Our Summary

This research paper discusses the issue of recurring instability in the back part of the shoulder after an initial repair, which is rare but poses a clinical challenge. Most reoperations in failed labral (a type of cartilage) repairs were linked to the shape of the glenoid bone (part of the shoulder) due to significant bone loss, retroversion (rotation backwards), or dysplasia (abnormal growth). There are several treatment options available including another labral repair with or without tightening of the joint capsule, cutting and reshaping the glenoid or humerus bone, or adding bone to the glenoid. No single method has been proven to be the best and each one has its own pros and cons. Therefore, it’s important to carefully evaluate and plan for each patient’s unique condition to ensure the best outcome after reoperation.

FAQs

  1. What causes recurrent posterior shoulder instability after a primary labral repair?
  2. What are the different treatment options for failed labral repair?
  3. How is the best technique for revision surgery determined after a failed labral repair?

Doctor’s Tip

A doctor might tell a patient undergoing labral repair surgery to follow their post-operative care instructions closely, including attending physical therapy sessions as prescribed. They may also advise the patient to avoid activities that could put excessive strain on the repaired labrum, such as heavy lifting or overhead movements, to allow for proper healing. Additionally, the doctor may stress the importance of attending follow-up appointments to monitor progress and address any concerns promptly.

Suitable For

Patients who may be recommended for labral repair include those with recurrent posterior shoulder instability after primary repair, as well as those with glenoid bone morphology issues such as critical bone loss, retroversion, or dysplasia. These patients may benefit from a variety of treatment options including revision labral repair with or without capsular plication, glenoid osteotomy, humeral rotational osteotomy, or glenoid bone augmentation. It is important for healthcare providers to carefully evaluate each patient’s individual pathology to determine the most appropriate treatment approach for maximizing success after surgery.

Timeline

Before labral repair:

  1. Patient presents with symptoms of shoulder instability, such as pain, clicking, or feeling of shoulder coming out of socket.
  2. Patient undergoes physical examination, imaging studies (such as MRI or CT scan), and possibly arthroscopic evaluation to confirm diagnosis of labral tear.
  3. Surgical consultation is conducted to discuss treatment options, risks, and benefits of labral repair.
  4. Patient undergoes pre-operative preparation, including medical clearance, physical therapy, and education on post-operative care.

After labral repair:

  1. Patient undergoes arthroscopic labral repair surgery, which involves reattaching the torn labrum to the glenoid socket.
  2. Patient experiences post-operative pain and swelling, and begins physical therapy to regain strength and range of motion in the shoulder.
  3. Patient follows a rehabilitation protocol, which typically includes gradual progression of exercises and activities to prevent re-injury.
  4. Patient undergoes follow-up evaluations with the surgeon to monitor healing and progress, and make any necessary adjustments to the rehabilitation plan.
  5. Patient may gradually return to normal activities and sports, with guidance from the surgeon and physical therapist to prevent recurrence of shoulder instability.

What to Ask Your Doctor

  1. What are the reasons for the failure of my initial labral repair surgery?
  2. What is the best treatment option for my specific case of recurrent posterior shoulder instability?
  3. What are the potential risks and complications of revision labral repair surgery?
  4. How long is the recovery period after revision labral repair surgery?
  5. Are there any alternative treatment options to consider before undergoing revision surgery?
  6. Will I need physical therapy or rehabilitation after the revision surgery?
  7. What are the success rates of revision labral repair surgery for patients with recurrent instability?
  8. How will the revision surgery impact my daily activities and sports participation in the long term?
  9. Are there any specific precautions or restrictions I should follow after the revision surgery to prevent further instability?
  10. How can I best prepare for the revision surgery and optimize my chances of a successful outcome?

Reference

Authors: Karwandyar A, Sumpter AE, LeClere LE. Journal: Clin Sports Med. 2024 Oct;43(4):755-767. doi: 10.1016/j.csm.2023.12.003. Epub 2024 Jan 9. PMID: 39232578