This illustration shows the telescope looking into the shoulder joint from the back. At the front of the socket, three anchored sutures (blue) are fixing the torn labrum back to the bone of the glenoid socket. As part of the procedure the stretched inferior capsule of the shoulder is re-tensioned (red arrow). Some intra-operative photographs below show a torn labrum and some of the steps in the repair
Arthroscopic view of an extensive anterior labral tear
Strong suture tape is passed around the torn labrum. A drill hole
is made at the edge of the glenoid socket
The suture is passed through the eye of an anchor which is then driven
into the bone socket to secure the repair
A completed anterior repair with the labrum well restored
An anchor is a surgical implant that secures suture material to bone. The sutures are passed through the tissue to be repaired and then through the eyelet of the anchor. The anchor is then driven into a prepared bone socket to secure the suture inside the bone. No knots are tied inside the joint, so this minimises the chance of any rubbing against the articular cartilage. The anchors used in shoulder surgery are normally made of a 'biocomposite' material. This means they are slowly replaced by bone so that, after a few years, no anchor material remains. The suture material is extremely strong. The flattened design improves compression of the tissue while reducing the chance of the suture cheese-wiring through the repaired tissue. An animation of the anchor system used by Mr Granville-Chapman for instability repair is available here:
https://www.arthrex.com/resources/animation/HAQm7ZkhmkyMbQE3lAffnQ/pushlock-knotless-instability-repair
You will normally go home a few hours after your operation. You will be in a sling.
Your rehab will involve three phases:
1. Protection (4-6 weeks) - during this time you will need to wear your sling. You will be given some simple exercises but will also need to avoid certain movements to protect your repair.
2. Regain Control and Motion (until 10-12 weeks) - in this phase you will come out of your sling and begin active range of motion exercises. The focus will be on restoring control of your shoulder through range.
3. Strengthening and Functional return (until 5-6 months) - now you will begin to strengthen your shoulder and look towards functional exercises in preparation for your return to normal
Patients vary in their recovery after surgery, but in general you can expect to return to:
Office work after two weeks (in a sling)
Light physical work after twelve weeks
Heavier labour may take 18-24 weeks
Contact sport will take at least six months
Driving will probably take six to eight weeks
By six months, 85-90% of patients trust their shoulder, although further functional recovery is likely out to a year after surgery.
Arthroscopic shoulder surgery is very safe, but specific risks of keyhole shoulder stabilisation surgery include:
Re-dislocation or on-going instability symptoms - most studies report failure rates between 5 and 15% for this surgery at two years – this may include a repeat injury (e.g another rugby tackle). If you continue with contact sports, you may re-injure a successfully stabilised shoulder. The risk is higher in teenagers and those with a history of multiple pre-operative dislocations.
Stiffness (5%) – this rarely requires surgery as the tightened soft-tissues 'stretch out' over time
On-going pain. Occasionally patients notice on-going twinges of pain in their shoulder, despite it being stable and functioning well.