Evolution of Technology

Suture Anchor

Suture anchors are the technology of choice when performing labral repair. A variety of suture anchor types exist, each with their own benefits and limitations. Suture anchors contain three components: the anchor, the eyelet and the suture. The anchor can be a screw mechanism, or an interference fit.

Materials used for anchors include various metals or bioabsorbable composites. The eyelet is a loop in the anchor through which the suture passes. Finally, the suture is what connects the under-repair tissue to the anchor. Suture can be absorbable or permanent, and varies in strength and elasticity. The ideal anchor when performing a labral repair is low profile, to eliminate the possibility of the anchor violating the glenoid cartilage, and provides excellent pullout strength.

Evolution of Procedure

Shoulder Labral Repair

The treatment of choice for labral tears is direct repair of the labrum back to the glenoid. This repair restores the soft-tissue buttress to anterior and/or posterior translation of the humeral head on the glenoid. Effective labral repair first requires mobilization of the labrum off of the glenoid. Once mobilized, labrum and surrounding capsule are sutured together into a soft-tissue bumper to repair the area of damage. By including capsule into the repair, surgeons can create a larger barrier to translation or dislocation, and prevent further instability events.

Evolution of Diagnosis

Shoulder Instability

Shoulder labral tears are a common finding in patients with shoulder instability. Often secondary to a traumatic shoulder dislocation, these tears can lead to progressive and debilitating instability. When associated with a bony fleck off of the glenoid, these tears are known as Bankart lesions. They are often associated with a Hill Sachs deformity, which is an indentation on the humeral head where it impacts the glenoid.

Shoulder labral tears alter the biomechanics of the shoulder joint, and cause diminished restraint to humeral head translation. Labral tears can also occur in the posterior labrum, and are known as Kim lesions. These lesions are common in football linemen and powerlifters, as the strong posterior forces experienced by these athletes’ shoulders can cause posterior labral tearing. Failure to properly address labral tears will lead to continued instability about the shoulder and may lead to earlier degenerative joint disease.