Dr. Ticker Explains His Approach to First Time Anterior Glenohumeral Dislocation

Dr. Johnathan Ticker explains his tips and tricks for a first time anterior glenohumeral dislocation. Dr. Ticker is a presenter at the 53rd Annual meeting, SBOT

Arthroscopic Management of First-Time Anterior Glenohumeral Dislocation

In this comprehensive instructional lecture, Jonathan Ticker, MD presents his evidence-based and technique-driven approach to the arthroscopic management of first-time traumatic anterior glenohumeral dislocation. Using today’s clinical, biomechanical, and economic data as a guide, Dr. Ticker emphasizes the importance on choosing the right patients, making sound surgical decisions, and executing the procedure with precision to help prevent recurrence. This will help deliver consistent and durable outcomes. Dr. Ticker opens by addressing a central and ongoing debate in shoulder instability care: whether first-time anterior dislocations should be treated nonoperatively or with early surgical stabilization. He supports the position that early arthroscopic repair is appropriate for many, but not all patients, particularly those at high risk for recurrence.

Clinical and Evidence-Based Rationale

Drawing from military and civilian population studies, Dr. Ticker reviews the evolving literature supporting early surgical intervention:

Long-term follow-up studies demonstrate durable outcomes and reduced recurrence rates following acute arthroscopic stabilization.
Comparative studies show higher patient satisfaction and quality-of-life scores in surgically treated patients versus nonoperative management.
Meta-analyses and pooled data reveal statistically significant reductions in redislocation with surgery, while acknowledging the importance of weighing surgical risk.
Cost-effectiveness analyses support acute arthroscopic Bankart repair, particularly in:
- Patients aged 15–30
- Young, active males
- Populations with high nonoperative recurrence rates

Bone Loss and Recurrence: A Key Driver of Decision-Making for Surgery (or not)

A major focus of the lecture is the impact of recurrence on bipolar bone loss, which significantly complicates future stabilization efforts:

Glenoid bone loss increases substantially with recurrent instability episodes
Hill-Sachs lesion prevalence and size worsen with repeated dislocations
Off-track Hill-Sachs lesions are rarely seen after a first event but become common following recurrence
Long-term studies correlate increased preoperative dislocations with higher grades of glenohumeral osteoarthritis

Key takeaway: Reducing recurrence early may help prevent progressive bone loss and degenerative changes.

Arthroscopic Surgical Technique: Practical Pearls

Dr. Ticker emphasizes that preparation is as critical as repair, walking through his surgical workflow and decision-making process, as follows:

Diagnostic Arthroscopy

Assess Hill-Sachs engagement and glenoid morphology
- Evaluate labral pathology, including:
- Bankart lesions
- ALPSA lesions
- HAGL lesions

SLAP pathology is addressed selectively and rarely combined with Bankart repair

Capsulolabral Release

Considered the most critical step of the procedure
Develop a clean plane between the capsulolabral tissue and glenoid neck
Release inferiorly past the 6 o’clock position
Preserve tissue integrity while achieving full mobilization
Enables superior and lateral translation of tissue back to the glenoid rim

Glenoid Preparation

Denude the glenoid neck to optimize healing
Preserve small bony fragments when present to promote bone-to-bone healing

Anchor Placement and Fixation Strategy

Dr. Ticker discusses the evolution of his anchor placement philosophy and preferred techniques:

Inferior anchor placement directly on the glenoid rim
Use of angled drill guides (25°) to optimize trajectory and avoid skiving
Preference for all-suture anchors to improve positioning flexibility
Retrograde suture shuttling to enhance capsular shift and tissue translation

Suture Management and Knot Tying

Proper tensioning and tissue reduction are critical for durable stabilization:

Translate capsulolabral tissue superiorly before securing knots
Restore tension to the inferior glenohumeral ligament
Ensure loops are perpendicular to anchor position
Secure fixation using alternating half-hitches positioned away from the articular surface
Typical constructs include 3–4 anchors, depending on lesion extent

Outcomes and Rehabilitation Considerations

Final construct is tested intraoperatively with controlled external rotation
Stable fixation allows for safe, progressive rehabilitation protocols
Clinical examples demonstrate successful outcomes at 4–6 months postoperatively

Final Perspective: Individualized Care and Surgical Judgment

Dr. Ticker concludes by reinforcing that while technology and implants continue to evolve, the most important tool in shoulder instability surgery is sound clinical judgment. Treatment recommendations should be individualized and guided by:

Patient age (particularly under 30)
Documented traumatic dislocation requiring reduction
Persistent anterior apprehension
Bone and soft tissue status
Patient goals and activity level

While consensus on first-time dislocation management remains elusive, Dr. Ticker advocates for early arthroscopic stabilization in appropriately selected patients through a shared decision-making process.

Jonathan B Ticker, MD

Average rating:

40 reviews

Sharon

Dec 4, 2025

by Sharon on Jonathan B Ticker, MD

Exceptional Care from Start to Finish – 5/5 Stars

Exceptional Care from Start to Finish – 5/5 Stars
ATHROSCOPIC Left Shoulder Surgery Multiole Procedures

"I am so grateful for Dr. Jonathan B. Ticker and his team — Anne Marie Lamneck, PA, Laura Brady, Kaylan Dimodugno, and surgical coordinator Denise Katsaros. From consultation to recovery, the care was professional, compassionate, and seamless. Dr. Ticker explained everything clearly, and the surgical team made me feel safe and supported throughout. My recovery has been smooth, and I am feeling much better. I highly recommend Dr. Ticker and his amazing staff to anyone in need of expert surgical care!"

SHARON S M

Nov 24, 2025

by SHARON S M on Jonathan B Ticker, MD

Exceptional Care from Start to Finish

"I am incredibly grateful for the outstanding care I received from Dr. Jonathan B. Ticker, the entire surgical team, and the office medical staff who work closely with him — Anne Marie Lamneck, PA, Laura Brady, and Kaylan Dimodugno. From my very first consultation through my post-operative recovery, the entire experience was seamless, reassuring, and made even better by having the same team consistently involved in my care.

A special shout-out to Denise Katsaros, his surgical coordinator. She was professional, patient, and supportive while handling all my questions and concerns.

The office team was consistently professional, friendly, and efficient. Scheduling was easy, wait times were minimal, and they were always helpful when answering my questions about appointments and the overall process. I felt valued and well-informed every step of the way — never like a number.

Dr. Ticker is an exceptionally talented, skilled, and compassionate surgeon. He explained my condition and the surgical procedure in clear, understandable terms, ensuring I fully understood my options and the recovery process. His expertise and attentive bedside manner instilled a strong sense of calm and trust, which meant a great deal to me going into major surgery.

The surgical team — Dr. Flaum, Anne Marie Lamneck, PA, and the nurses — were also fantastic. Their coordination and professionalism in the operating room and during recovery made me feel safe and comfortable. The level of excellence in their care and attention to detail was truly top-notch.

Thanks to this wonderful team, my recovery has been smooth. I am no longer feeling the pre-surgical pain — only normal post-surgical discomfort, which is expected — and I am already feeling so much better.

I highly recommend Dr. Ticker and the entire staff to anyone in need of exceptional surgical care. He is not only a highly skilled surgeon but also an expert, scholar, and author. The whole team truly puts patients first and works together with dedication and compassion. Having worked in the medical field myself, I can confidently say I will recommend him to everyone.

Thank you all for everything you do!"

Marcelo Riffaud

Aug 27, 2024

by Marcelo Riffaud on Jonathan B Ticker, MD

The Quality of Care -- Dr. Ticker

In July 2023, Dr. Ticker performed arthroscopic surgery to correct a full tear of my supraspinatus tendon (as well as, among other issues, removal of a bone spur on my acromion, performing a biceps tenodesis) in my left shoulder.

I had heard and read about the very challenging and difficult experiences of others who had experienced similar trauma and surgery. I was braced for the worst, which apparently would be during the first 2 weeks post-op. But I had no idea how fortunate I was to be in the care of the best hands possible for the surgery. The first 1-2 days post-op I was absolutely pain free due to a nerve block that was administered during surgery. After this wore off, I experienced only minimal discomfort over the next 2 weeks. I was able to rest and sleep on a recliner, my soreness easily managed by the prescribed meds. At 2 weeks post-op I started PT. I took my meds throughout but only as needed, and I ended up taking less than the prescribed amounts after the first week. I wasn't being a hero or toughing it out -- I just didn't need them. I was back to full range of motion and full activity since the 5th month post-op.

I am fully convinced that my amazing experience -- from the low level of discomfort to the speed of my recovery -- had everything to do with Dr. Ticker's significant experience, amazing talent, and care-giving approach. I am a beneficiary of his many years of dedication and hard work to his calling. He is also funny and approachable, with a great bedside manner, but he is also direct and serious about his work and about what I needed to do (and not do) to increase my chances for a full recovery. I could not recommend him more highly. Thank you, Dr. Ticker!

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