Shoulder Instabiltiy and Labral repair

The majority of patients who suffer a traumatic anterior shoulder dislocation have a structural lesion to the labrum and or glenoid bone. 85% have a bankart lesion (detachment of the anterior labrum from the glenoid rim) and 40-90% have a hill sachs lesion ( bony compression fracture of the posterior superior proximal humerus). Given the high rates of re-dislocation there is increasing acceptance of surgical treatment as first line care to reduce the risk of re-dislocation and further injury in patients at high risk of redislocation. Surgery should be considered in all patients at high risk for recurrence including young age, athletic activity, male sex and presence of a bony bankart lesion. Arthroscopic shoulder stabilisation with suture anchors has been shown to reduce redislocation rates to around 7% with 90% of patients returning to their preinjury level of sports participation. For patients with glenoid bone loss the most widely performed grafting technique is the latarjet procedure where the coracoid is osteotomised at its base and transferred to the face of the glenoid. Excellent results are reported with very low ( 3-5%) redislocation rates.