The labrum is a ring-shaped structure of tough fibrocartilage lining the rim of the socket in the shoulder and hip joints. It acts like a gasket, deepening the relatively shallow joint socket to stabilize the joint and keep the “ball” (humerus or femur) securely in place. When the labrum tears, the joint loses stability, causing pain, catching, and looseness. If the tear is significant or causes instability, surgical intervention is often necessary to restore function.
When Surgical Repair is Necessary
Surgery is generally considered after non-operative treatment fails to provide relief. Initial management involves rest, activity modification, non-steroidal anti-inflammatory drugs (NSAIDs), and a structured physical therapy program. This conservative approach aims to reduce inflammation and improve surrounding muscle strength, and is typically trialed for several weeks to a few months. Injections, such as corticosteroids, may also be used to confirm the diagnosis and temporarily ease symptoms.
Surgery is reserved for patients whose persistent pain, joint instability, or mechanical catching significantly limits daily life despite non-operative care. The type and location of the tear also influence the decision. For example, a Bankart tear in the shoulder, where the labrum pulls away from the socket, frequently causes recurrent dislocations and requires stabilization.
Another common shoulder injury is the SLAP tear, affecting the superior labrum where the biceps tendon attaches. If a SLAP tear involves instability or detachment of the biceps anchor, surgical fixation is often required. In the hip, tears are frequently associated with femoroacetabular impingement (FAI), where bony abnormalities cause the tear; surgery addresses both the tear and the underlying bone shape. Tears causing mechanical symptoms or instability are more likely to require surgical reattachment than smaller, stable tears.
The Arthroscopic Repair Procedure
Modern labral repair uses an arthroscopic, minimally invasive technique. This involves making several small incisions around the joint, usually less than a centimeter long. Through these incisions, the surgeon inserts a miniature camera (arthroscope) to visualize the joint interior on a monitor. Specialized instruments are introduced through other small incisions, minimizing trauma to surrounding tissues.
The first step is preparing the site where the labrum tore away from the socket bone (glenoid or acetabulum). The surgeon uses a motorized shaver or burr to clean damaged labral tissue and lightly roughen the bony rim. This controlled abrasion creates a bleeding surface, which enhances the biological healing response and promotes reattachment of the labrum to the bone.
Reattachment is accomplished using specialized suture anchors. These anchors, often made from biodegradable plastic or PEEK, are implanted directly into the socket bone. Each anchor is pre-loaded with high-strength sutures for fixation. The surgeon passes these sutures through the torn labral tissue and secures them, pulling the detached labrum back against the roughened bone surface.
The number and placement of anchors depend on the size and location of the tear; a large tear may require multiple anchors for secure reattachment. In hip repair, this reattachment recreates the labrum’s natural suction seal, which aids joint lubrication and stability. The anchors hold the labrum firmly against the bone until biological healing, a process taking several weeks, secures the tissue permanently.
Post-Surgical Recovery and Rehabilitation
Recovery begins immediately, focusing on protecting the newly fixed tissue and managing pain. Following shoulder repair, the patient wears a specialized sling or brace continuously for four to six weeks to immobilize the arm and allow healing. Hip repair patients are often restricted to partial or toe-touch weight-bearing with crutches for several weeks to protect the repair site from excessive load.
Physical therapy (PT) is a structured, progressive program that forms the foundation of successful recovery, often starting within the first few days post-surgery. The early phase focuses on passive range of motion (PROM), where the therapist moves the limb without the patient engaging muscles, ensuring the repair is not stressed. This gradually transitions into active-assisted range of motion (AAROM), followed by active range of motion (AROM).
The strengthening phase begins later, usually a few months after surgery, once the labrum has achieved sufficient biological healing. This phase targets surrounding muscles—such as the rotator cuff in the shoulder or the hip abductors and core—to restore dynamic stability and strength. Return to light activities is typically around four months. A full return to high-demand sports or labor-intensive work usually requires six to nine months, depending on individual progress.
The recovery phase carries risks, including joint stiffness and, less commonly, a re-tear if the rehabilitation protocol is not strictly followed. The slow, phased progression of physical therapy is designed to mitigate these risks by respecting tissue healing biology. Consistent adherence to instructions is the most important factor for secure healing and regaining full function.