Shoulder Labrum Surgery: Should We Fix More?

Unlike labral tears associated with shoulder dislocation, isolated labral lesions are generally not treated surgically, mainly due to associated risks such as capsulitis. This preliminary study aims to assess the relevance of conducting a randomized trial to potentially alter current practice guidelines regarding shoulder labral tears. The goal is to assess the effectiveness of such surgery by examining recovery, postoperative complications, as well as the impact of insurance coverage on patient outcomes. The study also assesses the diagnostic accuracy of labral tear detection using various imaging techniques. This retrospective descriptive study was conducted on 188 patients with isolated labral tears who underwent labral repair surgery performed by a single surgeon between October 2019 and December 2023. Cases involving concurrent rotator cuff or subscapularis repairs, and those associated with recurrent shoulder instability, were excluded from the record review. Data collected through chart review included patient outcomes, the presence of third-party payers, and the diagnostic accuracy of MRI arthrogram compared to CT arthrogram. Descriptive statistics were used. Preliminary results show that out of the 188 patients who underwent surgery, 95.2% reported an improvement in symptoms postoperatively, 3.7% noted no significant change at the time of review, one patient reported a worsening of symptoms, and one patient was lost to follow-up. Postoperative complications were noted in 8.5% of the patients, including 6.9% with stiffness and 1.6% with other complications. Capsulitis was noted in 14.3% of the cases, and all resolved with treatment. Among patients with third-party coverage (worker's compensation or insurance), 93% reported improvement, while 7% experienced no change. For patients without third-party coverage, 97% reported improvements, with one patient remaining stable, one reporting worsened symptoms, and one lost to follow-up. Out of the 188 patients with an intraoperatively confirmed labral tear, 91 had an MR arthrogram, and 66 had a CT arthrogram. Out of 91 MRI arthrograms, 41.8% were interpreted as normal, while 57.1% revealed a labral tear. Out of 66 CT arthrograms, 27.3% were interpreted as normal, while 59.1% revealed a labral tear. For the remaining exams, the radiologist concluded that a sublabral foramen was present. In all cases, a labral tear was noted intraoperatively and was repaired. Postoperative symptom improvement in most patients undergoing isolated labral tear repair outweighs the risk of capsulitis associated with surgery. The current gold standard imaging modality, MRI arthrogram, underestimates the presence of labral tears. CT arthrogram is more sensitive and should be favored when searching for a shoulder labral tear. These findings suggest that surgical repair of isolated labral tears is a promising treatment, highlight the need for improved diagnostic methods, and challenge current practice guidelines that often discourage surgical intervention for isolated labral tears.