Joint Dislocation Treatment in Germany

Joint dislocation (luxation) is complete displacement of articular bone surfaces with loss of contact between them. It is one of the most common musculoskeletal injuries, requiring emergency reduction and subsequent treatment to prevent recurrence. Recurrent (habitual) dislocation is an indication for surgical stabilization. German clinics employ arthroscopic techniques, Latarjet and Bristow procedures, as well as innovative MIBRAR® therapy for regeneration of damaged ligaments and joint capsule.

What is Joint Dislocation

In a dislocation, articular surfaces completely lose contact. Subluxation is partial displacement with partial contact preserved. A dislocation is always accompanied by damage to the joint capsule, ligaments, and often cartilage and bone. These associated injuries determine the prognosis: with insufficient ligament healing, joint instability and recurrent dislocations develop.

Statistics: shoulder joint — 50% of all dislocations, patella — 15%, elbow — 10%, hip — 5% (most severe). Recurrence after first shoulder dislocation in patients under 25 reaches 70–90% without surgical stabilization.

Types and Localization

Causes

1. Trauma — fall on an outstretched arm, impact, traffic accident, sports injury. The most common cause of primary dislocation.
2. Hypermobility — congenital connective tissue weakness (Ehlers–Danlos syndrome, benign joint hypermobility). Predisposes to habitual dislocations.
3. Anatomical features — socket dysplasia, bone mass deficiency (glenoid, acetabulum), high-riding patella (patella alta).
4. Stabilizer damage — labrum tear, ligament and capsule rupture during primary dislocation → chronic instability.
5. Neuromuscular disorders — muscle weakness, impaired proprioception.

Symptoms

• Acute pain — sharp, intense pain at the moment of dislocation.
• Deformity — visible change in joint contours. In shoulder dislocation — "epaulet" sign (flattening of the deltoid area).
• Inability to move — "springy fixation" — attempted passive movement meets elastic resistance.
• Swelling and hematoma — increase within the first hours.
• Numbness — with nerve damage (axillary nerve in shoulder dislocation, sciatic in hip dislocation).
• In recurrent dislocation: sensation of the joint "popping out" during certain movements, fear of movement (apprehension), spontaneous reduction.

Emergency: hip dislocation requires reduction within the first 6 hours (osteonecrosis risk of the femoral head with delay).

Diagnostics

1. Clinical examination — deformity, springy fixation, neurovascular status (pulse, sensation, motor function distal to dislocation). In recurrent dislocation — apprehension, relocation, Jobe tests.
2. X-ray — dislocation confirmation, fracture exclusion. Mandatory before and after reduction!
3. CT — bone defect assessment: Hill–Sachs defect (shoulder), glenoid deficiency > 20% (indication for bone grafting), acetabular fracture.
4. MRI — soft tissue visualization: Bankart lesion (labrum tear), SLAP lesion, MPFL tear (in patellar dislocation), rotator cuff injury, ligament tears.
5. 3D-CT with glenoid deficiency measurement — for shoulder surgery planning (Latarjet vs Bankart).

Conservative Treatment

• Emergency reduction — under anesthesia or sedation. Methods: Kocher, Hippocrates, Djanelidze (shoulder); axial traction (hip); patellar pressure (knee).
• Immobilization — sling or brace for 2–6 weeks (depending on the joint). In young patients with shoulder dislocation — external rotation (proven to reduce recurrence).
• Drug therapy — NSAIDs, analgesics, muscle relaxants if needed.
• Rehabilitation — physical therapy for range of motion and muscle strength recovery, proprioceptive training, taping.

Important: in patients under 25 after first shoulder dislocation, early arthroscopic stabilization is recommended (recurrence risk without surgery — up to 90%).

MIBRAR® Therapy

Joint dislocation (Gelenkluxation) is included in the list of indications for MIBRAR® technology (individual assessment). Professor Babayan's method is aimed at regeneration of structures damaged during dislocation.

MIBRAR® principles (from Prof. Babayan's book): three basic principles — (1) no incision, only a puncture (Kein Schnitt, nur ein Stich); (2) targeted microperforations in the affected area; (3) transplantation of autologous regenerative concentrate (ARK). With a puncture rather than an incision, stem cells are not spent on healing the access site but concentrate in the injury zone.

MIBRAR® for joint dislocation:

• Labrum regeneration — restoration of the cartilaginous ring providing stability (Bankart lesion).
• Capsule and ligament regeneration — strengthening the stretched or torn joint capsule. MPFL restoration in patellar dislocation.
• Cartilage regeneration — restoration of the damaged cartilage surface (Hill–Sachs defect, chondral injuries).
• Anti-inflammatory effect — reduction of post-traumatic inflammation and swelling without cortisone.

The procedure is performed on an outpatient basis, without anesthesia, under Sono Control Arm™ guidance (0.1 mm accuracy). Exclusively autologous material is used. Over 11,000 cases of international application without significant side effects.

Surgical Treatment

Surgery is indicated for recurrent dislocation, significant bone defects, and recurrent instability:

Shoulder joint:

1. Arthroscopic Bankart repair — reattachment of the torn labrum with suture anchors. Gold standard with glenoid deficiency < 20%. Success rate 85–95%.
2. Latarjet procedure — transfer of the coracoid process to the anterior glenoid surface. Indicated with glenoid deficiency > 20% or after failed Bankart repair. Success rate > 95%.
3. Remplissage — filling the Hill–Sachs defect with infraspinatus tendon. Supplement to Bankart repair.

Patella:

1. MPFL reconstruction — medial patellofemoral ligament repair with tendon graft. Gold standard for recurrent patellar dislocation.
2. Tibial tubercle osteotomy — tibial tuberosity transfer for pathological TT-TG (> 20 mm).
3. Trochleoplasty — deepening of the intercondylar groove in severe trochlear dysplasia.

Treatment Cost

All treatment prices in Germany.

Clinics