Despite advances in arthroscopic techniques and surgical implants, primary labral repairs in the shoulder can sometimes fail. Whether due to technical missteps, patient-specific anatomical challenges, or post-surgical issues, understanding these failure points is essential for both patients and surgeons when planning a revision or optimizing the outcome of the initial repair.
Common Reasons for Failure
Recurrent Instability and Re-Tears
One of the leading reasons a labral repair fails is because the shoulder remains unstable. This could be due to incomplete healing of the initial repair or a new injury that disrupts the repair site. High-risk groups—such as contact athletes, adolescents, or individuals with hypermobility—are particularly susceptible to this problem.
Anchor Malposition or Mechanical Failure
Surgical technique plays a key role in the success of labral repairs. Anchors placed in suboptimal positions may not provide adequate fixation, leading to loosening or failure over time. Mechanical issues like poor suture tension or insufficient tissue capture can also undermine the integrity of the repair.
Cartilage Damage or Chondrolysis
Though rare, some patients experience damage to the joint’s cartilage either from surgical implants or chemical irritants. Chondrolysis—a condition where cartilage rapidly deteriorates—can significantly compromise joint function and contribute to the overall failure of the labral repair.
Bone Loss in the Glenoid or Humeral Head
If a patient has substantial bone loss in the glenoid (socket) or the humeral head (ball), soft tissue repairs alone may not be enough to stabilize the joint. Without addressing the underlying bony deficiency, the shoulder can remain unstable, leading to failure despite a technically sound labral repair.
Poor Tissue Quality or Healing Capacity
Not all labral tissues are created equal. In some cases, the labrum may be too frayed, thinned, or degenerated to hold sutures effectively. Healing capacity can also vary between individuals based on age, activity level, or biological health—factors that directly affect repair success.
Inadequate Rehabilitation or Early Overuse
Postoperative care is as critical as the surgery itself. Patients who do not follow their rehabilitation plan or resume activity too soon place the repaired tissue at risk. Similarly, overly aggressive rehab protocols can lead to mechanical stress that compromises healing.
Intraoperative Complications
Although uncommon, complications such as infections, nerve injuries, or excessive scar formation can also lead to suboptimal outcomes. These complications may interfere with the healing process or lead to secondary problems that undermine the success of the original repair.
Overview of Failure Types
| Category | Description |
| Instability or Re-Tear | Recurrent dislocations or subluxations due to incomplete healing |
| Anchor or Technical Error | Malpositioned implants or failed mechanical fixation |
| Cartilage Damage | Chondrolysis or intra-articular damage from implants or chemicals |
| Bone Deficiency | Glenoid or humeral head bone loss affecting joint stability |
| Poor Tissue or Healing | Weak labral structure or inadequate biological healing response |
| Rehab or Compliance Issues | Early return to activity or improper physical therapy protocols |
| Surgical Complications | Infections, nerve damage, or other intraoperative adverse events |
Frequently Asked Questions
1. How can I tell if my labral repair has failed?
Common signs include persistent shoulder instability, clicking or catching sensations, pain during motion, or weakness. Imaging and a clinical exam are needed for diagnosis.
2. Is a revision surgery more difficult than the original procedure?
Yes. Revisions typically involve scar tissue, altered anatomy, or damaged tissue, which can make the surgery more complex.
3. Can bone loss be fixed in revision surgery?
Yes. Bone grafting procedures or techniques like the Latarjet can be used to restore bone and improve stability in revision cases.
4. How important is rehab after labral surgery?
Extremely. Rehabilitation is critical for regaining motion, rebuilding strength, and protecting the surgical repair during healing.
5. What is the success rate of revision labral repairs?
While success rates are slightly lower than for primary repairs, many patients still achieve significant improvement in pain and function with proper surgical planning and post-op care.
