Management of Labral Tears Associated with Glenohumeral Instability in Athletes

Glenoid labral tears account for more than 10% of surgically managed shoulder injuries and are classified and managed depending on location, mechanism, associated bone loss, and patient-specific risk factors. The purpose of this review is to examine the current literature on the evaluation and management of labral pathology with associated glenohumeral instability, with a focus on rehabilitation and return to sport.

While the management of anterior labral tears has historically been emphasized, recent studies demonstrate that posterior and combined capsulolabral injuries are more common than previously recognized. Advances in management include reduced time to surgical treatment, lower thresholds of critical glenohumeral bone loss, evolving surgical techniques with both bony and soft tissue reconstruction, as well as personalized rehabilitation protocols with a focus on periscapular and rotator cuff strengthening. Operative stabilization demonstrates superior outcomes compared to nonoperative treatment, especially in high-risk patients (e.g young age, contact sport participation, hyperlaxity). However, recurrent instability remains a persistent problem, necessitating a comprehensive approach to management in order to optimize outcomes. Optimal functional outcomes in managing labral tears require a multifaceted, patient-specific approach. Treatment decisions, rehabilitation protocols, and return to sport testing should consider individual risk factors, account for combined pathology and bone loss, and consider psychological readiness to prevent recurrent instability and optimize long-term outcomes.