Our Summary

This research paper discusses the best way to treat repeated shoulder instability in young athletes who are still growing. There’s ongoing debate on the best approach - some argue for a non-surgical approach until the patient’s bones are nearly fully grown, while others recommend early surgery to prevent more damage. The paper introduces a method for repairing the labrum (a piece of fibrocartilage in the shoulder) without using anchors, to avoid possible harm to the glenoid physis (the growth area in the shoulder joint).

FAQs

  1. What is the best treatment for recurrent shoulder instability in skeletally immature athletes?
  2. What is the concern with performing surgery on patients with significant growth remaining?
  3. Can you explain the anchorless approach to labral repair and how it can prevent potential damage to the glenoid physis?

Doctor’s Tip

One helpful tip a doctor might tell a patient undergoing labral repair is to follow their post-operative rehabilitation plan diligently. This may include physical therapy exercises to strengthen the shoulder and improve range of motion, as well as avoiding certain activities that could put strain on the repaired labrum. By following the rehabilitation plan carefully, the patient can help ensure a successful outcome and reduce the risk of re-injury.

Suitable For

Patients who are typically recommended labral repair are those with recurrent shoulder instability, especially in skeletally immature athletes who have significant growth remaining. These patients may benefit from surgery to avoid further damage to the shoulder.

Timeline

Before labral repair:

  1. Patient experiences recurrent shoulder instability, often resulting in pain and limited range of motion.
  2. Patient undergoes a physical examination and imaging studies, such as MRI, to confirm the diagnosis of labral tear.
  3. Orthopedic surgeon discusses treatment options with the patient, including conservative management and surgical repair.
  4. Patient undergoes preoperative preparation, which may include physical therapy to strengthen the shoulder muscles.

After labral repair:

  1. Patient undergoes arthroscopic labral repair using an anchorless approach to avoid damage to the glenoid physis.
  2. Patient is placed in a sling for a period of time to protect the repair and allow for healing.
  3. Patient undergoes a postoperative rehabilitation program, which includes physical therapy to regain strength and range of motion in the shoulder.
  4. Patient is monitored by the orthopedic surgeon for several months to ensure proper healing and recovery.
  5. Patient gradually returns to normal activities and sports, with guidance from the medical team to prevent re-injury.

What to Ask Your Doctor

  1. What is a labral repair and why is it necessary in my case?
  2. What are the potential risks and complications of a labral repair surgery?
  3. How long is the recovery process after a labral repair surgery?
  4. Will I need physical therapy or rehabilitation after the surgery?
  5. How successful is labral repair surgery in treating my specific condition?
  6. Are there any alternative treatments to labral repair that I should consider?
  7. How soon can I return to sports or physical activities after the surgery?
  8. What are the long-term outcomes and expectations following a labral repair surgery?
  9. How many labral repair surgeries have you performed and what is your success rate?
  10. Are there any restrictions or limitations I should be aware of after the surgery?

Reference

Authors: Clinker CE, Chalmers PN, Romeo A. Journal: Arthrosc Tech. 2022 Oct 20;11(11):e2049-e2053. doi: 10.1016/j.eats.2022.08.005. eCollection 2022 Nov. PMID: 36457387