Circumferential Lesions of the Glenoid Labrum: A Prospective Evaluation with Minimum 2-Year Follow-Up: A Multi-Center Study from the SOMOS Research Collaborative (SS-21)

Abstract

Symptomatic triple labral or circumferential (360 degree) tears of the glenohumeral labrum are an uncommon injury - currently there are 7 cases reported in the literature. The purpose of this study is to report the prospective surgical results of circumferential lesions of the glenoid labrum using validated outcome instruments. From July 2003 to May 2006, 41 shoulders in 39 patients with mean age of 25.1 years (range, 17 to 38) were prospectively enrolled in a multi-center study (3 surgeons) and treated for a circumferential (360-degree) lesion of the glenoid labrum. There were 34 men and 5 women, all with a primary diagnosis of pain and recurrent shoulder instability. All patients underwent arthroscopic repair of the circumferential labral tear with a mean of 7.1 suture anchors (range, 6 to 9). The outcomes in 39 of 41 shoulders (92.7% follow-up) were assessed at a mean final follow-up of 31.8 months (range, 24 to 53 months) with VAS pain and instability scales (0 to 10), a physical examination, the Single Assessment Numeric Evaluation Score (SANE), the American Shoulder and Elbow Surgeons Score (ASES), and the SF-12 score. Overall, patients reported an improvement in their VAS pain (4.3 to 1.1, SD=1.5) and VAS instability (7.3 to 0.2, SD=1.1) symptoms. The mean outcomes scores were statistically improved in all categories - SANE (36.7 to 88.5, SD=17.1), ASES (55.5 to 89.6, SD=14.3), and SF-12 (75.7 to 90.0, SD=9.2); all with p<0.001. There were six patients who required revision surgery, 2 for recurrent instability (2 revision stabilizations), 2 for recalcitrant biceps tendonitis and failed SLAP (2 had biceps tenodesis), and 2 for adhesive capsulitis (2 manipulation/capsular release). All patients returned to their pre-injury activity level. Pan-Labral or circumferential lesions are an uncommon yet extensive injury of the glenohumeral joint resulting in recurrent instability and pain. This study demonstrates that arthroscopic capsulolabral repair with suture anchor fixation can restore the stability of the glenohumeral joint and provide a reliable improvement in subjective and objective outcome measures. This is the first study to evaluate the surgical outcomes of this lesion in a prospective fashion with validated outcomes measures. Longer term studies with additional patients are warranted to determine the natural history of this extensive lesion.