Labral Repair for Shoulder Instability
For young to middle-aged adults with traumatic shoulder instability and labral tears, arthroscopic labral repair using suture anchors is the definitive treatment after failed conservative management, with excellent long-term outcomes and low recurrence rates.
Initial Diagnostic Workup
Obtain standard three-view radiographs first (anteroposterior in internal and external rotation PLUS axillary or scapula-Y view) to exclude fractures and bony pathology before proceeding 1, 2, 3. Never rely on AP views alone—they miss posterior dislocations in over 60% of cases 1, 3.
MR arthrography is the gold standard for diagnosing labral tears, with 86-100% sensitivity for detecting labral injury 2, 3. For acute dislocations, non-contrast MRI may be preferred to evaluate for labral tears, capsular injuries, and bone loss that predict recurrence 2, 3.
Conservative Management First
Implement a structured 3-month conservative program before considering surgery 2:
- Pain control with acetaminophen or NSAIDs (ibuprofen) if no contraindications 2
- Subacromial corticosteroid injection if pain relates to rotator cuff or bursal inflammation 2
- Initial physical therapy phase: Gentle stretching and mobilization focusing on external rotation and abduction 2
- Later phase: Progressive strengthening of rotator cuff and scapular stabilizer muscles 2
- Return to activities only after achieving pain-free motion and adequate strength 2
Surgical Indications
Proceed to arthroscopic labral repair with suture anchors when 2, 4, 5:
- Conservative management fails after 1-3 months 2
- Recurrent instability despite appropriate rehabilitation 2
- Significant glenoid bone loss (up to 10% of patients with recurrent instability may require bone grafting) 2
Surgical Technique and Outcomes
Arthroscopic capsulolabral repair using suture anchors is the standard approach 4, 5. The number of anchors depends on tear extent—circumferential tears require an average of 7.1 anchors 5.
Long-term outcomes are excellent: At minimum 10-year follow-up, patients show significant improvements in all validated outcome measures (Rowe, ASES, SANE scores all improve significantly, p<0.05) 4. The failure rate requiring revision surgery is approximately 14% 4.
For extensive labral tears (270° or circumferential lesions), arthroscopic repair restores mechanical stability long-term with complication rates similar to smaller tears 4, 5.
Age-Specific Considerations
Younger patients (<35 years) have higher risk of persistent instability and benefit more from surgical stabilization if conservative management fails 2, 3.
Older patients (>40-60 years) are more likely to have concomitant rotator cuff tears and may experience weakness in external rotation, abduction, or internal rotation 2, 3. Do not overlook these associated injuries, particularly with high-energy trauma 2, 3.
Critical Pitfalls to Avoid
- Never attempt reduction without radiographic confirmation—this could worsen fracture-dislocations 1
- Never rely on AP radiographs alone—the axillary or scapula-Y view is mandatory 1, 3
- Do not overlook rotator cuff tears in patients over 40 years with traumatic mechanisms 1, 2, 3
- Do not delay reduction in acute dislocations—this increases neurovascular complications 1
- Evaluate for glenoid bone loss in recurrent instability, as progressive bone loss occurs in up to 10% and may require specialized bone grafting procedures 1, 2