Restoring dislocated shoulders an innovative minimal way

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Arthroscopic approach with augmentation of the labrum repair has resulted in complete restoration of shoulder function and a permanent stop to dislocations.

Shoulder dislocations are a common orthopedic injury, often resulting from repetitive strain or trauma. While traditional treatments focused on reducing the dislocation and repairing the damaged tissue, one groundbreaking advancement in arthroscopic techniques has shown exceptional outcomes in more severe dislocation, helping restore shoulder function and improve stability in athletes of all ages.

Allegheny Health Network (AHN) is the only facility in the country to offer a minimally invasive labral scaffold procedure to eligible patients. Since 2017, Sam Akhavan, MD, AHN Director of Orthopaedics Sports Medicine, has performed this outpatient procedure that he developed on more than 20 patients. It has proven more effective and safer than traditional open procedures and has stopped patients’ dislocations permanently.

“What we found is that this procedure does restore the normal mechanics of the shoulder very well,” Dr. Akhavan said. “It also rebuilt the biomechanics of the shoulder better than a standard labrum repair and stopped virtually all dislocations once and for all.”

Rethinking the conventional way

When someone dislocates their shoulder, the tissue attached to the rim of the shoulder socket, which helps keep the ball of labrum in place, often tears.

“With a dislocation, the most common thing that happens is the labrum rips off the bone,” Dr. Akhavan explained. “The attached capsule and the ligaments become loose, and the shoulder will keep dislocating.”

Over time, a dislocated shoulder that goes unrepaired may start grinding away some of the bone. When the bone loss is small, most surgeons will repair the labrum back to the bone. However, this standard procedure has a high failure rate when the patient has more than 5% bone loss.

The alternative procedure is a surgery usually performed for patients who have a larger amount of bone loss — typically 25 to 35%. Surgeons use either a piece of a patient’s own bone from their shoulder blade or a cadaver bone and transfer it into the area of missing bone, fastening the piece with screws.

“There is a high incidence of people developing arthritis within 20 years after bone transfer surgery,” Dr. Akhavan said. “The complication rate from this surgery, including issues such as bones not healing or screws breaking, can be as high as 40%.”

Rethinking the conventional way

So, Dr. Akhavan studied taking a different approach. He led his team in the development of the labral scaffold procedure to reconstruct the bone of patients who have lost about 10 to 15% from shoulder dislocation.

“We take a piece of cadaveric human skin that’s obtained from the upper back where the skin is the thickest,” said Dr. Akhavan, who presented his surgery data at the American Academy of Orthopaedic Surgery earlier this year. “We arthroscopically transfer it into the area of bone loss and repair the labrum, filling the defect with skin.”

Dr. Akhavan has performed the procedure on high school and college athletes, weekend warriors, and patients who have failed multiple previous stabilization procedures. He has been extremely pleased with the results.

“The great thing about this procedure is that it’s minimally invasive, outpatient, and may prevent patients from having further dislocations or from requiring a bone block transfer procedure.”

To refer a patient to Dr. Akhavan, call 412-359-8095.