Other Arthroscopic Repairs
DISTAL CLAVICECTOMY
The A-C (acromioclavicular) joint is second only to the rotator cuff as a source of shoulder pain. This joint can be injured in three ways. First a fall on the shoulder can produce a sprain: this is the so-called “separated” shoulder. Secondly the joint can be become painful through degenerative arthritis. Thirdly it can become painful as a result of activites that force the arms together against resistance. The most common example of this is the bench press weight lifting exercise.
Whatever the cause, a painful A-C joint does not respond to physical therapy. The first treatment is injection of the joint with a cortisone like drug. This is usually helpful but in most cases the pain returns within a few months. If this occurs, many patients will elect to have outpatient arthroscopic distal clavicectomy. This procedure entails shaving down the end of the damaged clavicle and the removal of the inflamed or torn disk that exists within the joint. Because the ligaments that stabilize the joint are not disrupted, there should be no ill effects on the shoulder from this procedure. While recurrences after surgery can theoretically occur I have never seen this happen. Patients can resume light activities of daily living almost immediately and usually can resume upper body exercise lightly within a few weeks. Complete recovery occurs within a few months.
INSTABILITY REPAIR
When shoulders suffer a typical antero-inferior dislocation, the inferior glenohumeral ligament is torn. In most cases it does not heal and shoulders suffer repeated dislocations. The younger the person is at the time of the initial dislocation, the likelier this is to be true. When repeated dislocations occur surgery is usually needed. This surgery can be performed either through a traditional open incision or arthroscopically. The arthroscopic repair involves the use of three portals to allow the reattachment of the glenoid labrum (which is the attachment of the gleno-humeral ligament) as well as a tightening of the capsule. Bio-absorbable suture anchors are embedded into the bone to anchor the repair. The open repair is performed similarly but with an incision. Success rates are high but patients must protect the shoulder for six months to allow healing
S.L.A.P. LESION REPAIR
SLAP is an acronym for “superior labral anterior and posterior”. This condition entails a tearing away of a lip of tissue, the glenoid labrum, from the shoulder socket or bony glenoid, at the top of the shoulder. The labrum can be arthroscopically reattached with bioabsorbable suture anchors on an outpatient basis. Complete healing and full resumption of sports activities occurs in six months. The success rate after this procedure is high.