Updated Anterior Labral Repair 2024

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This procedure showcases Dr. Grant Garcia’s updated technique for an arthroscopic anterior labral (Bankart) repair. This approach is aimed at treating chronic or recurrent anterior shoulder instability, which usually occurs following a traumatic sports injury or subluxation that tears the fibrocartilage rim (the labrum) off the front of the shoulder socket (glenoid).

The refined procedure highlights advanced, ultra-low-profile instrumentation and systematic tensioning through these primary steps:

• Comprehensive Joint Inspection & Assessment: Dr. Garcia begins by introducing the arthroscope through a posterior viewing portal to evaluate the entire joint space. He examines the anterior-inferior labral detachment, notes any associated bone wear (glenoid bone loss), and checks for a matching Hill-Sachs lesion on the back of the arm bone.
• Aggressive Tissue Mobilization: Using arthroscopic elevators and tissue liberators, Dr. Garcia painstakingly frees the scarred, displaced labrum and the attached inferior glenohumeral ligament (IGHL) complex from the neck of the scapula. Complete mobilization is crucial so the tissue can be properly shifted back upward to its native seat.
• Creating a Vascular Bone Footprint: A mechanical shaver and a specialized curved rasp are introduced to lightly abrade the anterior glenoid rim. By stripping away dense scar tissue and exposing a raw, bleeding bone surface, the surgeon activates a localized healing response necessary for biological tissue-to-bone integration.
• Knotless Anchor Placement: Utilizing specialized, angled drilling guides positioned precisely on the face of the glenoid rim (typically starting at the 5 or 6 o'clock position and moving upward), Dr. Garcia places modern, high-strength knotless anchors (such as 1.8 mm FiberTack or PushLock constructs).
• Capsular Plication and Shift: Using a modern rotational suture lasso or a pinch-and-roll device, Dr. Garcia captures a robust, thick tissue bite from the lower joint capsule and the detached labrum. The sutures are sequentially tensioned and locked down flush against the bone bed without knots. This systematically shifts the lax capsule upward, taking up the slack.

The final visualization shows that the anterior "labral bumper" has been tightly reconstructed and perfectly elevated. This restores the physical lip of the socket, reducing excessive joint volume and reliably stabilizing the shoulder while minimizing the post-operative stiffness common with older, knotted techniques.