Preface:

This is to reconsider potential surgical procedures other than arthroscopic surgery which is one of the major options for those who suffer from recurrent shoulder dislocation. Among the contact sports players, some players experience recurrent shoulder dislocation after the surgery, e.g. Bankart lesion procedure, as they go back to the same sports, and they injure their shoulders during the games.
 

Contact sports:

Rugby, American football, Basketball, Football, Handball, Judo…
 

Ideal outcomes for the contact sports player:

Play the same sports as before without any anxiety or fear
No pain during the work out exercises
Return to the same sports in a short period
Gain improved shoulder motion

Please see the shoulder anatomy

The procedure uses an anchor equipped with code, designed to lock into the bony structure. It will stitch the Superior/Middle/Inferior/glenohumeral ligaments and Glenoid labrum to the Glenoid cavity.

Why does Bankart repair sometimes fail to prevent recurrent dislocations?

Arthroscopic Bankart repair may not be able to make the structure strong enough to bear the external force (e.g. tackles).
 
Therefore, Coracoid transfer procedures (Lararjet and Bristow procedures) are commonly performed for contact sports players.

Coracoid process is a small hook-like structure which functions connected with multiple ligaments. The short head of biceps brachii and the coracobrachialis muscle attach to the coracoid process.

In both Latarjet procedure and Bristow procedure, it will cut the edge of coracoid process and resituate it to the glenoid edge with using screws, once a hole/tunnel is made.

These procedures sometimes cause complications.

I would like to introduce a new procedure called Coracoid tip-conjoined tendon complex transfer

Details:

Tie a medical cord around the joint tendons at 1 cm away from coracoid process.
Make a tunnel in the bottom part of the glenoid cavity of scapula.
Put the medical cord through the tunnel and tie it with metal buttons.
The edge of the coracoid process enters the scapula, and the joint ligaments will control the head of humerus. It can also repair the glenoid labrum.

This procedure can be described as a combination of Bankart repair and the ★joint ligaments procedure which will reinforce the strength of the joint, and control better a motion of the head of humerus.

Postoperative schedule:

Use of shoulder orthosis for 3 to 4 weeks
Physical therapies
Strengthening exercises 2 months after the surgery
Return to sports 4 months after the surgery, depending upon the muscle strength
 
He was a rugby player who came to my clinic when he was 19 years old. He had shoulder dislocations 5 times, that made him be so afraid of contacting and tackling others in the game.

Postoperative course:

Started muscle strengthening exercises 3 months later
Practiced tackling 4 months later                       
Return to the game as a forward 6 months later

CT Image of this patient

Left - Before the surgery: Glenoid cavity partially lost its bony structure circled in red due to recurrent dislocation
 
Middle - Right after the surgery
 
Right – 2 years later. Remarkable to see the place circled in yellow, bony structure has been regenerated where it had been missing.

Here is another case for the same injury.

This video is taken 4 months after the surgery.

Here are CT images of this patient. 

In case of male patient, he is expected to start work out exercises 3 months after the surgery, and it takes about 4 months to fully return to sports. However, the postoperative schedule depends on the strength which each patient possesses.

They are Judo players in the same university. They had the same surgery within a week.

This patient had the surgery a year ago. He keeps a good shoulder motion and the coracoid process is well healed without any dislocations.

Summary：

I have presented a new procedure called coracoid tip-conjoined tendon complex transfer to let the sports players return to sports as soon as possible.
These procedures might be the one which can improve your conditions.

Advantages and disadvantages of Labrum repair and Lararjet and Bristow procedures

 
The table shows some advantages and disadvantages of each procedure. Please be reminded that the ratio of events may differ in various literatures.

These procedures are commonly performed and approved to be potential treatments. Please do not hesitate to talk to your doctor when you have questions or concerns.