Procedure
Arthroscopic labral repair
Keyhole shoulder surgery to re-attach a torn labrum to the rim of the shoulder socket. Also called Bankart repair or shoulder reconstruction. The procedure restores the soft-tissue restraint that prevents the shoulder from dislocating and is the operation of choice for first-time and recurrent instability where bone loss is not a major issue.
Indications
When labral repair is the right operation
Labral repair restores the torn labrum to the bone, but it does not add new bone or change the shape of the socket. That makes it a good fit for shoulders where the soft tissue is the main problem and the bony socket is intact.
- First-time anterior dislocation in a young, active patient. Recurrence rates after a first dislocation in this group are very high, and earlier surgery reduces the long-term risk.
- Recurrent anterior instability without significant bone loss. Recurrent dislocators with an intact glenoid rim and no engaging Hill-Sachs lesion.
- Posterior labral tears. Less common than anterior tears but treated with the same anchor-and-suture principles.
- Multidirectional instability after failed rehabilitation. In selected patients where physiotherapy has not restored stability.
- SLAP tears. Some labral tears at the top of the socket (where the biceps tendon attaches) are repaired with the same technique.
When there is significant glenoid bone loss, a large engaging Hill-Sachs lesion, or a previous labral repair has failed, the open Latarjet procedure is usually the better option. Imaging assessment, particularly a CT scan for bone loss, is the key driver of that decision.
How it works
Suture anchors and the labrum
The labrum is a tough ring of fibrous tissue that surrounds the rim of the socket. It deepens the socket, helps stabilise the joint, and serves as the attachment point for the glenohumeral ligaments that hold the shoulder in place.
When the shoulder dislocates, the labrum is usually pulled off the rim of the socket along with the attached ligaments. A labral repair re-attaches that torn labrum-ligament complex back to the rim using suture anchors.
Each anchor is a small device with sutures threaded through it, placed into the bone of the rim of the glenoid. The sutures pass around or through the labrum and are tied to bring the labrum back to the bone. As the labrum heals back to the bone, the shoulder regains its soft-tissue stability.
The procedure
What happens in the operating theatre
The procedure is performed under general anaesthetic, usually with a regional nerve block to help with post-operative pain control. The patient is positioned in a beach-chair or lateral position, and the operative arm is prepped and draped free.
Three or four small skin incisions are made around the shoulder. A camera (the arthroscope) is placed through one of the portals, and instruments through the others. The shoulder joint is examined first, and any associated injuries (cuff tears, biceps tendon damage) are identified and addressed.
The torn labrum is freed up from any scar tissue and prepared back to its anatomic position on the rim of the glenoid. The bony rim is freshened to encourage healing. Suture anchors are placed into the rim, and the sutures are passed around the labrum and tied to bring it back to the bone. Most repairs use three to four anchors.
The skin incisions are closed with absorbable sutures. A sling is applied at the end of the procedure. Most patients go home the same day.
Recovery
What recovery looks like
The sling is worn for four weeks to protect the repair while the labrum heals back to the bone. Passive exercises start within the first week or two under physiotherapy guidance. The aim is to maintain range of motion without putting the labrum under load.
Active movement out of the sling progresses through weeks four to twelve. Strengthening is introduced from around three months, starting with light resistance and building up gradually.
Most patients can drive at six weeks once out of the sling and with safe two-handed control of the steering wheel. Office work is usually possible within two to three weeks. Return to non-contact sport is typically at three to four months. Return to contact and collision sport is later, usually at four to six months, after the repair is well-healed and rotator-cuff strength has returned.
Complications and risks
What can go wrong
Arthroscopic labral repair is a well-established procedure with generally good outcomes. The specific risks include (but are not limited to):
- Recurrent dislocation. Recurrence is the main risk specific to this procedure. The rate depends on patient factors and on the original injury pattern. Recurrence rates after labral repair can be as high as around 15 percent in young active males with high-demand activity profiles. Recurrence after labral repair is the situation where Latarjet is then considered.
- Stiffness. A period of stiffness after sling removal is normal and improves with physiotherapy. Long-term stiffness is uncommon.
- Persistent pain or apprehension. Some patients have ongoing discomfort or apprehension in provocative positions. Often improves over time.
- Infection. Very rare with arthroscopic shoulder surgery.
- Nerve injury. Rare. Stretch injuries from positioning are uncommon and usually recover.
- Complex regional pain syndrome (CRPS). A rare condition that causes pain and stiffness in the hand.
- Anaesthetic complications. Discussed separately with the anaesthetist before surgery.
- DVT. Very rare with surgery of the upper limb.
FAQ
Frequently asked questions
- When is labral repair the right operation, and when is Latarjet better?
- Labral repair is used when the soft tissue is the main problem and the bony socket is intact. It is the operation of choice for first-time and recurrent instability without significant bone loss. The open Latarjet is used when there is significant glenoid bone loss, an engaging Hill-Sachs lesion, or a previous labral repair has failed. Imaging assessment, particularly a CT scan for bone-loss measurement, drives the decision.
- How long is the recovery from labral repair?
- A sling is worn for four weeks while the labrum heals back to the bone. Active movement progresses through weeks four to twelve. Strengthening starts from around three months. Most patients can drive at six weeks once out of the sling and with safe two-handed control of the steering wheel. Return to non-contact sport is typically at three to four months, and contact and collision sport at four to six months.
- How is the surgery performed?
- The procedure is arthroscopic, through three or four small skin incisions. The torn labrum is freed up from any scar tissue. The bony rim of the glenoid is freshened. Suture anchors are placed into the rim, and sutures are passed around the labrum to bring it back to the bone. Most repairs use three or four anchors.
- What is the chance of re-dislocation after labral repair?
- Recurrence rates depend on patient factors, the original injury pattern, and the bone-loss situation. Recurrence after labral repair can be as high as around 15 percent in young, active males with high-demand activity profiles. When recurrence happens after a labral repair, Latarjet is then considered.
- Will I be able to throw or play contact sport again?
- Most patients return to their previous level of activity, including contact sport. Return to throwing and contact sport typically takes four to six months and depends on regaining range of motion, strength, and confidence. The repair is at its weakest in the first few weeks and strengthens as the labrum heals to the bone.
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