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The isolated inferior glenohumeral labrum injury, anterior to posterior (the ILAP): A case series.

Irion V, Cheah M, Jones GL, Bishop JY - Int J Shoulder Surg (2015 Jan-Mar)

Bottom Line: Eleven of 12 patients (91.7%) had good or excellent scores.Ten of 12 patients (83.3%) had a feeling of stability in the shoulder.All 12 patients reached were satisfied with the procedure and would undergo surgery again in a similar situation.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.

ABSTRACT

Introduction: We describe the presentation, exam findings, surgical repair techniques, and short-term outcomes in a series of patients with isolated inferior labral tears.

Materials and methods: A retrospective chart review was performed at a large academic medical center. Isolated inferior labral tears were defined as between the 4 o'clock and 8 o'clock position of the glenoid as determined by direct arthroscopic visualization. Tears that were smaller were also included but were required to cross the 6 o'clock point, having anterior and posterior components. Patients were excluded if they had any other pathology or treatment of the shoulder. 1-year follow-up was required.

Results: Of the 17 patients who met inclusion criteria for review, 12 were available for a minimum 1-year follow-up. Average total follow-up for patients to complete the phone interview/Oxford Shoulder Instability Score (OSIS) was an average of 37.7 months (range: 16-79 months). Postoperatively, all reported symptom improvement or resolution since surgery. The mean preoperative pain on a scale of 0-10 was 6.3 (range: 0-10). Mean postoperative pain on a scale of 0-10 was 2.25 (range: 0-5). Eleven of 12 patients (91.7%) had returned to the level of activity desired. The mean OSIS was 41.4 (median: 43; range: 27-47). Eleven of 12 patients (91.7%) had good or excellent scores. Ten of 12 patients (83.3%) had a feeling of stability in the shoulder. All 12 patients reached were satisfied with the procedure and would undergo surgery again in a similar situation.

Conclusions: We have presented our series of patients with isolated inferior labral injury, and have shown that when surgically treated, outcomes of this uncommon injury are good to excellent and a full return to sports can be expected.

No MeSH data available.


Related in: MedlinePlus

The double-loaded posterior anchor is tied to close down the posterior aspect of the tear
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Figure 3: The double-loaded posterior anchor is tied to close down the posterior aspect of the tear

Mentions: Next, attention was turned to placement of the anchors. As placement of an anchor at the 6 o'clock position is both a technical challenge and dangerous secondary to the proximity of the axillary nerve, our technique calls for placement of anterior and posterior anchors as low as possible in order to adequately stabilize the inferior labrum anteriorly and posteriorly so that it may heal at this low position. The anchors utilized were the Arthrex (Naples, FL, USA) 3.0 mm Bio-SutureTak®. The mean number of anchors used was 3.75, and the anchors were either single or double loaded. As the standard posterior portal creates difficulty in getting low enough on the glenoid, we used a percutaneous technique at a 5 or 7 o'clock position, localizing with an 18-gauge spinal needle first, to place posterior anchors. The placement of the anchors and use of the percutaneous posterior technique is demonstrated in Figure 2. The suture lasso (Arthrex, Naples, FL, USA) is used percutaneously to pass the sutures around the labrum. The sutures were shuttled through our cannula in the standard posterior portal and then tied sequentially in order to close the posterior aspect of the labral tear as seen in Figure 3. The arthroscope is placed in the posterior portal to visualize and work anteriorly. The anchors were then placed at the 6:30 and 5 o'clock positions, (anteriorly and posteriorly, respectively, as viewed on the left shoulder) remaining cognizant of the location of the axillary nerve. Subsequent anchors were then placed at the 4 and 8 o'clock positions if necessary. The sutures are then shuttled and tied through the cannulas in the standard fashion anteriorly [Figure 4]. The final labral repair after all sutures have been tied is shown in Figures 5 and 6. Postoperatively, the patient was placed in an UltraSling (DJO, Vista, CA, USA) for immobilization.


The isolated inferior glenohumeral labrum injury, anterior to posterior (the ILAP): A case series.

Irion V, Cheah M, Jones GL, Bishop JY - Int J Shoulder Surg (2015 Jan-Mar)

The double-loaded posterior anchor is tied to close down the posterior aspect of the tear
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325385&req=5

Figure 3: The double-loaded posterior anchor is tied to close down the posterior aspect of the tear
Mentions: Next, attention was turned to placement of the anchors. As placement of an anchor at the 6 o'clock position is both a technical challenge and dangerous secondary to the proximity of the axillary nerve, our technique calls for placement of anterior and posterior anchors as low as possible in order to adequately stabilize the inferior labrum anteriorly and posteriorly so that it may heal at this low position. The anchors utilized were the Arthrex (Naples, FL, USA) 3.0 mm Bio-SutureTak®. The mean number of anchors used was 3.75, and the anchors were either single or double loaded. As the standard posterior portal creates difficulty in getting low enough on the glenoid, we used a percutaneous technique at a 5 or 7 o'clock position, localizing with an 18-gauge spinal needle first, to place posterior anchors. The placement of the anchors and use of the percutaneous posterior technique is demonstrated in Figure 2. The suture lasso (Arthrex, Naples, FL, USA) is used percutaneously to pass the sutures around the labrum. The sutures were shuttled through our cannula in the standard posterior portal and then tied sequentially in order to close the posterior aspect of the labral tear as seen in Figure 3. The arthroscope is placed in the posterior portal to visualize and work anteriorly. The anchors were then placed at the 6:30 and 5 o'clock positions, (anteriorly and posteriorly, respectively, as viewed on the left shoulder) remaining cognizant of the location of the axillary nerve. Subsequent anchors were then placed at the 4 and 8 o'clock positions if necessary. The sutures are then shuttled and tied through the cannulas in the standard fashion anteriorly [Figure 4]. The final labral repair after all sutures have been tied is shown in Figures 5 and 6. Postoperatively, the patient was placed in an UltraSling (DJO, Vista, CA, USA) for immobilization.

Bottom Line: Eleven of 12 patients (91.7%) had good or excellent scores.Ten of 12 patients (83.3%) had a feeling of stability in the shoulder.All 12 patients reached were satisfied with the procedure and would undergo surgery again in a similar situation.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.

ABSTRACT

Introduction: We describe the presentation, exam findings, surgical repair techniques, and short-term outcomes in a series of patients with isolated inferior labral tears.

Materials and methods: A retrospective chart review was performed at a large academic medical center. Isolated inferior labral tears were defined as between the 4 o'clock and 8 o'clock position of the glenoid as determined by direct arthroscopic visualization. Tears that were smaller were also included but were required to cross the 6 o'clock point, having anterior and posterior components. Patients were excluded if they had any other pathology or treatment of the shoulder. 1-year follow-up was required.

Results: Of the 17 patients who met inclusion criteria for review, 12 were available for a minimum 1-year follow-up. Average total follow-up for patients to complete the phone interview/Oxford Shoulder Instability Score (OSIS) was an average of 37.7 months (range: 16-79 months). Postoperatively, all reported symptom improvement or resolution since surgery. The mean preoperative pain on a scale of 0-10 was 6.3 (range: 0-10). Mean postoperative pain on a scale of 0-10 was 2.25 (range: 0-5). Eleven of 12 patients (91.7%) had returned to the level of activity desired. The mean OSIS was 41.4 (median: 43; range: 27-47). Eleven of 12 patients (91.7%) had good or excellent scores. Ten of 12 patients (83.3%) had a feeling of stability in the shoulder. All 12 patients reached were satisfied with the procedure and would undergo surgery again in a similar situation.

Conclusions: We have presented our series of patients with isolated inferior labral injury, and have shown that when surgically treated, outcomes of this uncommon injury are good to excellent and a full return to sports can be expected.

No MeSH data available.


Related in: MedlinePlus