Glenolabral articular disruption lesions are not associated with increased risk of recurrent instability following arthroscopic Bankart repair: A systematic review
Restricted accessReview articleFirst published online 2026
Glenolabral articular disruption lesions are not associated with increased risk of recurrent instability following arthroscopic Bankart repair: A systematic review
The relationship of glenolabral articular disruption (GLAD) lesions with arthroscopic Bankart repair (ABR) failure has not previously been reported in a systematic review. This study examines recurrent instability and revision surgery along with postoperative patient-reported outcomes in patients undergoing ABR with and without GLAD lesions.
Methods
Four databases were queried for studies assessing GLAD lesions in the setting of ABR. Studies reporting recurrent instability and patient-reported outcomes were included.
Results
Six articles consisting of 285 patients who underwent ABR (132 with GLAD lesions) were included. Five studies compared outcomes between ABR patients with and without GLAD lesions, and one study classified GLAD lesions by size. The pooled prevalence of recurrent instability and revision surgery in patients with GLAD lesions who underwent ABR was 10% (95% CI 0.03–0.19) and 3% (95% CI 0.00–0.10), respectively. Five studies comparing ABR with and without GLAD lesions reported no significant differences in recurrent instability or revision surgery. Postoperative patient-reported outcomes were comparable between groups.
Discussion
GLAD lesions were not associated with greater rates of recurrent instability or revision surgery after ABR. Future studies examining the relationship between GLAD lesion size and outcomes will help better understand failure risk following arthroscopic stabilization.
AlmajedYAHallACGillingwaterTH, et al.Anatomical, functional and biomechanical review of the glenoid labrum. J Anat2022; 240: 761–771.
3.
BiglianiLUKelkarRFlatowEL, et al.Glenohumeral stability. Biomechanical properties of passive and active stabilizers. Clin Orthop Relat Res1996; 330: 13–30.
4.
IshikawaHHenningerHBKawakamiJ, et al.A stabilizing role of the glenoid labrum: the suction cup effect. J Shoulder Elbow Surg2023; 32: 1095–1104.
OldsMEllisRParmarP, et al.The immediate and subsequent impact of a first-time traumatic anterior shoulder dislocation in people aged 16–40: results from a national cohort study. Shoulder Elbow2021; 13: 223–232.
7.
KruckebergBMLelandDPBernardCD, et al.Incidence of and risk factors for glenohumeral osteoarthritis after anterior shoulder instability: a US population-based study with average 15-year follow-up. Orthop J Sports Med2020; 8: 2325967120962515.
8.
NeviaserTJ. The GLAD lesion: another cause of anterior shoulder pain. Arthroscopy1993; 9: 22–23.
9.
AntonioGEGriffithJFYuAB, et al.First-time shoulder dislocation: high prevalence of labral injury and age-related differences revealed by MR arthrography. J Magn Reson Imaging2007; 26: 983–991.
10.
O’BrienJGrebenyukJLeithJ, et al.Frequency of glenoid chondral lesions on MR arthrography in patients with anterior shoulder instability. Eur J Radiol2012; 81: 3461–3465.
11.
AmramiKKSperlingJWBartholmaiBJ, et al.Radiologic case study. Orthopedics2002; 25: 29–96.
12.
NeviaserTJ. The GLAD lesion: another cause of anterior shoulder pain. Arthroscopy1993; 9: 22–23.
WaldtSBurkartAImhoffAB, et al.Anterior shoulder instability: accuracy of MR arthrography in the classification of anteroinferior labroligamentous injuries. Radiology2005; 237: 578–583.
15.
GunternDVPfirrmannCWASchmidMR, et al.Articular cartilage lesions of the glenohumeral joint: diagnostic effectiveness of MR arthrography and prevalence in patients with subacromial impingement syndrome. Radiology2003; 226: 165–170.
16.
ZhuWLuWZhangL, et al.Arthroscopic findings in the recurrent anterior instability of the shoulder. Eur J Orthop Surg Traumatol2014; 24: 699–705.
17.
PogorzelskiJFritzEMHoranMP, 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 Surg2018; 27: e235–e242.
18.
FoxMADrainNPRaiA, et al.Increased failure rates after arthroscopic Bankart repair after second dislocation compared to primary dislocation with comparable clinical outcomes. Arthroscopy2023; 39: 682–688.
19.
DelgadoCCalvoEMartínez-CatalánN, et al.High long-term failure rates after arthroscopic Bankart repair in younger patients with recurrent shoulder dislocations: a plea for early treatment. Knee Surg Sports Traumatol Arthrosc2025; 33: 1044–1054.
20.
ShanmugarajASakhaSTejpalT, et al.Revision arthroscopic Bankart repair for anterior shoulder instability after a failed arthroscopic soft-tissue repair yields comparable failure rates to primary Bankart repair: a systematic review. HSS J2022; 18: 145–155.
21.
PageMJMcKenzieJEBossuytPM, et al.The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Br Med J2021; 372: n71.
22.
SlimKNiniEForestierD, et al.Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg2003; 73: 712–716.
23.
HigginsJPTThompsonSG. Quantifying heterogeneity in a meta-analysis. Stat Med2002; 21: 1539–1558.
24.
WanXWangWLiuJ, et al.Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol2014; 14: 135.
25.
DaveyMSHurleyETColasantiCA, et al.Clinical outcomes of patients with anterior shoulder instability and glenolabral articular disruption lesions: a retrospective comparative study. Am J Sports Med2020; 48: 3472–3477.
26.
OrnerCBastromTPennockA, et al.Clinical outcomes of adolescents with anterior shoulder instability and glenolabral articular disruption lesions compared with isolated Bankart lesions. Orthop J Sports Med2023; 11: 23259671231214007.
27.
ElrickBPArnerJWHoranMP, et al.Concomitant glenolabral articular disruption (GLAD) lesion is not associated with inferior clinical outcomes after arthroscopic Bankart repair for shoulder instability: a retrospective comparative study. Arthrosc Sports Med Rehabil2022; 4: e1015–e1022.
28.
ErnatJRakowskiDRuzbarskyJ, et al.Arthroscopic characterization, treatment, and outcomes of glenoid labral articular disruption lesions. Am J Sports Med2022; 50: 1328–1335.
29.
DvorskyJLLinRTNjoku-AustinC, et al.Glenoid labral articular disruption lesions in the setting of first-time anterior shoulder instability. Arthroscopy2025; 41: 3503–3509.
30.
VieiderRSiebenlistSSanchezJ, et al.Glenolabral articular disruption (GLAD) is not associated with worse outcomes or higher instability recurrence after arthroscopic Bankart repair- a matched-pair analysis. J Clin Med2024; 13: 5067.
31.
YamamotoNItoiEAbeH, et al.Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: a new concept of glenoid track. J Shoulder Elbow Surg2007; 16: 649–656.
32.
ZhangMLiuJJiaY, et al.Risk factors for recurrence after Bankart repair: a systematic review and meta-analysis. J Orthop Surg2022; 17: 113.
33.
DekkerTJPeeblesLABernhardsonAS, et al.Risk factors for recurrence after arthroscopic instability repair-the importance of glenoid bone loss >15%, patient age, and duration of symptoms: a matched cohort analysis. Am J Sports Med2020; 48: 3036–3041.
34.
LeeSHLimKHKimJW. Risk factors for recurrence of anterior-inferior instability of the shoulder after arthroscopic Bankart repair in patients younger than 30 years. Arthroscopy2018; 34: 2530–2536.
35.
WermersJSchliemannBRaschkeMJ, et al.The glenolabral articular disruption lesion is a biomechanical risk factor for recurrent shoulder instability. Arthrosc Sports Med Rehabil2021; 3: e1803–e1810.
36.
WermersJSchliemannBRaschkeMJ, et al.Glenoid concavity has a higher impact on shoulder stability than the size of a bony defect. Knee Surg Sports Traumatol Arthrosc2021; 29: 2631–2639.
37.
MoroderPDammPWiererG, et al.Challenging the current concept of critical glenoid bone loss in shoulder instability: does the size measurement really tell it all?Am J Sports Med2019; 47: 688–694.
38.
SeidlAJKraeutlerMJ. Management of articular cartilage defects in the glenohumeral joint. J Am Acad Orthop Surg2018; 26: e230–e237.
39.
SteinmetzGHamiltonJFernandesC, et al.Matrix-induced autologous chondrycte implantation for a glenoid chondral defect: a case report. JBJS Case Connect2020; 10: e0264.
40.
ElserFBraunSDewingCB, et al.Glenohumeral joint preservation: current options for managing articular cartilage lesions in young, active patients. Arthroscopy2010; 26: 685–696.
