Overview
Shoulder stabilization repairs the labrum and capsule that hold the ball of the shoulder centered in its socket. When the shoulder dislocates, the labrum is peeled off the front rim of the glenoid (a Bankart lesion) and the capsule stretches, so the shoulder keeps slipping with far less force. Dr. O'Donnell reattaches the labrum with suture anchors and retensions the capsule. A posterior labral repair does the same at the back of the socket for patients who sublux backward, typically linemen, weightlifters and swimmers.
The goal is a shoulder that stays in place in the cocked position, in a tackle, or on a fall. The operation is arthroscopic and outpatient at Bayside Surgery Center; return to contact sport is typically around six months.
Who It's For
Repair is recommended for recurrent dislocations or subluxations, and for a first dislocation in a patient under about 25 who plays contact, collision or overhead sport, because in that group a second dislocation is likely and every recurrence takes more bone from the socket. Patients who feel the shoulder about to slip during throwing, serving or bench pressing, with a labral tear on MRI arthrogram, are candidates without a full dislocation. See shoulder instability and labral / SLAP tears for how the diagnosis is made.
A first dislocation in a patient over 30 who does not play contact sport is usually treated with a sling and a therapy program, since recurrence is much less likely with age. Patients with generalized laxity and no labral tear are also better served by rehabilitation. Two groups are usually treated with a different operation. When CT shows more than about 20% of the front of the glenoid worn away, or an engaging Hill-Sachs dent in the humeral head, a soft-tissue repair fails too often and Dr. O'Donnell recommends a Latarjet, transferring the coracoid to the front of the socket to rebuild the rim. And a patient over 40 who dislocates is checked for a rotator cuff tear, the more common injury at that age, which is treated with a rotator cuff repair when the tear meets the criteria on that page.
A labral tear on an MRI arthrogram is not by itself an indication for stabilization; labral changes are common in shoulders that have never dislocated. Dr. O'Donnell recommends the operation when the history of dislocation or subluxation, apprehension and relocation tests on exam, and the imaging of the labrum and bone all agree, and the patient's age and sport favor repair. See shoulder instability and labral and SLAP tears.
What the Procedure Involves
Surgery is performed under an interscalene block plus general anesthesia, with the patient on their side and the arm in gentle traction. An examination under anesthesia confirms the direction of instability, then the labrum is inspected from front to back along with the biceps anchor, the humeral head for a Hill-Sachs lesion and the glenoid rim for bone loss.
For an anterior repair, the detached labrum and capsule are mobilized off the neck of the glenoid until they float freely, and the rim is roughened to bleeding bone. Three or more small anchors are placed along the rim, and their sutures reattach the labrum and capsule on top of it, recreating the bumper and taking up capsular slack. A large Hill-Sachs lesion is filled by a remplissage, suturing the infraspinatus into the dent so it can no longer engage the rim. A posterior repair follows the same principles through a posterior portal. A SLAP tear in an overhead athlete is repaired with anchors; over about 35 the biceps is more reliably treated with a biceps tenodesis.
The operation takes about 60 to 90 minutes. The arm goes into a sling, or a neutral-rotation brace for posterior repairs, and patients go home the same day.
Risks & How They Are Minimized
The principal risk is recurrent instability, highest in young contact athletes, with bone loss, and with return to sport before the repair has matured. Dr. O'Donnell reduces it by measuring bone loss on CT and choosing Latarjet when the threshold is crossed, by using enough anchors to restore the whole detached segment, and by holding contact sport until about six months. Loss of external rotation is the trade-off of an anterior repair; the protocol limits it to 30° for four weeks and then progresses it so that throwers regain their range.
Infection is rare with arthroscopic portals and is guarded against with preoperative antibiotics. The axillary nerve runs just below the capsule and is protected by portal placement and anchor angle; block numbness resolves within a day. Cartilage damage from a proud anchor is avoided by placing anchors on the rim. Blood clots are uncommon; patients walk the same day and take aspirin if they have risk factors.
Recovery & Rehabilitation
Anterior (Bankart) and posterior repairs follow separate protocols because they protect opposite sides of the joint. The table shows the Bankart timeline with posterior differences noted.
| Phase | Timing | What happens |
|---|---|---|
| Protected motion | Weeks 0–4 (posterior: 0–6) | Sling except for exercise and hygiene. Pendulums, passive flexion to 90–120°, passive external rotation limited to 30°, isometrics avoiding external rotation and extension. Posterior: brace, no internal rotation past neutral, no cross-body adduction, flexion limited to 90° early. |
| Progressive motion | Weeks 4–8 (posterior: 6–12) | Sling discontinued. Flexion to full, external rotation to about 45° then full by 8–10 weeks, active motion in all planes, light cuff and scapular strengthening. No apprehension position until 8 weeks. |
| Strengthening | Weeks 8–16 (posterior: 12–16) | Progressive resistive cuff and scapular work, rhythmic stabilization, closed- then open-chain loading, full external rotation stretching once cleared. Advance at 80% strength. |
| Return to sport | Months 4–6 | Advanced strengthening and plyometrics, interval throwing or sport-specific progression, contact drills as cleared. Return to contact sport typically about 6 months (posterior 5–6). |
Desk work is possible within a week in the sling, driving at four to six weeks, running and cycling from about three months, and throwing, serving, tackling and swimming by five to six months.
Protocol summary
After an anterior repair the sling is worn for four to six weeks, external rotation is limited to 0–30° for four weeks, the abduction-external rotation position and extension behind the body are avoided, and there is no weight bearing through the arm for six weeks. After a posterior repair the sling or neutral-rotation brace stays on for six weeks, with internal rotation, cross-body adduction, flexion past 90° and pushing restricted over the same period.
Phase I ends with passive flexion of about 120° after four (anterior) or six (posterior) weeks. Motion is then progressed without forced stretching, strengthening begins once motion is full without apprehension, and contact sport is cleared at symmetric strength and full painless motion, typically six months.
Physical Therapy Protocols
Bankart Repair — Anterior Shoulder Stabilization PDF ↗Posterior Labral Repair — Posterior Shoulder PDF ↗Frequently Asked Questions
Should I have surgery after my first shoulder dislocation?
It depends on your age and sport. Under 25 and playing contact or overhead sport, another dislocation without surgery is likely and each one removes more socket bone, so Dr. O'Donnell usually recommends early repair. Over 30 and not in contact sport, a sling and therapy come first, with surgery reserved for recurrence.
What is the difference between a Bankart repair and a Latarjet?
A Bankart repair reattaches the torn labrum and capsule to the socket rim with suture anchors, arthroscopically. A Latarjet transfers a piece of the coracoid bone with its tendon to the front of the socket to rebuild a rim that has worn away. It is chosen for bone loss over about 20% on CT or a failed previous repair.
How long am I in a sling, and when can I drive, after labral repair surgery?
Four to six weeks in a sling for an anterior (Bankart) repair, six weeks for a posterior repair; it comes off for showering and the passive exercises taught in the first week. Driving resumes once the sling is discontinued and you can turn the wheel comfortably without prescription pain medication.
When can I return to contact sport or throwing after a Bankart repair?
Running and non-contact training from about three months. Interval throwing, serving and contact drills begin in months four to six, and full contact sport is cleared at around six months when strength is symmetric and there is no apprehension. Criteria are in the Bankart and posterior labral repair protocols.
Can the shoulder dislocate again after surgery?
Yes, though far less often than without repair. Recurrence is most likely in young collision athletes, with unrecognized bone loss, or when sport resumes before six months. Choosing Latarjet when bone loss is significant and completing the strengthening phase are the best protection.
This page is for general education and is not a substitute for a medical evaluation. The right procedure depends on your individual diagnosis, anatomy, and goals. Kevin O'Donnell, MD sees patients from Coral Gables, Miami, Brickell, Pinecrest and Coconut Grove at 475 Biltmore Way, and out-of-town patients by telemedicine.