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Our 18-year old daughter is just graduating from high school. She was on the volleyball team and tore the cartilage in the front of her shoulder. Now she needs surgery to repair it. I understand there are two ways to do this: open incision or arthroscopically. Which one is better?

The cartilage you have described is called the labrum. After a labral tear, the shoulder can become unstable. Repeated shoulder dislocations often lead to the recommendation of surgical repair. Repair is especially important for athletes who need a strong overhead motion.

Traditionally, the labrum has been repaired using an open incision. This allows the surgeon to see more clearly while making the repair. The cartilage can be repaired and the capsule tightened at the same time. The capsule is a fibrous covering around the shoulder to give it support and stability during motion.

Special sutures called anchors are used to tack down the cartilage. Studies show it's important to have enough anchors and to put them in the right place. The open incision makes it easier to reach down under along the bottom of the labral tear and insert the needed anchors.

The one disadvantage of the open surgery is that the subscapularis muscle is cut away and then later reattached. This can result in significant shoulder stiffness. It's difficult to externally rotate fully. This position is important for overhead serves or any overhead motion in sports.

The arthroscopic surgery is minimally invasive. Very small incisions are made but it's also more difficult to place the anchors along the bottom of the tear. It is not necessary to cut through the subscapularis muscle.

Early efforts to use arthroscopic surgery for this repair did not always have good results. Results appear to be improving with improved surgical technique. Studies consistently show that surgeons who do more of these procedures have better results. Likewise, hospitals where a larger number of any one surgical procedure is done seem to have better results.

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