Labral Repair Surgery

When is the operation performed?

The operation is intended to treat recurrent dislocations. This condition is also called shoulder instability. In addition to repeated dislocation episodes, the patient usually has difficulty using the shoulder and has to avoid sport or activities with the arm raised, for fear that the shoulder will dislocate.

In most cases, shoulder instability comes from a tear of a structure called the labrum. The damage is usually caused in the first dislocation; it does not heal and disrupts the shoulder's stabilizing mechanisms.

The only way to stabilize the shoulder and prevent dislocations is surgery.

Today it is standard to perform one of two operations to stabilize the shoulder:

• An operation to repair the torn labrum, called a "Bankart repair"
• An operation to reinforce the shoulder with bone – the "Latarjet" procedure

This article covers the labral repair operation.

What is the goal of the operation?

The goal is to treat the problem of instability, to prevent further dislocations of the shoulder joint and to allow a return to normal activity – while restoring normal anatomy, with minimal damage to the tissues.

What is done during the operation?

The operation repairs the tear in the anterior labrum using anchors.

In addition, the posterior capsule is usually reinforced against the humeral head – a procedure called remplissage.

Course of the operation

The operation is performed under general and regional anesthesia, using an arthroscopic technique.

During the operation the torn anterior labrum is stitched back to the glenoid.

In the first stage the tissue is released.

In the second stage anchors are inserted into the glenoid bone, and the sutures that come out of the anchor are used to stitch the tissue back in place. In most cases 2–4 anchors are used (depending on the type of anchor).

In the third stage another anchor is inserted into the back of the humeral head, and the capsule is fixed onto the head in a way that stops the head from moving forward beyond the edge of the glenoid bone. This helps prevent further dislocations.

At the end of the operation the shoulder is immobilized in a sling.

How long is the expected recovery after surgery?

Within about three weeks most shoulder movements usually return. A return to full activity is expected about 6 months from the time of surgery. The return to activity depends on daily physiotherapy to rehabilitate function.

A return to full activity can be expected, including contact sports and physical work.

Complications and risks

In principle the operation is very safe, and there are no anatomical structures nearby that could be injured.

The two common complications are:

• failure of the operation, with continued dislocations
• stiffness of the joint after the operation.

As for stiffness, it usually resolves after about 9 months.

If the stiffness does not resolve, or if dislocations continue, repeat surgery is usually needed.

In any case of a complication, it is important to go back to the operating surgeon and discuss the implications and treatment options.