Traumatic Shoulder Instability Involving Anterior,Inferior,and Posterior Labral Injury

Abstract

Background

Traumatic labral tears involving the anterior, inferior, and posterior aspects of the glenoid fossa represent a unique subpopulation of shoulder instability.

Purpose

This study was undertaken to evaluate prospectively the clinical results of patients who underwent arthroscopic repair of 270° labral tears.

Study Design

Case series; Level of evidence, 4.

Methods

This was a prospective outcomes analysis of patients who underwent arthroscopic stabilization of a 270° labral tear. Inclusion criteria included patients with traumatic injury and primarily anteroinferior instability but several had posterior instability as well. Imaging revealed extensive labral injury in all patients. Indications for repair included symptomatic instability, 2+ anterior-inferior and posterior-inferior load-shift testing, and arthroscopic confirmation of labral lesions that extended anteriorly, inferiorly, and with extension to the midglenoid posteriorly. Exclusion criteria were SLAP (superior labrum anterior and posterior) lesions, revisions, and nontraumatic injuries. All patients underwent an arthroscopic repair utilizing modern suture anchor technique. Outcome measures included preoperative and postoperative Rowe, American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (SST), and Constant Murley scores. The Western Ontario Shoulder Instability Index (WOSI) and the Single Assessment Numeric Evaluation (SANE) scores were collected postoperatively. Failure was defined as any days missed from sport activity or work due to an instability event.

Results

Twenty-three 270° labral repairs were performed in 21 patients by a single surgeon. Twenty shoulders in 19 patients (92%) were followed for a mean of 28 months (range, 14-47 months) postoperatively. The mean preoperative and postoperative outcome scores showed statistically significant improvements (P ≤ .001): Rowe (59 to 92), ASES (76 to 93), SST (9 to 11), and Constant scores (73 to 95). The mean SANE score was 91 of 100 and the mean WOSI score was 302. Three of the 20 shoulders (in 19 patients) had subsequent episodes of instability for a failure rate of 15%. One required a second procedure for continued instability for a revision rate of 5%. Two patients developed adhesive capsulitis postoperatively of which one required an arthroscopic arthrolysis.

Conclusion

Arthroscopic repair of these extensive labral injuries involving 270° of the glenoid fossa was an effective surgical treatment and restored mechanical stability of the shoulder. The arthroscopic approach allowed for complete visualization and repair of all labral pathology.