Dr Kuo specialises in all aspects of shoulder surgery and sports injuries around the knee.

 

Shoulder Procedures commonly performed include:

Manipulations Under Anaesthesia and Hydrodilatation

Shoulder stiffness is quite a common problem. Many patients improve with time and physiotherapy but those who do not may opt for a manipulation under a general anaesthetic, injection of cortisone and hydrodilatation.

Arthroscopic Capsular release

This can be performed in recalcitrant cases of frozen shoulder. It is also frequently necessary to be performed during routine rotator cuff surgery as many patients will often have a degree of capsular restriction in conjunction with their tears.

Arthroscopic Subacromial Decompression/Acromioplasty

Advances in technology over the past 5- 10 years has allowed surgeons to perform many shoulder operations via arthroscopy or key hole surgery. The procedure is performed via very small incisions using specialised instruments. Impingement occurs due to a number of causes. There may be inflammation of the tendon (tendinitis), bursa (bursitis) or some spurs. These conditions can be treated successfully by cleaning up the inflamed tendons, removing the inflamed bursa and trimming off any spurs. You will be placed in a sling after surgery for comfort, but once your pain levels start to settle, you will be encouraged to discard the sling and start to use the shoulder as normally as possible.

 

The quicker you can regain your movement, the quicker the recovery.

Arthroscopic Rotator Cuff Repair

Advances in technology over the past 5- 10 years has allowed surgeons to repair torn tendons via arthroscopy or key hole surgery. The procedure is performed via very small incisions using specialised instruments. We place anchors into the shoulder (humerus) with strong sutures/threads attached to them. These threads are passed through the torn edge of the tendon which are then tightened bringing the tendon back onto the bone. The larger the tear, the more anchors that will be required. You will then be placed in a sling after surgery to protect the repaired tendon for 6 weeks. Any associated problems inside the shoulder eg spurs can be visualised and treated at the same time.

Arthroscopic Biceps procedures (Tenotomy and Tenodesis)

If the long head of the biceps tendon has been partially torn off its attachment (SLAP lesion) or there is inflammation, fraying or damage to the main substance of the tendon itself then a biceps procedure may be required. It can be safely cut and left to retract. This is called a Biceps tenotomy. Although it sounds drastic to cut a tendon and not reattach it, the LONG head (as opposed to the SHORT head which is left untouched) contributes very little to strength and its main function is the contour and shape or look of the muscle. The overwhelming majority of patients who undergo a biceps tenotomy do not report any loss in strength and are pleased by the relief in pain. A small number of patients may report some spasm in the muscle with lifting in the initial stages but in most cases this will settle. Most patients are not concerned or even aware of any asymmetry. A Biceps Tenodesis is when the tendon is reattached in a position outside the shoulder joint. The recovery time is slower compared to a tenotomy alone but there contour is better preserved. It can often be performed in association with a Rotator cuff repair. If Dr Kuo is anticipating that a Biceps Procedure may be necessary for you, he will discuss these 2 options with you beforehand to allow you decide what is the best treatment for your individual circumstances.

Arthroscopic Stabilisations

Shoulder dislocations occur mostly in young active people. It is typically associated with a specific injury eg tackled in football, fall while snowboarding and can result in recurrent episodes. When the shoulder repeatedly pops out and affects a patient's ability to play sports or even function reliably on a day to day basis, then surgery may be required. The usual problem is a tear in the soft tissue ring around the shoulder socket. This tissue is called the labrum. It is most commonly torn at its lower front portion (Bankart lesion). This is referred to as anterior instability. If it is torn at the back it is called posterior instability (posterior Bankart lesion). If it is torn at the top it is called a SLAP lesion. The aim of surgery is to repair the labrum and put it back into its correct position. This is performed via arthroscopy/keyhole surgery in most cases. This is performed using specialised instruments, anchors and sutures/threads. On some occasions (depending upon the degree of damage), the procedure may need to be performed via a traditional cut. Your arm will be placed in a sling for up to 6 weeks after surgery.

Arthroscopic SLAP repair

In this condition, the labrum (soft tissue ring around the shoulder socket) is torn at the top of the socket. It is where the long head of the biceps attaches to the bone. There are 4 main types: Type 1- fraying only of the labrum Type 2- detachment of the labrum Type 3-like a type 2 but with a "bucket handle" tear in addition to the detachment Type 4- when the tear extends into the biceps tendon itself The treatment will depend on the type of tear. The Type 1 only needs to be cleaned up/debrided. The Type 2 usually needs to be repaired. Type 3 sometimes only needs a clean up but may need to be repaired or the biceps itself may need to released +/- reattached. Type 4 lesions require a biceps release or reattachment.

Acomio-clavicular (AC) joint procedures (excision, stabilisation)

Some patients develop pain from arthritis or damage to the AC joint. It is often related to heavy lifting. Spurs often develop and can also cause impingement to the shoulder as well as direct pain in the joint. In these cases, the spurs can be trimmed (co-planing) or a small portion of the end of the collar bone (which is worn out) can be removed or excised. This is usually performed arthroscopically.
Some patients will sustain an injury when they fall on the point of their shoulder which results in the end of the collar bone coming out of joint. This is known as an AC joint dislocation and is different to a true shoulder dislocation. Depending upon the degree of dislocation, most of these injuries can be treated without surgery. However, significantly displaced cases may require surgical stabilisation. This is most often an open procedure requiring an incision to bring the end of the collar bone back into its correct position.

Shoulder Arthroplasty (Total Shoulder Replacement (TSR), resurfacing Hemiarthroplasty, Reverse TSR )

The most frequent reason for replacing a joint is for osteoarthritis. But it can be for rheumatoid and other inflammatory arthritis, avascular necrosis, post traumatic arthritis, fractures and more recently, has been beneficial for cuff tear arthropathy. The type of implant will be dependent upon the exact problem, age of the patient, functional demands, quality of the bone, and whether or not the rotator cuff is working normally. A total shoulder replacement (TSR) is most common. It involves replacing both sides of the joint (the ball and socket) with implants made of metal and high grade polyethylene. On some occasions, in younger patients or if there is not much damage to the socket, then only the ball needs to be replaced (hemiarthroplasty). When the rotator cuff tendons are completely torn for a long time and the patient cannot lift their arm or arthritis develops, a traditional TSR cannot be used as it depends upon the tendons to hold the implants in place. On these occasions, a Reverse TSR can be used (in older people only). It is called a Reverse TSR because the Ball is replaced by a Socket and the Socket replaced by a Ball. This design does away with the need for the rotator cuff tendons by changing the centre of rotation and using the deltoid muscle to aid in lifting the arm.

 

 

 

 

Knee Procedures commonly performed include:

  • Knee arthroscopy
  • Meniscectomy
  • Meniscal Repair
  • Lateral release
  • ACL reconstruction

 

For further information regarding a procedure, please click on the Xray Logo next to it and a new window will open taking you to Educational Resources from the American Academy of Orthopaedic Surgeons.