Menu
Arthroscopic labral repair is a minimally invasive surgical procedure performed to repair tears or injuries to the labrum, a ring of cartilage that surrounds the shoulder socket (glenoid). This procedure is commonly performed for patients with labral tears resulting from trauma, repetitive overhead activities, or shoulder instability.
The procedure begins with the patient under general anesthesia, positioned in either the beach chair or lateral decubitus position. Small incisions (portals) are made around the shoulder to introduce the arthroscope and surgical instruments. The joint is filled with sterile fluid to expand the surgical space and improve visualization.
The surgeon first performs a diagnostic arthroscopy to assess the extent of labral damage and identify any concurrent pathology. The torn labrum is evaluated, and the glenoid rim is prepared by removing damaged tissue and creating a bleeding bone surface to promote healing. If necessary, the surgeon may place additional portals for optimal instrument positioning and suture management.
Suture anchors, typically made of biocompatible materials, are inserted into the glenoid rim. These anchors secure strong sutures that will be used to reattach the labrum to the bone. The number and placement of anchors depend on the size and location of the tear. The surgeon passes sutures through the labral tissue using specialized instruments and ties them to restore the labrum to its anatomical position.
The repair is tested for stability and proper tension. Any associated pathology, such as biceps tendon injuries or rotator cuff tears, may be addressed during the same procedure. The instruments are removed, and the portals are closed with sutures.
Post-operative rehabilitation is crucial for optimal outcomes. Initially, the shoulder is immobilized to protect the repair. A structured physical therapy program begins with passive range of motion exercises, progressing to active motion and eventually strengthening exercises. Full recovery typically takes 4-6 months, though return to high-demand activities may require additional time.
Success rates for arthroscopic labral repair are generally high, with most patients experiencing significant improvement in shoulder stability and function. However, outcomes depend on various factors, including tear pattern, tissue quality, and patient compliance with rehabilitation protocols.
Potential complications include infection, stiffness, anchor failure, and recurrent instability. Proper patient selection, meticulous surgical technique, and appropriate post-operative care are essential for minimizing these risks and achieving favorable outcomes.
The procedure has evolved significantly with advances in arthroscopic technology and surgical techniques, allowing for more precise repair and faster recovery compared to open surgery. Modern instrumentation and improved understanding of shoulder biomechanics have made arthroscopic labral repair the preferred treatment for many types of labral pathology.
Shoulder labral tears are common injuries in athletes, particularly those involved in overhead and contact sports. Advances in arthroscopic techniques have revolutionized the approach to labral repairs, offering minimally invasive solutions with improved outcomes. This report reviews the current state-of-the-art arthroscopic techniques for shoulder labral repairs from a sports medicine perspective.
The glenoid labrum is a fibrocartilaginous rim that surrounds the glenoid fossa, deepening the socket and providing stability to the glenohumeral joint. It serves as an attachment site for the glenohumeral ligaments and the long head of the biceps tendon. Understanding the complex anatomy and biomechanics of the labrum is crucial for successful repair.
Types of Labral Tears:
1. SLAP (Superior Labrum Anterior to Posterior) lesions
2. Bankart lesions (anteroinferior labral tears)
3. Posterior labral tears 4. Pan-labral tears
Each type requires specific repair techniques tailored to the location and extent of the injury.
Preoperative Evaluation:
– Thorough history and physical examination
– Advanced imaging (MRI or MR arthrogram)
– Assessment of concomitant injuries (rotator cuff, biceps tendon)
– Consideration of patient factors (age, activity level, sport-specific demands)
1. Portal Placement:
– Standard posterior viewing portal
– Anterosuperior and anteroinferior working portals
– Additional portals as needed (e.g., Neviaser portal for SLAP repairs)
2. Diagnostic Arthroscopy:
– Systematic evaluation of the glenohumeral joint
– Identification and classification of labral pathology
– Assessment of associated injuries
3. Labral Preparation:
– Debridement of frayed or degenerative tissue
– Mobilization of the labrum
– Preparation of the glenoid rim (light decortication or microfracture)
4. Suture Anchor Placement:
– Biodegradable vs. non
-biodegradable anchors
– Knotless vs. knot-tying anchors – Single-loaded vs. double-loaded anchors
– Optimal anchor positioning and spacing
5. Suture Management:
– Suture shuttling techniques
– Horizontal vs. vertical mattress configurations
– Simple vs. complex suture patterns
6. Knot Tying:
– Arthroscopic knot-tying techniques (e.g., SMC, Tennessee slider)
– Proper tensioning and security of knots
– Knot stacks positioned away from the articular surface
1. SLAP Repair:
– Identification of SLAP tear type (I-IV)
– Biceps tendon management (tenotomy vs. tenodesis in older athletes)
– Anchor placement at 12, 1, and 11 o’clock positions – Suture configuration to recreate labral bumper and tension biceps anchor
2. Bankart Repair:
– Mobilization of anteroinferior labrum
– Creation of adequate labral shift – Sequential anchor placement from 5:30 to 3 o’clock
– Consideration of capsular plication in cases of laxity
3. Posterior Labral Repair:
– Patient positioning (lateral vs. beach chair)
– Anchor placement from 6 to 10 o’clock
– Management of reverse Hill-Sachs lesions if present
4. Pan-labral Repair:
– Systematic approach to address circumferential labral pathology
– Combination of techniques for anterior, posterior, and superior labral repair
1. Remplissage:
– Complementary procedure for engaging Hill-Sachs lesions
– Arthroscopic posterior capsulodesis and infraspinatus tenodesis
2. Knotless Repair Systems:
– All-suture anchors
– Tape augmentation for improved load distribution
– Suture-passing devices for efficient tissue manipulation
3. Augmented Repair Techniques:
– Biological augmentation (PRP, stem cells)
– Collagen-based scaffolds for tissue reinforcement
4. Labral Reconstruction:
– Autograft or allograft options for irreparable labral deficiency
– Iliotibial band, hamstring, or biceps tendon graft sources
Postoperative Management:
– Immobilization protocol based on repair type and tissue quality
– Staged rehabilitation focusing on:
– Protection of repair
– Range of motion restoration
– Strengthening
– Sport-specific training
Return-to-play criteria:
– Full range of motion
– Adequate strength (compared to contralateral side)
– Functional testing
– Sport-specific performance metrics
Outcomes and Complications:
– Success rates:
– SLAP repair: 63-94%
– Bankart repair: 85-95%
– Posterior labral repair: 80
-90%
– Potential complications:
– Recurrent instability
– Stiffness
– Hardware-related issues
– Chondral injury – Infection
– Factors affecting outcomes:
– Age
– Number of dislocations prior to surgery
– Presence of bone loss
– Compliance with rehabilitation
Future Directions:
1. Advancements in bioengineered materials for labral augmentation
2. Refinement of arthroscopic techniques for complex labral pathologies
3. Integration of robotics and navigation systems for improved precision
4. Development of novel biological therapies to enhance healing
Arthroscopic shoulder labral repair has become the gold standard for managing labral pathology in athletes. The evolution of techniques, from basic suture anchor repairs to advanced knotless systems and biological augmentation, has significantly improved outcomes. Sports medicine specialists must stay abreast of these advancements to provide optimal care for athletes with shoulder instability. Careful preoperative planning, meticulous surgical technique, and appropriate postoperative management are crucial for successful outcomes and return to sport.
As the field continues to evolve, future research should focus on long-term outcomes, prevention strategies, and novel biological approaches to enhance labral healing and function. The integration of cutting-edge technology and personalized treatment algorithms will further refine our approach to shoulder labral repairs in the athletic population.
©2025 Dr Frank McCormick All Rights Reserved.
©2025 Dr Frank McCormick All Rights Reserved.
