Clinical Outcomes of Patients With Anterior Shoulder Instability and Glenolabral Articular Disruption Lesions: A Retrospective Comparative Study

Abstract

Background:

Anterior shoulder instability is a common clinical condition that often requires surgical stabilization. Glenoid labral tears are often associated with instability, with glenolabral articular disruption (GLAD) lesions occasionally being identified arthroscopically during repair, particularly in collision athletes.

Purpose:

To evaluate the clinical outcomes and recurrence rates in patients who had GLAD lesions and underwent arthroscopic Bankart repair (ABR) and compare them with a control group without GLAD lesions.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A retrospective review of patients who underwent ABR with GLAD lesions, by a single surgeon between July 2012 and March 2017, was performed. Additionally, these were pair matched in a 2:1 ratio for age, sex, sport, and level of play with a control group who underwent ABR without GLAD lesions. Return to sport, the level of return, and the timing of return were assessed. The visual analog scale (VAS) for pain score, Rowe score, Shoulder Instability–Return to Sport after Injury (SIRSI) score, and Subjective Shoulder Value (SSV) were evaluated.

Results:

The study included a total of 66 patients (22 and 44 patients for the GLAD and control groups, respectively), with a mean age of 25.8 years and a mean follow-up of 66 months. Overall, there was no significant difference in any of the clinical outcome scores (VAS, Rowe, SIRSI, and SSV) utilized for the GLAD and control groups (P > .05 for all). Similarly, there was no significant difference in the total rate of return to play (90.9% vs 88.6%; P > .99) or return at the same/higher level (68.2% vs 72.7%; P = .78). There was no significant difference in timing of return to play (6.3 ± 6.6 months vs 6.4 ± 2.5 months; P = .98). There were 3 cases (13.6%) requiring further surgery (1 revision stabilization, 1 arthroscopic release, and 1 rotator cuff repair) in the GLAD group and 2 cases (4.5%) requiring further surgery (both revision stabilization) in the control group; the difference was not statistically significant (P = .32).

Conclusion:

After arthroscopic repair, patients with GLAD lesions had similar midterm outcomes when compared with a control group without GLAD lesions.

Keywords

shoulder instability GLAD lesion arthroscopy

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References

Balg

Boileau

The Instability Severity Index Score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br. 2007;89(11):1470-1477.

Buckup

Welsch

Gramlich

, et al. Back to sports after arthroscopic revision Bankart repair. Orthop J Sports Med. 2018;6(2):2325967118755452.

Burkhart

De Beer

Barth

, et al. Results of modified Latarjet reconstruction in patients with anteroinferior instability and significant bone loss. Arthroscopy. 2007;23(10):1033-1041.

Castagna

Markopoulos

Conti

, et al. Arthroscopic Bankart suture-anchor repair: radiological and clinical outcome at minimum 10 years of follow-up. Am J Sports Med. 2010;38(10):2012-2016.

Dickens

Owens

Cameron

, et al. Return to play and recurrent instability after in-season anterior shoulder instability: a prospective multicenter study. Am J Sports Med. 2014;42(12):2842-2850.

Flinkkilä

Hyvönen

Ohtonen

Leppilahti

Arthroscopic Bankart repair: results and risk factors of recurrence of instability. Knee Surg Sports Traumatol Arthrosc. 2010;18(12):1752-1758.

Gyftopoulos

Beltran

Yemin

, et al. Use of 3D MR reconstructions in the evaluation of glenoid bone loss: a clinical study. Skeletal Radiol. 2014;43(2):213-218.

Hurley

Montgomery

Jamal

, et al. Return to play after the Latarjet procedure for anterior shoulder instability: a systematic review. Am J Sports Med. 2019;47(12):3002-3008.

Ialenti

Mulvihill

Feinstein

Zhang

Feeley

BT.

Return to play following shoulder stabilization: a systematic review and meta-analysis. Orthop J Sports Med. 2017;5(9):2325967117726055.

10.

Imhoff

Ansah

Tischer

, et al. Arthroscopic repair of anterior-inferior glenohumeral instability using a portal at the 5:30-o’clock position: analysis of the effects of age, fixation method, and concomitant shoulder injury on surgical outcomes. Am J Sports Med. 2010;38(9):1795-1803.

11.

Kandziora

Jäger

Bischof

, et al. Arthroscopic labrum refixation for post-traumatic anterior shoulder instability: suture anchor versus transglenoid fixation technique. Arthroscopy. 2000;16(4):359-366.

12.

Kawasaki

Ota

Urayama

, et al. Incidence of and risk factors for traumatic anterior shoulder dislocation: an epidemiologic study in high-school rugby players. J Shoulder Elbow Surg. 2014;23(11):1624-1630.

13.

Kirkley

Litchfield

Thain

Spouge

Agreement between magnetic resonance imaging and arthroscopic evaluation of the shoulder joint in primary anterior dislocation of the shoulder. Clin J Sport Med. 2003;13(3):148-151.

14.

Krøner

Lind

Jensen

The epidemiology of shoulder dislocations. Arch Orthop Trauma Surg. 1989;108(5):288-290.

15.

Memon

Kay

Cadet

, et al. Return to sport following arthroscopic Bankart repair: a systematic review. J Shoulder Elbow Surg. 2018;27(7):1342-1347.

16.

Murphy

Hurley

Pauzenberger

Mullett

Long-term outcomes of the arthroscopic Bankart repair: a systematic review of studies at 10-year follow-up. J Shoulder Elbow Surg. 2019;28(11):2084-2089.

17.

Neviaser

TJ.

The GLAD lesion: another cause of anterior shoulder pain. Arthroscopy. 1993;9(1):22-23.

18.

Owens

Duffey

Nelson

, et al. The incidence and characteristics of shoulder instability at the United States Military Academy. Am J Sports Med. 2007;35(7):1168-1173.

19.

Pogorzelski

Fritz

Horan

, et al. Failure following arthroscopic Bankart repair for traumatic anteroinferior instability of the shoulder: is a glenoid labral articular disruption (GLAD) lesion a risk factor for recurrent instability? J Shoulder Elbow Surg. 2018;27(8):e235-e242.

20.

Porcellini

Campi

Pegreffi

Castagna

Paladini

Predisposing factors for recurrent shoulder dislocation after arthroscopic treatment. J Bone Joint Surg Am. 2009;91(11):2537-2542.

21.

Randelli

Ragone

Carminati

Cabitza

Risk factors for recurrence after Bankart repair a systematic review. Knee Surg Sports Traumatol Arthrosc. 2012;20(11):2129-2138.

22.

Sanders

Tirman

Linares

Feller

Richardson

The glenolabral articular disruption lesion: MR arthrography with arthroscopic correlation. AJR Am J Roentgenol. 1999;172(1):171-175.

23.

Shin

Lee

Intra-articular lesions and their relation to arthroscopic stabilization failure in young patients with first-time and recurrent shoulder dislocations. J Shoulder Elbow Surg. 2016;25(11):1756-1763.

24.

Simonet

Melton

III Cofield

Ilstrup

DM.

Incidence of anterior shoulder dislocation in Olmsted County, Minnesota. Clin Orthop Relat Res. 1984;186:186-191.

25.

van derLinde

van Kampen

Terwee

, et al. Long-term results after arthroscopic shoulder stabilization using suture anchors: an 8- to 10-year follow-up. Am J Sports Med. 2011;39(11):2396-2403.

26.

Voos

Livermore

Feeley

, et al. Prospective evaluation of arthroscopic Bankart repairs for anterior instability. Am J Sports Med. 2010;38(2):302-307.

27.

Widjaja

Tran

Bailey

Proper

Correlation between Bankart and Hill-Sachs lesions in anterior shoulder dislocation. ANZ J Surg. 2006;76(6):436-438.

28.

Young

Maia

Berhouet

Walch

Open Latarjet procedure for management of bone loss in anterior instability of the glenohumeral joint. J Shoulder Elbow Surg. 2011;20(2) (suppl):S61-S69.

29.

Zarins

Anterior shoulder stabilization using the Bankart procedure. Sports Med Arthrosc Rev. 1993;1(4):259-265.

30.

Zarins

McMahon

Rowe

CR.

Diagnosis and treatment of traumatic anterior instability of the shoulder. Clin Orthop Relat Res. 1993;291:75-84.