Glenoid Labral Articular Disruption Lesions in the Setting of First-Time Anterior Shoulder Instability

Abstract

Purpose

To compare the clinical outcomes and rates of recurrent instability in patients after arthroscopic Bankart repair with and without glenolabral articular disruption (GLAD) lesions in the setting of first-time anterior instability events.

Methods

This was a retrospective comparative case series of consecutive patients with GLAD lesions in the setting of first-time anterior instability events who underwent arthroscopic Bankart repair. Patients with GLAD lesions (cases) were matched at a 1:3 ratio for sex, age, body mass index, and sports participation to those without GLAD lesions (controls). Primary outcomes included postoperative range of motion (forward elevation and external rotation) and patient-reported outcomes: Subjective Shoulder Value, visual analog scale score, and Western Ontario Shoulder Instability Index. Rates of recurrent instability after primary arthroscopic stabilization were also collected. Statistical analysis was performed to compare outcomes between the control and GLAD groups, with significance set to P ≤ 0.05.

Results

A total of 56 patients undergoing arthroscopic anterior stabilization between 2012 and 2020 were included for analysis, of whom 14 had GLAD lesions whereas the remaining 42 were controls. The average follow-up time from surgery in controls was 8.2 years (range, 3.1-11.7 years), whereas the average follow-up time in patients with GLAD lesions was 7.6 years (range, 3.8-11.8 years). There were no differences in postoperative forward flexion or external rotation, Subjective Shoulder Value, visual analog scale score, or Western Ontario Shoulder Instability Index. The rate of recurrent instability was found to be the same in both the control and GLAD groups (7% and 7%, respectively; P = .16).

Conclusions

Patients with GLAD lesions in the setting of first-time anterior instability had comparable patient-reported outcomes, forward flexion, and external rotation postoperatively to control patients. In addition, the presence of a GLAD lesion did not influence the rate of recurrent instability.

Level of Evidence

Level IV, retrospective comparative case series.