AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-Primary Labral Repair_ Anterior to Posterior-Cassandra A. Lee, M.D.

Primary Labral Repair_ Anterior to Posterior-Cassandra A. Lee, M.D.

Pdf Summary

This presentation by Dr. Cassandra A. Lee focuses on primary labral repair for anterior shoulder instability, an issue particularly relevant in collision sports and military populations, with incidence rates up to 1.69/1000 person-years. Anterior shoulder dislocation commonly results in Bankart lesions (87-100%), bony Bankarts, and Hill-Sachs lesions, with high recurrence rates (80-90%) when treated nonoperatively. Surgical intervention dramatically reduces recurrence to 3-15% and improves quality of life and cost-effectiveness.<br /><br />Anatomically, dynamic stabilizers like the rotator cuff and biceps enhance joint stability by increasing compressive forces, while ligaments (SGHL, MGHL, AIGHL, PIGHL) provide restraint in specific shoulder positions. Shoulder instability often involves pathoanatomical changes such as ALPSA, Hill-Sachs lesions, and HAGL.<br /><br />Evaluation protocols include the Beighton criteria for hyperlaxity and physical tests (Load Shift, Apprehension, Sulcus, Gagey, Push-Pull, Jerk, and Kim tests) to identify instability patterns.<br /><br />Surgical technique is critical in arthroscopic Bankart repair outcomes. Modern approaches emphasize positioning the patient laterally with dual traction, thorough identification of injury zones, labral mobilization, and secure anchor placement typically at or below the 3 o’clock position on the glenoid rim. Using at least three suture anchors is recommended to reduce failure rates (7.9% vs. 17.8% with fewer anchors). Procedures may include additional steps like Hill-Sachs lesion remplissage for posterior defect management.<br /><br />The overall strategy is to address the primary instability direction and augment repair to ensure reliable healing, restored motion, and lower recurrence. The technique relies on precise anchor placement, suture passage through the labrum, and balanced stabilization throughout the capsulolabral complex. This approach improves long-term outcomes for patients with anterior shoulder instability.

Keywords

primary labral repair

anterior shoulder instability

Bankart lesions

Hill-Sachs lesions

arthroscopic Bankart repair

rotator cuff

shoulder dislocation

suture anchors

shoulder instability evaluation

remplissage procedure