dislocations.

Procedure Details

During the remplissage procedure, after the labral repair is completed, the surgeon introduces a device through another small incision to deploy anchors into the humeral head, within the Hill-Sachs lesion. The infraspinatus tendon, along with a portion of the posterior capsule, is then secured into the defect using these anchors. This effectively "fills" the defect, preventing the humeral head from slipping out of the socket.

Indications for Surgery

Candidates for arthroscopic labral repair plus or minus remplissage are typically individuals who suffer from shoulder instability, recurrent dislocations, and have failed to improve with conservative treatments such as physical therapy. The presence of a labral tear and a Hill-Sachs lesion are key indicators for combining labral repair with the remplissage technique.

Advantages of Arthroscopic Techniques

The arthroscopic approach to shoulder stabilization offers several benefits over traditional open surgery, including:

• Reduced Pain and Swelling: The minimally invasive nature of the procedure results in less tissue damage.

• Quicker Recovery: Smaller incisions and less invasive techniques allow for a faster return to daily activities.

• Lower Risk of Infection: The risk of postoperative infection is decreased due to smaller incisions.

• Improved Cosmetic Outcome: Smaller scars are less noticeable and often more acceptable to patients.

Recovery and Rehabilitation

Recovery from arthroscopic labral repair and remplissage is a structured process that emphasizes gradual healing and strengthening of the shoulder. Initially, patients wear a shoulder immobilizer for about 6 weeks to protect the shoulder and facilitate healing. Pain management, including medications and ice, plays a crucial role in the early recovery phase.

Physical therapy is an integral part of the rehabilitation process, beginning with gentle range-of-motion exercises and progressing to strengthening exercises as healing advances. The specific timeline for recovery varies among individuals, but most patients can expect to engage in light activities within a few weeks, with a full return to sports and strenuous activities occurring several months post-surgery.

Long-term Outcomes

The combination of arthroscopic labral repair and remplissage has shown excellent results in terms of reducing the recurrence of shoulder dislocations and improving joint stability. Patients often experience significant improvements in pain, function, and quality of life following these procedures. However, adherence to postoperative rehabilitation protocols is critical to achieving optimal outcomes.

Conclusion

Arthroscopic shoulder stabilization techniques, including labral repair and the remplissage procedure, represent significant advancements in the treatment of shoulder instability and associated injuries. By offering a minimally invasive solution with favorable recovery profiles, these procedures have become the standard of care for patients experiencing recurrent shoulder dislocations and labral tears. Through detailed surgical planning, expert execution, and dedicated postoperative rehabilitation, patients can look forward to a stable shoulder and an active lifestyle post-surgery. Please contact our office for a consultation to determine the most appropriate treatment plan for individual cases.

About the Author

Disclaimer: All materials presented on this website are the opinions of Dr. Michael Fu and any guest writers, and should not be construed as medical advice. Each patient’s specific condition is different, and a comprehensive medical assessment requires a full medical history, physical exam, and review of diagnostic imaging. If you would like to seek the opinion of Dr. Michael Fu for your specific case, we recommend contacting our office to make an appointment.