This is a minimally invasive surgical technique. In arthroscopy, small incisions are made, between 5 and 8 mm, through which cannulas are introduced, an optic that allows the surgeon to visualize the glenohumeral joint, tendons and other structures of the shoulder on a monitor. In addition, it allows the use of instruments to perform most of the interventions that previously required conventional open surgery.
Because arthroscopy involves less dissection of structures and tissues with small scars, it reduces the pain and complications associated with conventional surgery. It also allows a faster recovery, facilitating outpatient surgery, which we currently perform on all our patients.
The anesthesia used is a regional block of the operated shoulder and arm. It is a conscious sedation without requiring general anesthesia, which allows surgery and pain control during the 24-36 postoperative hours.
What procedures can be performed with arthroscopy?
At present, all shoulder repair and reconstruction procedures can be performed and can be simply classified into two groups:
- Joint arthroscopy, in which lesions are treated in relation to:
– Acute and recurrent glenohumeral dislocation or instability both anterior, the most frequent, also when associated with bone lesions, as well as posterior and multidirectional instability.
– SLAP or anterosuperior labrum injuries and associated with injuries of the tendon of the long portion of the biceps.
– Cartilage injuries and associated fractures.
– Articular ruptures of the rotator cuff tendons, mainly subscapularis, supraspinatus and infraspinatus.
- Subacromial arthroscopy, the space between the superior aspect of the rotator cuff tendons and the acromion, acromioclavicular joint and clavicle, in which mostly tendon ruptures are repaired and occasionally it is necessary to perform a release.
– Subacromial decompression: in this space we usually perform a bursectomy of the inflamed synovial tissue, resection of the tip or anterior osteophyte of the acromion, called anterior acromioplasty, which we currently perform only in 47% of cases of tendon suture and resection of the distal end of the clavicle in patients with a painful acromioclavicular joint.
– Rotator cuff tendon repair is the most frequent arthroscopic surgery, in which the supraspinatus, supraspinatus and subscapularis tendons are repaired. Bone anchors, currently made of organic “composites”, are used to carry the sutures that allow the tendon to be sutured to the bone again.
What happens after surgery?
There is a post-operative resuscitation and recovery stay in the Major Outpatient Surgery Unit for 4-5 hours until discharge to your home, after evaluation by your surgeon and nurse from the Unit. After the evaluation, the discharge documents will be explained and given to you, with the treatment and care recommendations, previously explained in the preoperative period by the consultation nurse and physiotherapist of the Shoulder Unit.
Postoperative period and expectations:
- Multimodal pain treatment: different analgesic and anti-inflammatory drugs are used, acting at different levels, a few days before, during and after surgery to reduce pain, with fewer side effects.
- Rest in a sling: depending on the injury treated, between 3 and 6 weeks, which allows the patient to progressively perform toileting activities, daily activities and exercises.
- An average rehabilitation period of 3 to 5 months, progressive integration into daily activities, work, leisure and sports according to the demand and expectations of physical demands, in most patients with satisfaction and no functional restrictions.
Are there possible complications?
Arthroscopy decreases the incidence of problems and morbidity associated with conventional open surgery, although it can be associated:
- Intense nocturnal pain.
- Sensitive alterations in the arm and hand.
- Drug or anesthetic allergy.
- Postoperative infection.
- Rupture of the repair and stiffness.
For more information contact a specialist in Traumatology.