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.

The Glenolabral Articular Disruption Lesion Is a Biomechanical Risk Factor for Recurrent Shoulder Instability

“…Davey et al had a closer look on this assumption and analyzed the effect of a GLAD lesion by means of other patient-reported outcome scores. 24 They identified no significant impact of a GLAD lesion after ABR. However, patients with a GLAD lesion showed a mean subjective shoulder value that was 8 points lower compared with controls.…”

Clinical Outcomes in Patients With Humeral Avulsion Glenohumeral Ligament Lesions in the Setting of Anterior Shoulder Instability: A Retrospective Comparative Study

“…Any associated labral tear was then repaired arthroscopically using a previously described technique. 5…”

“…8 The complexity of the anatomic shoulder stabilizers results in a variety of pathologies in patients with anterior shoulder instability. 3,10,13,14,20,25 Davey et al 5,6 previously reported that the average collision athlete with anterior shoulder instability experiences a multitude of pathologies secondary to recurrent dislocations displayed on preoperative imaging before surgical stabilization, with bony Bankart and Hill-Sachs lesions being the most common. In addition, the humeral avulsion glenohumeral ligament (HAGL) lesion has been shown to occur in up to 10% of cases of recurrent anterior shoulder instability.…”

Rehabilitation and Return to Play of the Athlete after an Upper Extremity Injury

“…Rehabilitation after surgical intervention for shoulder instability can be broadly characterized by a few main phasesdprotection, endurance, strength, then return to sport. [61][62][63][64][65] Sling immobilization semioperatively varies significantly across the literature from 0 to 2 weeks, 65,66 3 weeks, 62 4 weeks, 61,67 or even up to 6 weeks. 68 After immobilization, athletes can begin active-assisted and active ROM exercises around 4 to 6 weeks semioperatively.…”

“…In 66 collision athletes, the return to play rate after arthroscopic Bankart repair was 90.9% at a mean of 6 months. 62 A study of martial art athletes found 95% RTP rate in 6.4 months after arthroscopic Bankart repair. 67 After arthroscopic Bankart repair or open Latarjet reconstruction, 22 of 23 professional athletes were able to return a mean of 4.5 months after surgery.…”