FIXED FOR
GOOD

Expert correction of recurrent
Shoulder Dislocation

An active 51-year-old left-hand dominant gentleman was brought to BLK Super Speciality Hospital with a history of recurrent left shoulder dislocation. The patient had a long-standing history of left shoulder instability for which he underwent an Arthroscopic Bankart Repair in some other hospital in the year 2005. However, following a year after the procedure, the patient had recurrent episodes of left shoulder dislocation. He visited multiple centres and was advised an Open Latarjet Surgery for recurrent anterior instability of his left shoulder. He further consulted the expert team at Arthroscopy and Sports Medicine Centre, BLK Hospital.

On clinical examination, the patient had tenderness and terminally restricted range of motion in his left shoulder. The Apprehension test was positive, characteristic of anterior shoulder instability. Radiographs and Magnetic Resonance Images (MRI) revealed a large Hill Sachs lesion and a soft tissue Bankart lesion. The experts at BLK, hence, concluded that failure of the initial procedure was due to re-injury leading to mechanical failure. After examining the job profile of the patient and activity level, the treatment options were discussed with the patient. With his consent, the team decided to go ahead with Arthroscopic evaluation and a definitive plan of either Revision

"The Bankart lesion is one of the common soft tissue injuries of the shoulder involving a tear in the anterior inferior Glenoid labrum due to anterior shoulder dislocation."
Bankart Repair or Latarjet procedure would subject to intra-operative Arthroscopic findings.

On Arthroscopic evaluation, the glenoid bone loss was found to be less than 25% but with an engaging Hill Sachs lesion; hence, the Latarjet procedure was not done, and an Arthroscopic Revision Bankart Repair with Remplissage was done to address the bipolar bone loss. The patient’s post-operative course and rehabilitation were uneventful. The patient was gradually gaining near-normal activity.

The major advantages of an Arthroscopic approach, in this case, was preserving the corocoid other than the regular benefits like lesser surgical morbidity, post-operative pain, the reduced cost of an outpatient setting, improved cosmesis and an easier if not shorter rehabilitation period. All of these are of paramount importance in an active young individual for an earlier return to routine / sporting activity.

The above case report is one of the many examples of Revision Bankart where we chose to go in for a revision Arthroscopic procedure after a thorough pre-operative evaluation and planning. Clinical experience coupled with surgical expertise and access to state-of-the-art technology can shift the balance in the patient's favour to provide reliable and superior outcomes.