Anterior Glenohumeral Instability: Classification of Pathologies of Anteroinferior Labroligamentous Structures Using MR Arthrography

Abstract

We examined labroligamentous structures in unstable anteroinferior glenohumeral joints using MR arthrography (MRA) to demonstrate that not all instabilities are Bankart lesions. We aimed to show that other surgical protocols besides classic Bankart repair are appropriate for labroligamentous lesions. The study included 35 patients (33 males and 2 females; mean age: 30.2; range: 18 to 57 years). MRA was performed in all patients. The lesions underlying patients' instability such as Bankart, anterior labral periosteal sleeve avulsion (ALPSA), and Perthes lesions were diagnosed by two radiologists. MRA yielded 16 diagnoses of Bankart lesions, 5 of ALPSA lesions, and 14 of Perthes lesions. Albeit invasive, MRA seems to be a more reliable and accurate diagnostic imaging modality for the classification and treatment of instabilities compared to standard MRI.

Anterior and Posterior Capsule- Periosteal sleeve avulsion as an unusual cause of Shoulder Instability

“…Velpeau [8]. In our case report, the comparative study between the two shoulders shows the alteration of the Gothic arch that should form the lower border of the scapula and the lower border of the humerus (Figure 1) Arthro-MRI is more effective [10], in the diagnosis of labrum-ligamentous lesions, such as ALPSA type lesions, which are sometimes unnoticed with conventional MRI, and according to Forsythe [11], it should be preferred in young athletes. Schreinemachers et al [12], discussed whether to perform arthro-RM in different positions, to detect ALPSA type injuries and they conclude that the results of conventional arthro-MRI in neutral position is comparable to that performed in ABER position (abduction and external rotation).…”

Arthroscopic Soft Tissue Procedures for Anterior Shoulder Instability

“…Magnetic resonance (MR) imaging is useful to investigate soft tissue defects in the capsulolabral structures and the rotator cuff muscles [ 18 ]. MR... arthrography (MRA) and CT arthrography are especially useful in delineating the type and extent of capsulolabral injuries [ 19 , 20 ], especially if there has been previous surgery. Results should be interpreted with caution as subtle undetected glenoid damage is recognised as a primary cause of labral stabilisation failure and recurrent instability [ 21 , 22 ].…”

MR Arthrography of the Shoulder: Technical Update and Clinical Applications

“…Anterior shoulder instability can be the result of prior anterior subluxation/dislocation with development of pathologic lesions including Hills-Sachs deformities, osseous and nonosseous Bankart lesions, Perthes lesions, anterior labrum periosteal sleeve avulsion (ALPSA) lesions, glenoid cartilage injury, loose bodies, osseous and nonosseous humeral avulsion of the glenohumeral ligament (HAGL) lesions, SLAP lesions, and rotator cuff tears. 18,[137][138][139][140][141] The most common causes of shoulder instability include Bankart lesions (45.72%), Perthes lesions (40%), and ALPSA lesions (14.28%). 18 Hill-Sachs lesions are best visualized on radiographs on the anteroposterior view of the glenohumeral joint with the humerus in 45 degrees internal rotation, the notch (Stryker) view, and the modified Didiee view.…”

“…18,[137][138][139][140][141] The most common causes of shoulder instability include Bankart lesions (45.72%), Perthes lesions (40%), and ALPSA lesions (14.28%). 18 Hill-Sachs lesions are best visualized on radiographs on the anteroposterior view of the glenohumeral joint with the humerus in 45 degrees internal rotation, the notch (Stryker) view, and the modified Didiee view. 142 On MR arthrography, the Hill-Sachs lesion is often seen on the most superior axial slices of the humeral head.…”

“…147,148 ALPSA lesions are thought to only occur in patients with a history of chronic recurrent dislocations and do not usually occur with patients with a single dislocation. 149 Like Perthes lesions, ALPSA lesions are difficult to visualize arthroscopically and are best visualized by the arthroscopist from an anterosuperior portal, 18 and so should be identified preoperatively to help guide the arthroscopist.…”