Labral repair

Labral repair

Labral repair surgery is a procedure used to reverse damage to the labrum, or cartilage, in the shoulder. The head of the upper arm bone (humeral head) rests in a shallow socket in the shoulder blade called the glenoid. A soft fibrocartilaginous tissue rim, labrum surrounds the socket like a form of “weather stripping” and deepens it by up to 50 percent so that the head of the upper arm bone fits more securely and moves easily within the socket. If the labrum is torn, it can greatly hinder movement in the shoulder while causing a tremendous amount of pain.

The labrum can be torn due to a sports injury to the shoulder and often occurs in people who participate in football, baseball, golf, weightlifting and tennis or who suffer traumatic injuries such as falls or motor vehicle accidents. A labral tear also can be caused by the aging process that makes the labrum brittle and more susceptible to tears. When you have a labral tear, your shoulder becomes stiff and painful and tends to catch during movement. Activity will be limited and painful to accomplish. Labral repair surgery can regain motion in the shoulder and ease the painful symptoms.

Types

The type of labral repair depends on the type of tear that has occurred in the shoulder. Most labral tears can be treated with nonsurgical methods, but when painful symptoms persist despite treatment, labral repair surgery could be necessary. The different types of labral repair include:

  • SLAP repair – SLAP stands for superior labrum from anterior to posterior, which means that the tear runs from front to back in the socket of the shoulder. The SLAP tear occurs at the point where the bicep muscle tendon connects to the labrum in the shoulder socket.

SLAP repair is performed using shoulder arthroscopy, a minimally invasive surgical procedure to repair various painful disorders of the shoulder such as rotator cuff tendon tears, torn ligaments and bone spurs. An arthroscope is a small fiber optic tube, about the diameter of a pencil, with a system of lenses, a light and a small video camera. The camera sends real-time images to a video monitor next to the operating table, thus allowing the surgeon to see more detail than is seen with a larger incision (open surgery) and the naked eye.

The arthroscope is inserted into the shoulder joint to inspect for a labral tear. Once the tear is found, the surgeon removes any excess tissue and drills a small hole in the bone where the labrum has torn away. An anchor attached to a strong suture is placed in the hole. One or more anchors may be used, depending on the extent of the injury. The sutures are then tied around the torn labrum to reattach it to the bone.

  • Bankart repair – A Bankart lesion occurs when the ligaments are torn from the front of the socket. During this type of labral repair surgery, the torn labrum of the Bankart lesion is reattached to the shoulder socket.
  • Internal impingement repair – Internal impingement occurs when the underside of the rotator cuff is pinched against the socket of the shoulder, particularly in athletes who use overhead motion. This pinching is caused when the arm is moved all the way back in throwing position. Over time, this pinching can lead to the tearing of the tendon in the back side of the shoulder. Shoulder arthroscopy is usually combined with a surgical procedure known as debridement or stabilization to correct the internal impingement. Debridement consists of removing loose tendon fragments, thickened bursae (fluid filled sacs that cushion the shoulder joint) and other debris around the shoulder joint.

The multidisciplinary team of shoulder experts at North Shore-LIJ Orthopaedic Institute performs labral repair surgery as well as a broad range of nonsurgical and surgical treatments for conditions that affect the shoulder and elbow.

Animated video: Repair of detached labrum


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