York, ME (207) 363 3490 | Portsmouth, NH (603) 431 1121

20Hip Care
10Hip-Conditions and Injuries
Cartilage Injury
Femoroacetabular Impingement (FAI)
Gluteal Tears
Hamstring Tears
Hip Instability
Deep Gluteal Space Syndrome
Labral Tears
Psoas Impingement (Internal Snapping Hip)
Trochanteric Bursitis
10Hip-Treatment and Surgeries
Gluteal Repair
Labral Debridement
Labral Reconstruction
Labral Repair
Psoas Release
Trochanteric Bursa Debridement
33Knee Care
13Knee Conditions and Injuries
ACL Tear
Cartilage Injury
Discoid Meniscus
Lateral Meniscus Tear
LCL Injury
MCL Injury
Medial Meniscus Tear
Osteochondritis Dessicans
Patellar Instability
Patellofemoral Chondromalacia
Posterolateral Corner Injury
Trochlear Dysplasia
20Knee Treatment and Surgeries
Anterior Cruciate Ligament (ACL) Reconstruction
Cartilage Restoration Surgery – Autologous Chondrocyte Implantation (ACI-Carticel)
Cartilage Restoration Surgery – Donor Graft
Collagen Meniscal Implant (CMI)
Lateral Collateral Ligament (LCL) Reconstruction
Medial Collateral Ligament (MCL) Reconstruction
Meniscus Repair
Meniscus Root Repair
Meniscal Transplant
Medial Patellofemoral Ligament (MPFL) Reconstruction
Osteochondral Allograft Transfer
Osteochondral Autograft Transfer (OATS)
Partial Knee Replacement (MAKO)
Partial Meniscectomy
Posterior Cruciate Ligament (PCL) Reconstruction
Posterolateral Corner (PLC) Surgery
Tibial Tubercle Osteotomy
Total Knee Replacement (MAKO)
20Shoulder Care
10Shoulder-Conditions and Injuries
AC Joint Injuries
Biceps Tendon Injuries
Calcific Tendinitis
Clavicle Fractures
Frozen Shoulder
Labral and SLAP Tears
Rotator Cuff Injuries
Shoulder Dislocation/Instability
Subacromial Impingement/Busitis
10Shoulder-Treatment and Surgeries
A-C Joint Stabilization
Biceps Tenodesis
Clavicle Fracture Fixation
Pectoralis Major Repair
Rotator Cuff Repair
Shoulder Instability Surgery – Bankart Repair
Shoulder Instability Surgery – Latarjet Procedure
Subacromial Decompression and Acromioplasty
Superior Capsular Reconstruction
Total Shoulder Replacement


When an individual sustains a shoulder dislocation or multiple shoulder dislocations, the labrum (bumper) on the front of the shoulder joint tears. This type of labral tear is called a “Bankart” tear. In addition, the ligaments that surround the shoulder joint – the capsule – stretch and loosen. Also, on occasion, a piece of bone may break off of the humeral head when it “pops out” of the socket during a dislocation. This type of fracture is called a Hill-Sachs lesion.

In those patients who require surgical stabilization for an unstable shoulder, Dr. Welch usually uses a minimally-invasive approach. During surgery, Dr. Welch positions the arthroscope (camera) into the shoulder joint and identifies the torn labrum and stretched capsular tissue. He then uses small instruments to place suture anchors (medical screws with strong sutures) along the border of the front of the socket. Next, Dr. Welch, threads the sutures from the anchors through the stretched tissue and around the torn labrum. He then uses a special device to tie strong knots against the shoulder socket. With this technique, Dr. Welch achieves two goals: he re-tightens the shoulder capsule and repairs the shoulder labrum (bumper) back down to its native position on the shoulder socket.

In those patients with a large Hill-Sachs lesion (divot fracture on the humeral head), Dr. Welch may also perform a Remplissage technique. The goal of this technique is to further stabilize the shoulder. During Remplissage, Dr. Welch positions the arthroscope in the shoulder and places suture anchors inside the divot fracture on the humerus bone. Dr. Welch then harnesses the infraspinatus tendon with the sutures and tensions the tendon by tying knots inside the divot fracture. By filling in the divot fracture with tensioned tendon, Dr. Welch helps stabilize the shoulder further.

Post-Operative Rehabilitation

Following surgery, patients are given a sling for comfort. Dr. Welch recommends intermittent icing and gentle range of motion following surgery. Dr. Welch also recommends starting physical therapy approximately 2-4 weeks after surgery. Physical therapy focuses on reducing swelling in the shoulder, restoring full range of motion, and maintaining strength in the shoulder. It is also important to avoid certain shoulder positions for 8-12 weeks after surgery.