What is shoulder instability?
The shoulder is the most mobile joint in the body, and this mobility comes at the cost of inherent bony stability. The humeral head (ball) is held in the glenoid socket (a shallow cup on the shoulder blade) by a combination of the labrum (a cartilage rim that deepens the socket), the joint capsule, and surrounding ligaments — particularly the inferior glenohumeral ligament. When the shoulder dislocates — most commonly forward (anteriorly) — the labrum is typically torn away from the front of the glenoid in an injury called a Bankart lesion. If this is not repaired, the shoulder is at high risk of dislocating again, particularly in young, active patients. Over time, recurrent dislocations can cause progressive bone loss from both the glenoid and the humeral head.
Who needs surgery?
After a first dislocation, rehabilitation is trialled in most patients. Surgery is recommended for: patients who have dislocated more than once; younger patients (under approximately 30) after a first dislocation, due to the very high recurrence rate in this group; patients with significant bone loss on the glenoid or humerus; patients whose instability significantly limits their activities; and those returning to contact or overhead sport. The timing and exact approach will be discussed at consultation.
What happens during surgery
Arthroscopic shoulder stabilisation is performed under general anaesthetic with the patient positioned on their side or in a beach chair position. Using small keyhole incisions, Dr Mooney inspects the shoulder joint in detail and addresses all pathology found. The torn labrum (Bankart lesion) is re-attached to the glenoid rim using small bone anchors, and the stretched capsule is tightened. Associated injuries such as Hill-Sachs lesions or rotator cuff tears are assessed and addressed at the same time. The procedure typically takes 60–90 minutes. A sling is required after surgery.
Bone loss and the Latarjet procedure
In patients with significant glenoid bone loss (typically more than 20–25% of the glenoid surface), an arthroscopic stabilisation alone may have a higher failure rate. In these cases, a Latarjet procedure — which transfers a bone graft from the coracoid process to the front of the glenoid — may be recommended instead. Dr Mooney will assess bone loss on pre-operative imaging and discuss the best approach for your anatomy at your consultation.
What to expect after surgery
Frequently asked questions
Arthroscopic stabilisation is highly effective. The re-dislocation rate after a well-performed Bankart repair in an appropriate patient is approximately 5–10%, compared with over 50% (and much higher in young athletes) without surgery.
Not always, but the evidence strongly supports early surgery in young, active patients involved in contact or overhead sport, as the recurrence rate without surgery is very high in this group. Dr Mooney will give you an honest assessment based on your individual situation.
Most patients wear a sling for approximately 4–6 weeks following surgery. Dr Mooney's physiotherapy team will guide your rehabilitation throughout.
Return to non-contact sport is typically 4–6 months. Return to contact or overhead sport is usually 6 months or later, once functional testing criteria are met.
Risks include infection, bleeding, stiffness, nerve injury (particularly to the axillary nerve), failure of the repair, and re-dislocation. These will be discussed with you in detail at your consultation.