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


In those patients who sustain 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 – stretches and loosens. In addition, on occasion, part of the bone on the front of the socket (glenoid) may fracture or break down. If there is significant bone loss on the front of the socket, an arthroscopic procedure (Bankart repair) could fail and Dr. Welch may recommend a Latarjet procedure.

The Latarjet procedure has been popular in Europe for many years and has become much more popular in the United States in the past decade. There is now clear evidence that the Latarjet stabilizes the shoulder better than the arthroscopic Bankart repair in those patients with significant bone loss in the front of the shoulder socket.  During surgery, Dr. Welch makes an incision along the front of the shoulder. He then removes a bony prominence (the coracoid) from the scapular bone. Next, Dr. Welch opens the capsule in front of the shoulder and places the coracoid bone block on the front of the shoulder socket. Dr. Welch then fixes the bone block to the shoulder with two screws. He then tensions the shoulder capsule over the front of the shoulder. The added bone increases the stability of the shoulder joint. Further, the tendons attached to the coracoid bone block provide a stabilizing “sling” to the front of the shoulder. This “sling effect” provides added stability to the shoulder joint when the shoulder is placed in certain positions.

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.