The Incidence of Traumatic Posterior and Combined Labral Tears in Patients Undergoing Arthroscopic Shoulder Stabilization

Javed, Saqib; Gheorghiu, Daniel; Torrance, Emma; Monga, Puneet; Funk, Lennard; Walton, Michael

doi:10.1177/0363546519865910

Cited by 18 publications

(17 citation statements)

References 22 publications

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“…Furthermore, our findings were consistent with those in the study by Song et al 21 in showing that there is a larger percentage of patients with posterior and combined labral tears in the military population than typically reported in the civilian population. 1,5,7,13,17,20…”

Section: Discussionmentioning

confidence: 99%

High Incidence of Combined and Posterior Labral Tears in Military Patients With Operative Shoulder Instability

et al. 2022

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Background: Anterior shoulder instability is the pattern most commonly reported in the civilian population, but military servicemembers may represent a unique population. At 1.7 per 1000 person-years, servicemembers not only have a higher incidence of instability events compared with civilians (reported rate of 0.2-0.8), but the distribution of labral tears in the military may differ significantly as well. Hypothesis: The incidence of combined and posterior labral tears in the military population will be greater than numbers previously reported. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The Wounded, Ill, and Injured Registry, a Department of Defense patient reported outcomes data collection platform that includes all military branches, was queried retrospectively for all patients who had undergone a primary arthroscopic or open shoulder stabilization procedure (Current Procedural Terminology codes 29806, 23455, 23462) between October 2016 and January 2019. Demographic information was obtained through intake forms completed by patients at the time of enrollment into the Military Orthopaedics Tracking Injuries and Outcomes Network. Tear location was determined arthroscopically and labeled as anterior, inferior, posterior, superior, or any combination thereof. Chi-square analysis was used to compare the percentage of patients with isolated anterior, isolated posterior, isolated inferior, or combined labral tears in the current study cohort with those in a previously reported cohort of patients with operative shoulder instability at a single military treatment facility. Results: A total of 311 patients were included who had undergone primary shoulder stabilization during the study period. Of these patients, 94 (30.2%) had isolated anterior tears, 76 (24.4%) had isolated posterior tears, and 136 (43.7%) had combined tears. We observed a higher percentage of combined tears in our data set than in a data set from a single military treatment facility (χ2(2) = 48.2; P < .00001). Chi-square analysis demonstrated that significantly more female patients had an isolated anterior labral tear (51.2%) compared with male patients (27.1%; χ2(2) = 9.4; P = .009). Conclusion: The incidence of combined and posterior labral tears in the military population is greater than numbers previously reported in both military and civilian populations.

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Section: Discussionmentioning

confidence: 99%

High Incidence of Combined and Posterior Labral Tears in Military Patients With Operative Shoulder Instability

et al. 2022

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“…3 Additionally, prior biomechanical work has noted that an isolated anterior injury alone should not result in frank anterior instability, with combined anterior and posterior injuries required to produce a frank dislocation on cadaveric testing. 17,22 In a recent review, Javed et al 4 investigated the incidence of isolated, as well as combined, posterior POSTERIOR BANKART EXTENSION e5 labral injury in a cohort of patients undergoing arthroscopic shoulder stabilization. The authors noted a rate of 16.3% isolated posterior injury, with 30.8% of patients noted to have combined anteroposterior instability.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 The potential for more extensive injury patterns is also supported by recent biomechanical data demonstrating increased strain in the posterior labrum following an anterior dislocation. 3 Further, recent investigation 4,5 has noted a far greater prevalence of posterior labral injury than the 2 to 6% that has been classically reported following traumatic dislocation, [6][7][8][9] suggesting that a diagnosis of concomitant posterior labral injury may often be overlooked during Bankart repair.…”

Section: Introductionmentioning

confidence: 99%

Posterior Labral Tear Extension Concomitant With Shoulder Bankart Injuries Is not Uncommon

Golan

Atte

Drummond

et al. 2022

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To identify the rate and risk factors of posterior labral involvement in operatively managed Bankart lesions and assess the effectiveness of MRI arthrogram for preoperative identification of such injury patterns. Methods: A consecutive cohort of patients undergoing arthroscopic Bankart repair were retrospectively reviewed. All subjects underwent a prearthroscopy MRI arthrogram. Operative findings were used as the gold standard for posterior labral tear extension. Patient demographic and surgical data were then analyzed to identify independent factors associated with the presence of concomitant posterior labral injury. Results: Of 124 patients undergoing arthroscopic Bankart stabilization, 23 (19%) were noted to demonstrate posterior labral injury on arthroscopic evaluation. Factors associated with injury to the posterior labrum included those sustaining two or fewer dislocations events (P ¼.001), an earlier average presentation (P ¼ .001), and a reported "contact" mechanism of dislocation (P ¼ .02). Posterior labral involvement did not correlate with surgical positioning (beach-chair versus lateral) or the need for revision surgery. On the basis of review of preoperative imaging, MRI arthrogram demonstrated a sensitivity of 83% and a specificity of 95% for detection of posterior labral injury. Conclusion: Posterior propagation of Bankart lesions is relatively common following shoulder dislocations, with a rate of 18.5%. Risk factors for posterior labral extension include two or fewer dislocations, early presentation from the time of injury, and contact sports. On the basis of these findings, careful assessment of the posterior labrum on MRI arthrogram may reveal the majority, but not all, of these lesions.

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“…Recently published studies found that combined-type shoulder instability in both military and nonmilitary populations accounts for over 30% of all shoulder instability cases treated surgically. 12,38 While outcomes after surgical stabilization have been described extensively in the nonmilitary population, there is a paucity of data on outcomes in the military population after 270° (or greater) labral repair. 6,7,9,32…”

Section: Discussionmentioning

confidence: 99%

Outcomes of 270° Labral Repair for Combined Shoulder Instability in Active-Duty Military Patients: A Retrospective Study

et al. 2021

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Background: There is a high prevalence of combined shoulder instability in military patients. Short-term outcomes after 270° labral repair are promising; however, there is a paucity of longer term outcome data in this high-demand group of patients. Purpose: To report the midterm outcomes of active-duty military patients treated with 270° labral repair for combined shoulder instability. Study Design: Case series; Level of evidence, 4. Methods: All consecutive patients between January 2011 and January 2019 who underwent 270° labral repair by the senior surgeon with complete outcome scores were identified. All patients had experienced a shoulder dislocation after a traumatic event and had magnetic resonance imaging and intraoperative findings consistent with combined-type instability. A total of 52 patients met the inclusion criteria for the study, and all were active-duty servicemembers at the time of surgery. Results: The mean follow-up was 78.21 months (range, 24-117 months). There was a statistically significant increase in the mean American Shoulder and Elbow Surgeons score (from 44.92 to 89.31; P < .0001), Single Assessment Numeric Evaluation score (from 52.32 to 93.17; P < .0001), and Rowe instability score (from 46.63 to 91.35; P < .0001) from preoperatively to postoperatively. Mean pain decreased significantly as measured by the visual analog scale for pain (from 8.04 to 1.44; P < .0001). Range of motion in forward flexion (from 155.29° to 155.96°; P = .6793), external rotation (from 67.50° to 65.29°; P = .0623), and internal rotation (from T9.58 to T9.56; P = .9650) did not change significantly postoperatively. Outcomes did not differ significantly for patients who underwent surgery on their dominant shoulder versus those who underwent surgery on their nondominant shoulder, nor did outcomes vary with the type of anchor utilized (biocomposite vs all-suture). The overall rate of return to active duty was 92.31%. Conclusion: Midterm outcomes in this population of active-duty patients undergoing 270° labral repair for combined shoulder instability demonstrated a statistically and clinically significant improvement in patient-reported outcome scores, a significant decrease in pain, and an overall rate of return to active duty of 92.31%.

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The Incidence of Traumatic Posterior and Combined Labral Tears in Patients Undergoing Arthroscopic Shoulder Stabilization

Cited by 18 publications

References 22 publications

High Incidence of Combined and Posterior Labral Tears in Military Patients With Operative Shoulder Instability

High Incidence of Combined and Posterior Labral Tears in Military Patients With Operative Shoulder Instability

Posterior Labral Tear Extension Concomitant With Shoulder Bankart Injuries Is not Uncommon

Outcomes of 270° Labral Repair for Combined Shoulder Instability in Active-Duty Military Patients: A Retrospective Study

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