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Arthroscopic Labral Repair (Shoulder)
Dr Kau Chung Yuan (许医生)
MBBS (S’PORE)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
What is Arthroscopic Labral Repair?
Arthroscopic labral repair is a surgical procedure used to treat tears in the labrum of the shoulder joint.
The labrum, a ring of cartilaginous tissue that encircles the shoulder socket, serves to stabilise the joint and support a wide range of motion. The primary goal of arthroscopic labral repair is to reattach the torn labrum to the shoulder socket’s bone, restoring the joint’s stability and function.
When is Arthroscopic Labral Repair Needed?
The labrum can tear due to various reasons, including shoulder dislocation, chronic shoulder instability, overuse injuries (common in athletes, particularly those involved in overhead sports), or degenerative changes in older adults. The following scenarios typically necessitate an arthroscopic labral repair:
- Shoulder Instability
This occurs when the labrum is torn from the bone, leading to a sensation of the shoulder ‘giving way’. Patients often report feelings of uncertainty and discomfort during certain shoulder movements, particularly with activities raising the arm overhead or moving it in certain directions. - SLAP (Superior Labrum Anterior and Posterior) Tears
These specific types of labral tears occur at the top (superior) part of the labrum and involve both the front (anterior) and back (posterior) of this area. SLAP tears are common in athletes and can result from acute trauma or repetitive shoulder motion. - Bankart Lesions
These occur following a shoulder dislocation when the labrum tears away from the lower part of the shoulder socket. Bankart lesions often lead to recurrent dislocations and chronic instability if not treated. - Degenerative Tears
In older adults, the labrum can become more brittle and prone to tearing, often due to degenerative changes in the shoulder joint.
Benefits and Risks of Arthroscopic Labral Repair
Benefits
- Minimally Invasive: Arthroscopy is a minimally invasive technique, involving small incisions and using a camera-equipped arthroscope and specialised instruments. This typically leads to less pain, a lower risk of infection, and a quicker recovery.
- Improved Joint Stability: The procedure effectively reattaches the torn labrum to the bone, restoring stability to the shoulder joint.
- Pain Relief: Many patients experience significant relief from shoulder pain following the repair of a torn labrum.
- Increased Range of Motion: Patients often regain a greater range of motion in their shoulder after recovery.
- Return to Activities: Successful arthroscopic labral repair can allow patients to return to their daily activities, sports, or work without the limitations imposed by a torn labrum.
Risks
- Anaesthesia Complications: As with any surgery requiring anaesthesia, there is a risk of complications related to the anaesthetic agents used.
- Infection: Although the risk is lower in arthroscopic procedures compared to open surgeries, there is still a potential for infection at the incision sites or within the joint.
- Nerve Injury: There can be a small risk of injury to the nerves around the shoulder during the procedure.
- Recurrence of Instability or Pain: In some cases, the repaired labrum may not fully heal, or the shoulder may remain unstable or painful, requiring further treatment or surgery.
- Stiffness and Limited Mobility: Some patients may experience stiffness or limited mobility in the shoulder during the recovery period. This is usually temporary but can be longer-lasting in some individuals.
Preparing for Arthroscopic Labral Repair Surgery
Preparation for arthroscopic labral repair surgery is a critical step in ensuring a successful outcome. Here are key considerations for patients undergoing this procedure:
- Preoperative Assessment
A thorough medical examination is necessary to assess the patient’s overall health status and readiness for surgery. This typically includes blood tests, imaging studies, and other diagnostic tests. - Consultation with the Orthopaedic Surgeon
Discussion with the orthopaedic surgeon will cover details of the procedure, potential risks, benefits, and the expected recovery process. It is an opportunity for patients to ask questions and express any concerns. - Anesthesia Evaluation
Before surgery, patients typically meet with the anesthesiologist to discuss the type of anaesthesia to be used and any potential risks, particularly if the patient has a history of reactions to anaesthesia or other medications. - Medication Review
Patients should inform their orthopaedic surgeon and anesthesiologist about all medications they are taking, as some may need to be stopped or adjusted before surgery. - Fasting
Patients will be instructed to fast for a certain period before the surgery, usually starting from midnight the night before.
What Can You Expect During an Arthroscopic Labral Repair
An arthroscopic labral repair is generally performed as an outpatient procedure, meaning the patient can go home on the same day.
The Surgical Process
- Anaesthesia: The surgery is typically performed under general anaesthesia, which means the patient will be asleep during the procedure and will not feel any pain.
- Incision and Access: The orthopaedic surgeon makes small incisions around the shoulder area to insert the arthroscope and surgical instruments. The arthroscope is a thin tube equipped with a camera and light, allowing the orthopaedic surgeon to view the inside of the joint on a monitor.
- Repairing the Labrum: Using specialised instruments inserted through the incisions, the orthopaedic surgeon reattaches the torn labrum to the bone. This may involve the use of sutures or anchors to secure the labrum in place.
- Inspection and Treatment of Other Issues: The orthopaedic surgeon may also inspect and address any other issues within the joint, such as loose cartilage, that may contribute to pain or instability.
- Closure: The incisions are closed with stitches or surgical tape and covered with a dressing.
Recovery and Rehabilitation Post-Surgery
The success of the surgery is significantly influenced by the patient’s commitment to the rehabilitation process and adherence to postoperative guidelines.
Immediate Postoperative Period
- Rest and Pain Management: Initially, managing pain and allowing the shoulder to rest is important. Pain medication prescribed by the orthopaedic surgeon should be taken as directed.
- Use of a Sling: Patients are typically required to wear a sling for a specified period (often several weeks) to immobilise the shoulder and facilitate healing.
- Wound Care: Proper care of the surgical site to prevent infection is essential. Instructions on how to care for the incisions will be provided by the healthcare team.
Early Rehabilitation
- Physical Therapy: Physical therapy usually begins within a few days to weeks after surgery, depending on the orthopaedic surgeon’s protocol. The initial focus is on gentle exercises to maintain range of motion without straining the repaired labrum.
- Gradual Increase in Activity: Gradually, the intensity of physical therapy exercises is increased to strengthen the shoulder muscles and improve flexibility.
Advanced Rehabilitation
- Strengthening Exercises: As healing progresses, more strenuous exercises are introduced to further strengthen the shoulder.
- Return to Daily Activities: The timeline for returning to daily activities, including work and sports, varies depending on the individual’s progress and the nature of their activities. This is typically discussed with the orthopaedic surgeon and physical therapist.
Long-Term Care
- Continued Exercise: Even after formal physical therapy ends, continuing with exercises to maintain shoulder strength and flexibility is recommended.
- Follow-up Visits: Regular follow-up visits with the orthopaedic surgeon are important to monitor the progress of recovery.
Patient Feedback
Dr. Kau Chung Yuan
MBBS (S’pore)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.
He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.
- Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
- Master of Medicine (Orthopaedics), Singapore (MMed) 2013
- Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
- Bachelor of Medicine and Surgery (MBBS, Singapore) 2004
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Frequently Asked Questions (FAQs)
How Long Does It Take to Fully Recover from the Surgery?
Full recovery from arthroscopic labral repair can take several months. The initial healing phase typically lasts for 4 to 6 weeks, during which time activities are limited and a sling is often used. Gradually, patients return to normal activities, with a complete return to sports or strenuous activities taking up to 6 months or longer.
Can I Return to Sports After Arthroscopic Labral Repair?
Many patients can return to sports after arthroscopic labral repair, but the timeline varies. A gradual return to sports-specific activities is usually initiated after the initial recovery period, often under the guidance of a physical therapist. The final decision to return to sports should be made in consultation with the orthopaedic surgeon, based on the patient’s progress and the specific demands of the sport.
Will I Need Physical Therapy After Surgery?
Yes, physical therapy is a crucial part of the recovery process. It typically starts with gentle range-of-motion exercises and progresses to more advanced strengthening exercises. The specific rehabilitation protocol may vary based on the orthopaedic surgeon’s preference and the patient’s individual needs.
Is Arthroscopic Labral Repair Painful?
Patients may experience pain after the surgery, but it is typically manageable with medications prescribed by the orthopaedic surgeon. The level of pain varies among individuals but generally decreases significantly within the first few weeks after surgery.