Nammour Michael, Arner Justin W, Eads Ryan, Bradley James P
University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA.
Sports Medicine, Aptiva Health, Louisville, Kentucky, USA.
Video J Sports Med. 2023 Jun 19;3(3):26350254231156221. doi: 10.1177/26350254231156221. eCollection 2023 May-Jun.
Rotator cuff tears after anterior shoulder instability are more common in patients >40 years of age and rare in younger patients where shoulder instability is most common. Although infrequent, little data exist on the evaluation of combined labral and rotator cuff tears in athletes.
Combined rotator cuff and labral tears in the young patient population have a high risk of recurrent instability and require unique intraoperative and postoperative considerations. This patient is a Division 1 collegiate wrestler who sustained a 360° labral and full-thickness rotator cuff tear after an acute traumatic anterior shoulder dislocation.
The lateral decubitus position is utilized and a posterior viewing portal is established along with anterior and accessory lateral portals. The 360° labral tear is first addressed by appropriately preparing the glenoid creating a quality healing surface. Tape sutures are then utilized to perform a knotless anterior labral repair. The superior labrum, anterior to posterior (SLAP) and then posterior labral repair are sequentially performed. The posterior portal is closed with a polydioxanone (PDS) suture to prevent a stress riser in the capsule. The rotator cuff tear is then repaired in a knotless double row configuration after appropriate greater tuberosity preparation.
Recent studies evaluating athletes with combined rotator cuff and labral pathology who underwent arthroscopic repair reported 90% good to excellent satisfaction with 77% returning to pre-injury level of athletics. Although few studies have evaluated combined labral and rotator cuff repair and concerns with stiffness exist, the current literature and the authors own experience have found good outcomes following single-stage repair.
DISCUSSION/CONCLUSION: Combined labral and rotator cuff tears after anterior shoulder dislocation in the young athletic population are rare and can be challenging to treat. Although there is limited data on these combined injuries in young athletic populations, the current literature and authors' experience support single stage surgical treatment of combined labral and rotator cuff tears which typically result in improved patient reported outcomes and return to sport.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
肩前不稳定后发生的肩袖撕裂在40岁以上患者中更为常见，而在肩不稳定最常见的年轻患者中则很少见。尽管这种情况不常见，但关于运动员合并盂唇和肩袖撕裂评估的数据却很少。
年轻患者群体中合并肩袖和盂唇撕裂有较高的复发性不稳定风险，需要独特的术中及术后考量。该患者是一名一级大学摔跤运动员，在急性创伤性肩前脱位后发生了360°盂唇和全层肩袖撕裂。
采用侧卧位，建立后观察入口以及前侧和辅助外侧入口。首先处理360°盂唇撕裂，通过适当准备肩胛盂来创建一个优质的愈合表面。然后使用带线缝合进行无结前盂唇修复。依次进行上盂唇从前到后的修复（SLAP）以及后盂唇修复。用聚二氧六环酮（PDS）缝线关闭后入口，以防止关节囊出现应力集中点。在适当准备大结节后，以无结双排结构修复肩袖撕裂。
最近评估接受关节镜修复的合并肩袖和盂唇病变运动员的研究报告显示，90%的患者满意度为良好至优秀，77%的患者恢复到受伤前的运动水平。尽管很少有研究评估合并盂唇和肩袖修复以及对僵硬情况的担忧，但当前文献和作者自身经验发现单阶段修复后效果良好。
讨论/结论：年轻运动员群体中肩前脱位后合并盂唇和肩袖撕裂很少见，治疗具有挑战性。尽管关于年轻运动员群体中这些合并损伤的数据有限，但当前文献和作者经验支持对合并盂唇和肩袖撕裂进行单阶段手术治疗，这通常会改善患者报告的结果并使其恢复运动。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本提交发表内容附上患者的豁免声明或其他书面批准形式。
