My shoulder keeps dislocating

[mark]

I am 35, and I have had a problem with my shoulder. When I was 18, I dislocated my dominant shoulder in a rugby game. After 2-3 more I finally had arthroscopic surgery in my late 20's, but after a couple of years I noticed that my shoulder started to feel like it was slipping in and out again. I am wondering if there is anything that can be done to definitively fix this, as I am very active and this is getting in the way of the activities I want to participate in.

[mtomaino]

This procedure is mainly performed when there is some bone loss from the front of the glenoid (as a result of repeated dislocations wearing away the front of the glenoid). However, it is also an option in cases where there is no bone loss, but rather significant attenuation/ stretching of the capsule and ligaments. In such cases, restoring their attachment may not result in stability. From the sounds of it, your repair has stretched out over time. Although looking inside the shoulder arthroscopically may reveal a "fixable" situation arthroscopically, you may alternatively be a candidate for a latarjet procedure---which is most commonly performed with an incision (arthroscopic techniques are currently being developed). It is extremely successful and because of the stability provided, one's sling can be disgarded as early as 2-3 weeks.

The procedure involves transfer of the coracoid with it's attached muscles to the deficient area over the front of the glenoid. This augments the glenoid bone, and the transferred muscle also acts as an additional muscular "strut" preventing further dislocations.

The technique I use is that described by Walch & Boileau , which is a modification of the original Latarjet procedure. It has the advantages of improving both the bony and soft tissue problems, with a strong fixation, allowing early active rehabilitation. I have attached a typical postoperative x-ray, as well as an illustration showing the encircled coracoid, which is transferred to the glenoid rim (rectangle), through a split made in the subscapularis muscle.