Shoulder Labral Repair

Surgical technique is tailored to address specific types of injuries. Factors to consider when deciding the best treatment options include the patient’s age, sports activity, and symptoms.

• Bankart Repair: This procedure is primarily performed for anterior labral tears, commonly associated with shoulder dislocations. It involves reattaching the torn labrum to the rim of the shoulder socket using sutures or anchors.
• SLAP (Superior Labrum Anterior and Posterior) Repair: SLAP repairs are indicated for tears at the top of the labrum. The approach for SLAP repairs can range from debridement, which involves trimming the torn area, to more complex reattachment techniques.
• Posterior Labral Repair: This is less common and is used for tears at the back of the labrum, often caused by overuse or direct injury.
• Capsular Shift: Although not a direct labral repair, this procedure is sometimes combined with labral repair to address joint laxity and instability. It involves tightening the joint capsule and reattaching it to stabilize the shoulder.

Surgical intervention is considered based on a variety of factors.

• The specific type of labral tear plays a crucial role in determining the need for surgery. Specific tears like Bankart lesions or SLAP tears are more amenable to surgical repair.
• Severe symptoms such as persistent pain, instability, and weakness in the shoulder, especially when conservative treatments have failed, also indicate the necessity for surgical intervention.
• The patient’s age, overall health, lifestyle and activity level are important considerations, particularly for athletes or active individuals aiming to return to their pre-injury activity levels.

The success rate of labral repair surgery is generally high, but it varies based on the type of repair and the patient’s adherence to postoperative protocols:

• Bankart repair success rates are reported to be between 80% to 90%, with a significant reduction in the recurrence of shoulder dislocations.
• SLAP repair success rates vary widely, from 60% to 90%, depending on the specific type of SLAP lesion and the surgical technique used. Recent studies report that biceps tenodesis in patients younger than 40 treated for SLAP tears has shown lower rates of reoperation and higher return to sport rates.
• Posterior labral repair success rates are similar to Bankart repairs.

Patient age, activity level, severity of the tear, and the surgeon’s experience play crucial roles in the outcome.

Recovery from shoulder labral repair is a gradual process, typically involving several stages:

1. The immediate postoperative phase, which lasts from 0 to 6 weeks, is focused on managing pain and allowing the repaired tissue to heal. During this phase, patients usually wear a sling to immobilize the shoulder and start gentle range-of-motion exercises.
2. As the patient progresses into the intermediate phase, which spans from 6 to 12 weeks, the goal shifts to regaining full range of motion. This is achieved through intensified physical therapy and more active exercises. The advanced strengthening phase, beginning at 12 weeks, includes exercises aimed at restoring shoulder strength and function.
3. The timeline for returning to normal activities varies, typically ranging from 4 to 6 months, with athletes possibly requiring up to 9 months before resuming competitive sports.

Factors such as the patient’s age, overall health, type of repair, and commitment to rehabilitation significantly impact recovery time and outcomes. With proper surgical intervention and diligent rehabilitation, most patients can expect a good functional outcome and return to their pre-injury level of activity.