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Labrum Refixation: Surgery, Technique & Recovery

Labrum refixation is a surgical procedure to reattach a torn labrum at the shoulder or hip joint, restoring stability and function to the affected joint.

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Things worth knowing about "Labrum refixation"

Labrum refixation is a surgical procedure to reattach a torn labrum at the shoulder or hip joint, restoring stability and function to the affected joint.

What is Labrum Refixation?

Labrum refixation is a surgical procedure in which the labrum – a ring of fibrocartilage that deepens and stabilizes a joint socket – is reattached to the bone after a tear or detachment. The labrum is found at both the shoulder joint (glenoid labrum) and the hip joint (acetabular labrum). It increases joint depth, improves stability, and helps distribute pressure across the joint surface. A labral tear can lead to joint instability, pain, and restricted movement.

Causes and Indications

Labrum refixation is indicated when the labrum has been damaged by one of the following mechanisms:

Traumatic shoulder dislocation: The most common cause of labral injury at the shoulder, often referred to as a Bankart lesion.
Chronic instability: Repeated microtrauma or persistent joint instability over time.
Femoroacetabular impingement (FAI): Mechanical pinching at the hip joint that damages the labrum.
Sports overuse: Particularly in throwing sports, martial arts, or high-impact athletic activities.
Degenerative changes: Wear-related damage, more commonly seen at the hip joint.

Diagnosis

Before surgery, the labral injury is confirmed through several diagnostic measures:

Clinical examination: Specific provocation tests such as the apprehension test (shoulder) or the FABER test (hip).
MRI (Magnetic Resonance Imaging): Standard method for visualizing soft tissue structures; often performed as MR arthrography with contrast agent for improved detail.
Arthroscopy: Can be used simultaneously for both diagnosis and treatment.

Surgical Technique

Labrum refixation is typically performed arthroscopically (minimally invasive) through small skin incisions. The procedure is carried out under general or regional anesthesia.

Surgical Steps

Insertion of the arthroscopic camera and working instruments through small access points (portals).
Visualization and assessment of the torn labrum and adjacent structures.
Preparation of the bony rim to promote tissue healing and reattachment.
Fixation of the labrum using specialized suture anchors that are embedded in the bone and secure the tissue with sutures.
Any associated injuries (e.g., cartilage damage, Bankart lesion, SLAP lesion) are addressed in the same procedure.

Open vs. Arthroscopic Technique

In certain cases – such as severe bone deficiency or recurrent dislocations – an open surgical approach may be necessary, for example the Latarjet procedure at the shoulder. This is more invasive but may offer superior long-term outcomes in selected indications.

Postoperative Care and Rehabilitation

Rehabilitation following labrum refixation is critical to the outcome of the procedure and consists of several phases:

Phase 1 (0–6 weeks): Immobilization in a sling or brace, protection of the reattached tissue, passive range-of-motion exercises.
Phase 2 (6–12 weeks): Progressively active mobility exercises, gentle muscle activation.
Phase 3 (3–6 months): Strengthening exercises, functional training, sport-specific movements.
Return to sport: Generally after 4–6 months for recreational sports and 6–12 months for competitive athletes, depending on the joint and sport.

Outcomes and Prognosis

Labrum refixation demonstrates generally good long-term results. Most patients experience significant pain relief and improved joint stability. At the shoulder, the recurrent dislocation rate following arthroscopic Bankart repair is approximately 5–15%, and may be higher in young athletes. At the hip, outcomes are particularly favorable when the underlying cause (e.g., FAI correction) is addressed simultaneously.

Possible Risks and Complications

Postoperative bleeding or infection
Nerve injury (e.g., axillary nerve at the shoulder)
Anchor malpositioning or anchor migration
Restricted range of motion or joint stiffness
Recurrent instability or re-tear of the labrum
Risk of deep vein thrombosis (particularly with hip procedures)

References

Lill H., Voigt C. (eds.): Die Schulter – Diagnostik und Therapie. Springer Medizin Verlag, 2nd edition, 2014.
Tibor L.M., Sekiya J.K.: Differential diagnosis of pain around the hip joint. Arthroscopy, 2008; 24(12): 1407–1421. DOI: 10.1016/j.arthro.2008.06.019.
Bankart A.S.B.: Recurrent or habitual dislocation of the shoulder-joint. British Medical Journal, 1923; 2(3285): 1132–1133.

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