This critical analysis review synthesizes techniques, evidence, and outcomes for arthroscopic repair of anterior/inferior, superior (SLAP), and posterior labral tears. It frames patient selection factors, glenoid bone loss thresholds, and age cutoffs that guide operative decisions. Evidence grades and named classifications are reviewed to structure treatment recommendations.
When you evaluate a patient for arthroscopic labral repair, glenoid bone loss is the first thing that should change your plan. The traditional 20-25% threshold is being pushed lower by recent data (failure at ≥17.3%, worse scores at ≥13.5%), so any concern for bone loss warrants a CT scan and consideration of a Latarjet or bony augmentation rather than soft-tissue repair alone.
Use the ISIS to quantify risk before committing to arthroscopy: a score ≥7 carries a 70% redislocation rate and should push you toward an open or bony procedure, especially in a young contact athlete with hyperlaxity.
For SLAP tears, age is the decision axis. In patients ≥36 or those needing a concurrent cuff repair, favor biceps tenodesis or tenotomy over labral repair given the 77% failure rate reported in the older group.
For posterior tears, remember that pain, not instability, is the usual complaint, so maintain a high index of suspicion and counsel elite throwers that return to prior level is not guaranteed.
This critical analysis review synthesizes techniques, evidence, and outcomes for arthroscopic repair of anterior/inferior, superior (SLAP), and posterior labral tears. It frames patient selection factors, glenoid bone loss thresholds, and age cutoffs that guide operative decisions. Evidence grades and named classifications are reviewed to structure treatment recommendations.
When you evaluate a patient for arthroscopic labral repair, glenoid bone loss is the first thing that should change your plan. The traditional 20-25% threshold is being pushed lower by recent data (failure at ≥17.3%, worse scores at ≥13.5%), so any concern for bone loss warrants a CT scan and consideration of a Latarjet or bony augmentation rather than soft-tissue repair alone.
Use the ISIS to quantify risk before committing to arthroscopy: a score ≥7 carries a 70% redislocation rate and should push you toward an open or bony procedure, especially in a young contact athlete with hyperlaxity.
For SLAP tears, age is the decision axis. In patients ≥36 or those needing a concurrent cuff repair, favor biceps tenodesis or tenotomy over labral repair given the 77% failure rate reported in the older group.
For posterior tears, remember that pain, not instability, is the usual complaint, so maintain a high index of suspicion and counsel elite throwers that return to prior level is not guaranteed.