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Abstract

Background:

Circumferential labral tears are characterized by complete detachment of the labrum from the glenoid rim, and studies have reported significant improvements in patient-reported outcome measures (PROMs) after arthroscopic repair. However, patients’ perspectives on the meaningfulness of these outcomes remain unknown, and debate continues regarding whether circumferential tears can occur after a single instability event.

Purpose:

To investigate the number of preoperative instability events in patients with circumferential tears and evaluate their clinical outcomes after arthroscopic repair according to the minimal clinically important difference (MCID), Substantial Clinical Benefit (SCB), and Patient Acceptable Symptom State (PASS) parameters.

Study Design:

Case series; Level of evidence, 4.

Methods:

This study was retrospective review of a consecutive series of patients who underwent shoulder arthroscopy for instability between February 2015 and July 2023. Patients with primary circumferential tears repaired using arthroscopic suture anchors, glenoid bone defects <13.5%, and a minimum 24-month follow-up were included. Analysis was conducted of patient demographics, clinical characteristics, and PROMs, including American Shoulder and Elbow Surgeons (ASES), Western Ontario Shoulder Instability Index (WOSI), and visual analog scale (VAS) scores. Patients who achieved the MCID, SCB, and PASS thresholds for these scores were determined.

Results:

Circumferential tears were identified in 3.6% (n = 41) of 1147 patients undergoing arthroscopic procedures for shoulder instability. Of these, 31 patients (mean age, 29.5 ± 9.3 years; 90% male; mean instability events, 5.5 ± 6.9; mean follow-up, 60.4 ± 30.1 months) meeting the inclusion criteria were analyzed. Overall, 39% (n = 12) had a single instability event, with 6 participating in contact sports and 4 in overhead or throwing sports, 9 of them at a competitive level. The proportions of patients who achieved MCID, PASS, and SCB thresholds were as follows: ASES (100, 80.6, and 80.6, respectively), WOSI total (100, 90.3, and 80.6, respectively), and VAS (90.3, 87.1, and 80.6, respectively).

Conclusion:

Circumferential labral tears are rare. One-third of them may occur even after a single instability event and, therefore, should be considered during clinical evaluation, regardless of the number of prior instability events. Reassuringly, most patients who underwent arthroscopic repair of circumferential tears using suture anchors achieved successful clinically meaningful outcomes at a mean follow-up of approximately 5 years.

Keywords

shoulder instability circumferential tear arthroscopic repair

A circumferential labral tear is defined as the entire detachment of the labrum from the glenoid rim across the anterior, inferior, posterior, and superior quadrants.^{7,8,17,20,24,31} These tears were first identified in the foundational work by Powell et al,²⁴ with subsequent case series by Lo and Burkhart¹⁷ and Tokish et al³¹ contributing to their broader recognition. Circumferential lesions constitute approximately 2.4% to 3.6% of all labral injuries and are usually observed in physically active individuals.^4,17,27 Although this rare pathology has a daunting name, studies have demonstrated that satisfactory functional outcomes can be achieved through arthroscopic labral repair, a well-established procedure among shoulder surgeons.^{8,17,20,21,27,31,33}

Nonetheless, while studies conducted over the past 2 decades have taught us valuable understanding of circumferential tears, several aspects still require further investigation and discussion. One such point is the methodology used to evaluate the outcomes after arthroscopic repair of circumferential tears. To date, research has focused on redislocation rates and pre- and postoperative patient-reported outcome measure (PROM) comparisons to evaluate the results of labral repair.^21,27,31,33 However, whether clinically meaningful outcomes have been achieved from the patient's perspective remains largely unknown. Another notable point is the differing reports in the literature regarding the number of preoperative instability events. Although initial studies suggested that recurrent instability was a characteristic of circumferential tears, subsequent research has indicated that these lesions can also occur after a single instability event.^7,9,11,17,31 Given these considerations, evaluating the number of dislocations with patient characteristics and assessing outcomes using clinically meaningful parameters (the minimal clinically important difference [MCID], which signifies the smallest change required for a patient to perceive an improvement; the Substantial Clinical Benefit [SCB], which indicates the minimum change needed for a patient to consider their condition highly satisfactory; and the Patient Acceptable Symptom State [PASS], which reflects whether a patient is content with their current status) could enhance understanding of circumferential tear occurrence and provide a better framework for the satisfaction level after surgical treatment.^6,28,32

Therefore, the present study had 2 aims: (1) to investigate the number of preoperative instability events in patients with circumferential labral tears and (2) to evaluate the clinical outcomes of these patients after arthroscopic repair according to the MCID, SCB, and PASS parameters. We hypothesized that (1) a notable proportion of circumferential labral tears may result from a single instability event and (2) arthroscopic repair of these lesions would lead to satisfactory clinically meaningful outcomes.

Methods

Study Design and Patient Selection

This study was a retrospective review of a consecutive series of patients who underwent shoulder arthroscopy for traumatic shoulder instability between February 2015 and July 2023 at a single academic tertiary referral center. Institutional review board approval was obtained before the start of the study. The investigation was conducted in accordance with the principles of the Declaration of Helsinki, and written informed consent was obtained from all patients. The inclusion criteria for the study were circumferential labral tears repaired using an all-arthroscopic suture anchor, a follow-up period of at least 24 months, and available data, including clinical background, preoperative PROMs, computed tomography scans, and recordings of the surgery. The exclusion criteria were as follows: patients without circumferential labral tears, those with glenoid bone defects >13.5%, glenohumeral arthritis, revision surgeries, loss to follow-up, and incomplete data. Circumferential tears were defined as a 360° detachment of the labrum from the glenoid rim, encompassing all quadrants.^7,27,31

Surgical Technique and Rehabilitation

All surgeries were performed by the senior surgeon (U.K.), who has 20 years of experience in shoulder arthroscopy, with the patient in the lateral decubitus position using 4.5 kg of traction. The procedure began with the establishment of a posterior viewing portal, after which an anterior rotator interval portal was inserted using the outside-in technique with a spinal needle. The superior and anterior labrum were assessed using a probe under arthroscopic visualization through the posterior portal (Figure 1, A and B). Subsequently, an anterosuperior portal was established, and the inferior and posterior labrum were evaluated by viewing through this portal (Figure 1C). Finally, visualization was performed through the anterior portal to allow a more comprehensive assessment of the posterior region (Figure 1, D and E). After identification of the circumferential tear, the labrum was mobilized with an elevator, and the anchor positions were planned. Anterior and superior quadrant anchors were placed through the anterior and anterosuperior portals, posterior quadrant anchors through the posterior and posteroinferior portals, and inferior quadrant anchors through both the anterior and posteroinferior portals. Double-loaded suture anchors (2.9-mm GRYPHON, No. 2 sutures; DePuy Mitek) were used for repair. For each anchor, the first suture was knotted vertically, and the second was placed in a horizontal mattress configuration, positioned to center the construct over the initial suture. The repair sequence began with the inferior labrum, where the first anchor was placed at the 6-o’clock position. Subsequently, the anterior labrum was repaired using suture anchors inserted at approximately 8- to 10-mm intervals, starting from the 6-o’clock position and extending to the 1-o’clock position to address the anterior defect. Posterior labral repair followed a similar approach, beginning at the 6-o’clock position and progressing to the 11-o’clock position, with anchors placed at comparable intervals. Finally, the superior labrum was repaired using a vertical suture configuration, and the procedure was concluded after confirming that the labrum was securely reattached along the entire glenoid rim.

Figure 1.

Arthroscopic view of the right shoulder with the patient in the lateral decubitus position. In the clockface-based assessment, tears in the circumferential lesion were identified in the (A) superior, (B) anterior, (C) inferior, (D and E) posterior, and (F) posterosuperior regions. HH, humeral head; LHBT, long head of the biceps tendon.

Postoperatively, the operated arm was immobilized in a standard sling for 4 to 6 weeks. Patients began active range of motion exercises for the elbow, wrist, and hand between the third and fifth days after surgery. Pendulum exercises were performed during the first 2 weeks. Passive joint range of motion and isometric strengthening exercises were initiated after the second week. From the sixth week onward, active joint range of motion exercises and a progressive strengthening program targeting the deltoid and rotator cuff muscles were introduced. Full joint range of motion was targeted in the 12th week. The rehabilitation process was conducted under the supervision of a physical therapist following an individualized protocol for all patients. Return to contact sports was permitted beginning in the sixth postoperative month.

Data Collection

An author (A.A.) conducted a retrospective review of patient records and collected data on demographic and clinical characteristics, including age, sex, affected extremity, type of instability (subluxation or dislocation), time from the first instability event to surgery, number of instability episodes, level and type of sports activity, heaviness of work, presence of ligamentous laxity, operative reports, and preoperative PROMs (American Shoulder and Elbow Surgeons [ASES], Western Ontario Shoulder Instability Index [WOSI], and Visual Analog Scale [VAS] scores). Dislocation was defined as a documented shoulder dislocation confirmed by imaging from the institute records or the national database, and subluxation was defined based on patient-reported episodes describing the shoulder as “going out and right back in.” Ligamentous laxity was evaluated using the Beighton score, with a score ≥4 considered indicative of joint laxity.³ A senior surgeon (U.K.) confirmed the presence of circumferential tears by reviewing surgical videos after data collection from operative reports.

The final assessment of patient outcomes was conducted face to face with the patients during outpatient clinic visits by an author (F.A.) who was blinded to the study's protocol. As an initial step, patients were asked whether they had experienced recurrent shoulder dislocation or an instability event after surgery, and whether they had undergone any revision procedure. Anchor-based questions were then administered to determine the MCID, PASS, and SCB thresholds.^6,22 Function and pain were evaluated using 2 anchor questions: (1) “Has there been any change in your functional capacity after surgery?” and (2) “Has there been a change in your pain after surgery?” Responses were recorded using a 15-point Likert scale, in which 1 indicated “a very great deal worse,” 8 represented “no change,” and 15 indicated “a very great deal better.” The third anchor question asked to patients was, “Are you overall satisfied with the outcome of the surgery?” Responses were recorded as binary outcomes: satisfied or not satisfied. On completion of the anchor questions, ASES, WOSI, and VAS scores were assessed to finalize the follow-up examinations.

Statistical Analysis

Statistical analyses were performed using R (Version 4.4.3; R Foundation for Statistical Computing) and SPSS (Version 28.0; IBM). Preoperative and postoperative PROMs were compared using the Wilcoxon signed-rank test for paired data. Clinically meaningful outcome thresholds were determined using both anchor- and distribution-based methods.⁶ Because many patients undergoing circumferential labral repair will have improvements in outcomes, the MCID threshold for the ASES, WOSI total, and VAS scores was calculated using a distribution-based method, defined as one-half of the standard deviation of the overall change in each outcome score across the entire cohort.^12,28 Clinically meaningful outcome thresholds for the SCB and PASS were determined using anchor-based methods. Receiver operating characteristic (ROC) curves were constructed for these analyses. Change scores from preoperative to postoperative assessment were used as continuous predictor variables, while dichotomized anchor responses served as binary outcomes (improved vs not improved for the SCB; satisfied vs not satisfied for the PASS). The area under the curve (AUC) was calculated to assess the discriminative ability of each threshold, with an AUC ≥0.8 considered excellent.² Optimal cutoff points were identified using the Youden index. For SCB determination, function-related anchors were dichotomized for ASES and WOSI total scores such that patients reporting scores of 13 to 15 (13 = “a good deal better,” 14 = “a great deal better,” and 15 = “a very great deal better”) were considered to have achieved substantial functional improvement, while those scoring 7 to 9 (7 = “almost the same, hardly any worse,” 8 = “no changes,” and 9 = “almost the same, hardly any better”) were classified as having no change. Similarly, for the VAS analysis, pain-related anchors were dichotomized, with scores of 13 to 15 indicating substantial pain relief and 7 to 9 indicating no change. For the PASS analysis, postoperative scores were used as continuous variables. ROC curves were constructed using postoperative ASES, WOSI total, and VAS scores against a binary anchor question (satisfied vs not satisfied). The Youden index was again applied to identify the optimal cutoff points. Sensitivity and specificity values were calculated for all anchor-based thresholds to evaluate their performance in correctly classifying patients.

Results

In a cohort of 1147 patients who underwent arthroscopic procedures for shoulder instability, circumferential labral tears were identified in 3.6% (n = 41) of the cases. Of these, 31 patients met the study's inclusion criteria and were incorporated into the final analysis. The patient selection process is presented in Figure 2.

Figure 2.

Flowchart of the study.

The patients had a mean age of 29.5 ± 9.3 years (range, 17-51 years), and the majority were male (n = 28; 90%). The dominant extremity was affected in most cases (n = 24; 77%). Dislocations were identified in 68% of patients and subluxations in 32%, with a mean of 5.5 ± 6.9 (range, 1-30) preoperative instability events. All the dislocations were associated with anterior instability. Seventeen patients participated in sports at a competitive level (4 boxing, 3 soccer, 3 judo, 3 volleyball, 1 tennis, 1 basketball, 1 wrestling, and 1 handball), 5 participated at a recreational level (2 volleyball, 2 basketball, and 1 tennis), and 9 were not actively involved in any sport. Along with these demographic characteristics, clinical variables, including follow-up duration, time from the first instability event to surgery, heaviness of work, and presence of ligamentous laxity, are presented in Table 1. Overall, 39% of patients (n = 12) experienced a single instability event, and their characteristics are detailed in Table 2.

Table 1

Patient Characteristics ^a

	Value
Age, y	29.5 ± 9.3 (17-51)
Sex
Male	28 (90)
Female	3 (10)
Extremity involved
Dominant	24 (77)
Nondominant	7 (23)
Time to surgery, mo ^b	26.3 ± 30.8 (1-96)
No. of instability events	5.5 ± 6.9 (1-30)
Sports activity level
None	9 (29)
Recreational	5 (16)
Competitive	17 (55)
Types of sports
Contact	14 (45)
Overhead/throwing	8 (26)
Heaviness of work
Light	18 (58)
Intermediate	6 (19)
Heavy	7 (23)
Instability event
Subluxation	10 (32)
Dislocation	21 (68)
Ligamentous laxity ^c	4 (13)
Follow-up, mo	60.4 ± 30.1 (24-124)

Data are presented as mean ± SD (range) or n (%).

Time from the first instability event to surgery.

Beighton score ≥4 was considered indicative of laxity.

Table 2

Characteristics of Patients With Circumferential Tears After a Single Instability Event

Case No.	Age, y	Sex	Dominance	Sports	Sports Level	Instability Event	Ligamentous Laxity
1	37	Male	Nondominant	Boxing	Competitive	Subluxation	No
2	32	Male	Dominant	Handball	Competitive	Subluxation	No
3	29	Male	Dominant	Volleyball	Competitive	Subluxation	No
4	19	Male	Dominant	Soccer	Competitive	Subluxation	No
5	23	Male	Dominant	Judo	Competitive	Dislocation	No
6	41	Male	Dominant	Judo	Competitive	Dislocation	No
7	25	Female	Nondominant	Volleyball	Recreational	Dislocation	Yes
8	36	Female	Dominant	Tennis	Competitive	Dislocation	No
9	40	Male	Dominant	None	Not applicable	Dislocation	No
10	26	Male	Dominant	None	Not applicable	Dislocation	No
11	19	Male	Dominant	Wrestling	Competitive	Dislocation	Yes
12	27	Male	Nondominant	Boxing	Competitive	Dislocation	No

The patients demonstrated significant improvements in ASES, VAS, and WOSI total, physical, sports/recreational/work, lifestyle, and emotions scores at the final follow-up compared to the preoperative values (Table 3).

Table 3

Preoperative and Postoperative Patient-Reported Outcome Measures ^a

Outcome Measure	Preoperative	Postoperative	P Value
ASES score	33.4 ± 10.7 (29.6-37.1)	82.0 ± 15.6 (76.5-87.5)	<.001
WOSI score
Total	1322.9 ± 248.3 (1235.5-1410.3)	254.8 ± 99.2 (219.9-289.8)	<.001
Physical symptoms	642.6 ± 182.6 (578.3-706.9)	83.9 ± 32.5 (72.4-95.3)	<.001
Sports/recreation/work	256.8 ± 46.9 (240.3-273.3)	65.8 ± 27.3 (56.2-75.4)	<.001
Lifestyle	237.7 ± 45.3 (221.8-253.7)	47.4 ± 32 (36.1-58.7)	<.001
Emotions	185.8 ± 58.2 (165.3-206.3)	57.7 ± 25.5 (48.8-66.7)	<.001
VAS score	5.3 ± 2.1 (4.6-6)	1.2 ± 1.5 (0.7-1.7)	<.001

Data are presented as mean ± SD (95% CI). Boldface type indicates statistical significance (P < .05). ASES, American Shoulder and Elbow Surgeons; VAS, visual analog scale; WOSI, Western Ontario Shoulder Instability Index.

The threshold values for the MCID, PASS, and SCB are presented in Table 4. All PROMs demonstrated excellent discriminative ability for the SCB and PASS, with AUC values exceeding 0.80 for both. The achievement rates across the ASES, WOSI total, and VAS scores ranged from 90.3% to 100% for the MCID, 80.6% to 90.3% for the PASS, and 80.6% for the SCB (Table 4). During postoperative follow-up, 3 (9.7%) patients experienced recurrent instability. One case involved a competitive soccer player who sustained traumatic redislocation during a match in the second postoperative year. In the other 2 cases, one involving a recreational tennis player (1 year after surgery) and the other a competitive judo athlete (4 years after surgery), traumatic subluxations occurred during sports activities.

Table 4

Thresholds and Achievement Rates for Clinical Significance Metrics ^a

	MCID		PASS					SCB
	Threshold	% Achieving	Threshold	% Achieving	SN	SP	AUC	Threshold	% Achieving	SN	SP	AUC
ASES score	6.5	100	72.5	80.6	1.00	0.93	0.99	42.5	80.6	1.00	0.75	0.89
WOSI total score	133.8	100	420	90.3	0.75	1.00	0.80	955	80.6	1.00	0.75	0.85
VAS score	1.2	90.3	3.5	87.1	0.75	0.96	0.90	3	80.6	1.00	0.60	0.91

AUC, area under the curve; ASES, American Shoulder and Elbow Surgeons; MCID, minimal clinically important difference; PASS, Patient Acceptable Symptom State; SCB, Substantial Clinical Benefit; SN, sensitivity; SP, specificity; VAS, visual analog scale; WOSI, Western Ontario Shoulder Instability Index.

Discussion

The present study has 2 main findings: (1) the majority of patients with circumferential labral tear repair arthroscopically using suture anchors achieve successful clinically meaningful outcomes at a mean follow-up of approximately 5 years, and (2) one-third of circumferential tears occurred in first-time dislocators. Therefore, in certain cases, a single instability event could result in 360° labral damage.

The first large case series to evaluate the outcomes of circumferential tear repair was conducted by Tokish et al³¹ in a military population consisting of 39 patients (41 shoulders) with a mean age of 25 years. They reported significant improvements in PROMs at a mean follow-up of 31 months after arthroscopic repair, with only 2 (5%) patients experiencing a recurrent instability event after surgery. In another study, Ricchetti et al²⁷ examined 44 patients with a mean age of 32 years and found notable enhancements in PROMs after a mean follow-up period of 42 months. They also reported recurrent instability in 5 (11%) patients after repair. Consistent with these scoring assessments and recurrence rates, significant improvements in PROMs were observed in the current study, which analyzed 31 patients with a mean age of 29 years and a mean follow-up of 60 months, with recurrent instability identified in 3 (9.7%) cases. Regarding clinically meaningful outcomes, to our knowledge, no study in the current literature allows for a direct comparison specifically in patients with circumferential tears. However, Wall et al³³ reported no significant difference in patient satisfaction between circumferential repair and isolated anterior labrum repair, while Nascimento and Claudio²¹ found that 90% of patients achieved good or excellent outcomes after circumferential repair. In line with these findings, >80% of patients in the present study met the PASS and SCB thresholds, supporting the conclusion that circumferential labral repair is associated with high patient satisfaction. Moreover, in studies assessing the clinically meaningful outcomes of anterior instability management, it has been noted that 49% to 100% of patients achieve the MCID threshold, while 75% to 100% meet the PASS threshold.^5,14,19,23 In the current study, the finding that >90% of patients met the MCID and >80% reached the PASS suggests that the clinical improvements observed are comparable to those reported after anterior shoulder instability treatment. In summary, this study revealed that arthroscopic repair of circumferential lesions results in successful outcomes according to both classic scoring systems and patient-centered assessments. This finding provides valuable guidance for the surgical decision-making process, demonstrating that arthroscopic repair is an effective option for these complex lesions.

Another notable aspect of this study is the evaluation of the relationship between the number of preoperative instability events and the occurrence of circumferential lesions. Over time, the literature has presented varying perspectives on the number of instability episodes necessary for such lesions to develop. Early studies suggested that recurrent dislocations were essential for the development of 360° labral tears, with Tokish et al,³¹ in their series of 39 patients, and Lo and Burkhart,¹⁷ in a series of 7 patients, reporting recurrent instability in all cases. However, Dickens et al,⁷ in their report of 3 patients, demonstrated that circumferential labral tears can also occur after a single instability event, thereby presenting a new perspective in the literature and raising awareness among shoulder surgeons. This observation is supported by subsequent reports, including a case by Gupta et al¹¹ involving a panlabral tear after a single dislocation, and a similar case of a circumferential tear described by Godinho et al⁹ in a volleyball player. In line with these studies, the present study found that although most patients had a history of recurrent instability, circumferential tears developed in certain cases after only a single instability event. This observation raises 2 fundamental questions: (1) how does a panlabral tear occur after a single instability episode, and (2) why does the present study demonstrate a substantial proportion of single-instability cases, whereas earlier reports primarily involved patients with recurrent instability?

To address the first question, it is important to consider 2 hypotheses proposed in the literature. One hypothesis suggests that a dislocation resulting from high-energy trauma may cause a complete labral tear.^10,34 Given that 4 of the 6 contact sport athletes experienced dislocations, the potential impact of high energy could be considered. Nonetheless, this explanation should be approached with caution, as in the current study, about one-third of patients with a history of a single instability event experienced subluxation rather than a high-energy dislocation. Another hypothesis suggests that a preexisting posterior or posterosuperior labral tear associated with athletic activity, when combined with an anterior instability event, may result in a 360° labral tear based on the “circle concept” mechanism.^7,10 Consistent with this hypothesis, the present study found that among patients with a history of a single instability, 6 participated in contact sports and 4 in overhead/throwing sports. In other words, 83% of patients with single instability engaged in activities known to predispose them to posterior or posterosuperior labral lesions.^{1,13,15,16,18,29,30} Accordingly, this hypothesis, which proposes that a circumferential tear may result from an anterior instability episode superimposed on a preexisting lesion, is supported by our findings. However, these interpretations are speculative and require further mechanical research.

In response to the second question, the most plausible explanation appears to be the variability in surgeons’ approaches to managing instability. All patients in the study by Tokish et al³¹ initially received nonoperative treatment and subsequently underwent surgery after the failure of nonoperative management. Thus, it remains unclear whether the circumferential tear arose at the time of the initial dislocation or resulted from subsequent recurrent events. By contrast, in the present study, nonoperative treatment was not administered to athletes with instability complaints, even after a single event; instead, surgical management was chosen directly. This strategy may have enabled the detection of circumferential tears after a single dislocation or subluxation.

One of the most significant challenges in managing circumferential labral tears is the difficulty of making a preoperative diagnosis. Ricchetti et al²⁶ demonstrated that identifying these tears using magnetic resonance imaging (MRI) is challenging, with MRI showing relatively low sensitivity in detecting such lesions. Similarly, Rhee et al²⁵ reported that diagnosing these tears is difficult through both imaging modalities and physical examination. Regarding physical examination, Dickens et al⁷ highlighted that patients with circumferential labral tears often exhibit positive findings during assessment of the anterior, posterior, and inferior labrum. Therefore, in patients evaluated with anterior instability, a thorough clinical evaluation of the posterior and inferior labrum should also be performed to identify a more extensive labral injury.

This study has several limitations. The first limitation was the absence of documented preoperative physical examination findings related to instability. As a result, while imaging in dislocation cases suggested anterior instability, the potential for concomitant posterior or inferior instability could not be assessed; likewise, the direction of instability in subluxation cases remained undetermined. Second, although all patients had a history of trauma, data regarding the arm position and mechanism of injury that led to dislocation were unavailable. Third, when assessing patient satisfaction with their clinical experience, aspects that might affect treatment results, such as mental health and expectations about surgery, were not considered. In addition, the lack of data regarding return-to-sport rates represents another limitation of our study. Finally, the considerable time elapsed since surgery in some patients may have introduced a recall bias in their responses to the anchor questionnaire and number of events.

Conclusion

Footnotes

Final revision submitted December 27, 2025; accepted January 2, 2026.

The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Ethical approval for this study was obtained from the Gazi University Ethics Committee (Decision E-77082166-604.01-1299848; research code: 2025-1380).

ORCID iDs

Ibrahim Kaya

Ethem Burak Oklaz

Tayfun Ozel

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Circumferential Labral Tears: Instability History and Outcomes of Arthroscopic Repair