What is the Shoulder Labrum?
The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (upper arm bone), and the clavicle (collarbone). The labrum is the cartilage that surrounds the glenoid (shoulder socket) and provides stability to the shoulder. Tears or fraying may occur in the labrum from dislocating your shoulder, vigorous pulling or pushing of the arm, repetitive overhead activity, or direct trauma.
What is Labral Debridement and Repair?
Labral debridement and repair is a surgical procedure to remove loose and damaged cartilage in the labrum and to secure the torn labrum to its normal attachment to the bone.
When is Labral Debridement and Repair Surgery Necessary?
Labral debridement surgery is commonly performed for relatively large labral tears. If the tear is small and only causes minimal symptoms when you move your shoulder, removing the ragged edges and any loose labrum fragments may be enough to relieve your discomfort. The shoulder may become unstable if the labral tear is larger. If this is the case, the labral tear may need to be repaired with suture anchors, rather than simply removing the damaged portion of the labrum.
Preparation of the Labral Debridement and Repair Surgery
Preparation for labral debridement and repair may involve the following steps:
- Before the surgery, you will receive a complete medical evaluation and your doctor will discuss your surgery in detail.
- Your doctor will perform a physical exam of the shoulder and take a medical history.
- Talk to your doctor about the medicines you are taking prior to the procedure and allergies to any medicines or anesthesia.
- You may be asked to stop taking blood-thinners, anti-inflammatories, aspirin, or other supplements for a week or two.
- Do not eat or drink 6-8 hours before the surgery.
- Arrange for someone to drive you home after the surgery.
Procedure for Labral Debridement and Repair Surgery
- The surgery is performed under anesthesia
- Your surgeon makes several small incisions in the shoulder after the anesthesia has taken effect.
- An arthroscope is a tiny camera that is inserted into one of the incisions to help direct images during the procedure.
- To fill the joint with fluid, a tool is inserted into one of the small incisions. This widens the joint, allowing the surgeon to evaluate the damage more thoroughly.
- The surgeon will remove the loose and damaged cartilage and then the torn labrum is reattached to the bone with the help of suture anchors.
- The incisions may be closed with minimal sutures and covered with a bandage.
Postoperative Care after Labral Debridement and Repair Surgery
In general, postoperative care and recovery after labral debridement and repair surgery will involve the following steps:
- You will be transferred to the recovery area where you will closely observe for any allergic/anesthetic reactions and your vital signs will be monitored.
- Following the surgery, your arm will be placed in a shoulder sling for 2 to 4 weeks to rest the shoulder and promote healing.
- Ice packs can also be used to help reduce swelling and pain in the shoulder.
- You may experience pain, swelling, and discomfort in the shoulder area. Pain and anti-inflammatory medications are provided as needed to address these.
- An individualized physical therapy program may be given to help strengthen your shoulder muscles and improve your shoulder function.
- For labral repair, range of motion exercises are started at 1-week post-op, and strengthening begins at 8-12 weeks.
- A follow-up appointment will be planned on a regular basis to monitor your progress.
Risk and Complication of Labra Debridement
As with any surgical procedure, there are potential risks and complications that may occur. Those related to labral debridement and repair may include:
- Persistent or increased pain
- Anaesthetic/allergic reactions
- Damage of nerves or blood vessels
- Re-rupture of the labrum
Case: Posterior Labral Repair with Knotless Sutures
History: Young patient with posterior shoulder pain which is getting worse over time.
Arthroscope looking into the joint. A loose fragment of cartilage is floating in the joint. The fragment is removed.
The posterior labrum is shredded ad needs to be debrided (cleaned up) to more healthy tissue.
Following debridement of the labrum and cartilage you can see there is a small defect in the cartilage adjacent to the labrum. A suture is placed thru the posterior-inferior labrum.
The first suture anchor is placed into the edge of the glenoid (socket) starting posterior inferior. These sutures will be tightened after all the sutures are placed.
Additional suture anchors are placed going superior (up) the glenoid (socket). Sutures are passed thru the labrum as they are placed. The sutures are placed so that the labrum and capsule (soft tissue) will be imbricated and cover the cartilage defect.
The sutures are sequentially tightened and cut. These are knotless all-suture anchors which is why no knots are seen. Here is the final suture being tightened.
Final repair. The posterior labrum is repaired and imbricated back to the glenoid (socket) and over the cartilage defect. The humeral head is well centered over the glenoid.