Alexeev Mikhail, Kercher James S, Levina Yelena, Duralde Xavier A
Department of Orthopedic Surgery, Wellstar Atlanta Medical Center, Atlanta, GA, USA.
Peachtree Orthopaedics, Atlanta, GA, USA.
J Shoulder Elbow Surg. 2021 Dec;30(12):2762-2766. doi: 10.1016/j.jse.2021.05.004. Epub 2021 May 19.
Glenoid labrum tears are a common cause of shoulder pain and instability and tear patterns have historically been ascribed into categorical descriptions such as anterior, posterior, and superior labral tears (SLAP [superior labrum anterior and posterior]) with multiple subtypes. Although often quoted as representing no more than 10% of instabilities, posterior shoulder instability may be more common than previously recognized. The purpose of this study was to review observed labral tear patterns and compare incidence and morphologies to historical descriptions.
All patients undergoing arthroscopic or open labral repair (Current Procedural Terminology codes 29806, 29807, 23455, 23460, 23462, 23465) by 2 fellowship-trained shoulder surgeons from July 2012 to May 2019 were retrospectively reviewed. Labral tears were categorized into 3 groups: exclusively anterior to the midline of the glenoid, exclusively posterior, and those crossing the midline of the glenoid. Chief complaint, mechanism of injury, hand dominance, preoperative MRI interpretation by surgeon, and independent radiologist were analyzed for each tear type.
During the 7-year period, 280 patients underwent arthroscopic or open labral repair. Sixty percent of tears were traumatic, with dislocation being the most common traumatic mechanism at 31.4%. Ten distinct tear patterns were identified: 3 types of 90° tears (anteroinferior, posteroinferior, and posterosuperior), 4 types of 180° tears (anterior, posterior, inferior, and SLAP), 2 types of 270° tears (anteroinferior and anterosuperior), and 360° labral tears. A total of 134 tears (47.9%) were classified as posterior, and 72 tears (25.7%) were anterior. Seventy-four tears (26.4%) were combined anterior-posterior tears. Labral tears involving some portion of the posterior labrum constituted 74% of tears. A significant association between tear location and primary complaint (P < .001) was noted. Patients with anterior tears complained of only instability in 62.5% of cases, and only pain in 22%. Patients with posterior labral tears complained primarily of pain in 68% of cases, and instability in 21%. There was an accurate preoperative diagnosis given by both radiologists and surgeons on 30% (n = 63) of the tears.
There is a wide variety of labral tear patterns identified at the time of surgery, and the incidence of posterior labral tears is higher than previously described. Isolated Bankart lesions are relatively rare and are often associated with more extensive labral lesions. Patients with posterior labral pathology more often complain of pain rather than instability, whereas patients with anterior labral tears more often complain of instability.
盂唇撕裂是肩部疼痛和不稳定的常见原因，历史上撕裂模式被归类为诸如前、后和上盂唇撕裂（SLAP [上盂唇前后部]）等类别描述，且有多种亚型。尽管后肩部不稳定常被认为占不稳定情况的比例不超过10%，但其可能比之前认为的更为常见。本研究的目的是回顾观察到的盂唇撕裂模式，并将发病率和形态与既往描述进行比较。
回顾性分析2012年7月至2019年5月期间由2名接受过专科培训的肩部外科医生进行关节镜或开放盂唇修复手术（当前操作术语编码29806、29807、23455、23460、23462、23465）的所有患者。盂唇撕裂分为3组：完全位于盂肱关节盂中线前方、完全位于后方以及穿过盂肱关节盂中线的撕裂。分析每种撕裂类型的主要症状、损伤机制、利手、外科医生术前MRI解读以及独立放射科医生的诊断。
在7年期间，280例患者接受了关节镜或开放盂唇修复手术。60%的撕裂为创伤性，脱位是最常见的创伤机制，占31.4%。识别出10种不同的撕裂模式：3种90°撕裂（前下、后下和后上）、4种180°撕裂（前、后、下和SLAP）、2种270°撕裂（前下和前上）以及360°盂唇撕裂。共有134例撕裂（47.9%）被归类为后方撕裂，72例撕裂（25.7%）为前方撕裂。74例撕裂（26.4%）为前后联合撕裂。涉及后盂唇部分的盂唇撕裂占撕裂的74%。注意到撕裂位置与主要症状之间存在显著关联（P <.001）。前方撕裂患者在62.5%的病例中仅主诉不稳定，22%的病例仅主诉疼痛。后盂唇撕裂患者在68%的病例中主要主诉疼痛，21%的病例主诉不稳定。放射科医生和外科医生对30%（n = 63）的撕裂做出了准确的术前诊断。
手术时识别出多种盂唇撕裂模式，后盂唇撕裂的发生率高于既往描述。孤立的Bankart损伤相对少见，且常与更广泛的盂唇损伤相关。后盂唇病变患者更多主诉疼痛而非不稳定，而前盂唇撕裂患者更多主诉不稳定。
