Labral tear and shoulder arthroscopic labral (Bankart) repair
A labral tear is an injury occurring in the labrum – the ring of cartilage which deepens the shoulder socket and helps stabilise the joint. Perhaps the most well-known type of labral tear is the SLAP tear, which occurs across the top of the labrum.
A Bankart lesion is a type of tear which occurs in the labrum’s lower rim. Often resulting from traumatic injury, it is typically seen alongside anterior shoulder dislocations. Bankart lesions can also result from general wear-and-tear, particularly in throwing athletes and older patients.
Treating labral tears/Bankart lesions
Bankart lesions fall into two categories: soft lesions, and osseous (bony) lesions. While soft Bankart lesions only affect the cartilage itself, osseous Bankart lesions are accompanied by a fracture in the shoulder and may indicate earlier surgical intervention, although both types are able to heal on their own.
Treatment generally begins conservatively with rest and immobilisation. Non-steroidal anti-inflammatory drugs (NSAIDs) may be employed for pain relief. Following the initial rest period, physical therapy is employed to increase joint stability by strengthening the muscles in the shoulder.
If conservative measures fail to provide lasting pain relief and joint stability, surgical intervention may be considered.
Labral tear repair surgery
Surgical repair for labral tears can vary depending on the type of tear, its thickness, and location. In the case of Bankart tears, surgical repair is usually performed arthroscopically.
Using small, specialised tools, the surgeon enters the shoulder joint through several small incisions and places anchors in the glenoid bone. These are then used to secure sutures, which reposition the torn labrum and secure it to the bone. If a fracture is present, the anchors may be positioned to secure it and screws may sometimes be affixed in the same surgery.
In rare cases where arthroscopic repair fails to relieve pain and improve joint stability, an open surgical repair may be recommended later on.
Indications for arthroscopic repair
Bankart lesion repair is considered appropriate in cases which do not respond to conservative management. Although it tends to provide lasting relief in younger patients, patients under age 25 may not respond as well.
Patients with ligamentous laxity (especially stretchy ligaments) may receive less benefit from arthroscopic Bankart lesion repair, as this can also affect joint stability.
As with any case, Dr Jonathan Cabot approaches Bankart lesion and labral tear repair on an individual basis. Any treatments – surgical or otherwise – will be discussed and assessed for suitability at your consultation appointment.
Recovery from arthroscopic repair
Following surgery, the arm is immobilised in a sling for 4-6 weeks. Physiotherapy to strengthen the muscles in the shoulder begins after this period, serving to strengthen and increase stability in the joint. Driving can usually be resumed at this time also.
Most patients regain a normal range of movement within 6 weeks and return to normal strength levels after 10 weeks. Sports and other intensive activities may be gradually introduced from 6 months following the procedure.