Axillary Nerve Position in Humeral Avulsions of the Glenohumeral Ligament

Background: The axillary nerve is at risk during repair of a humeral avulsion of the glenohumeral ligament (HAGL). Purpose: To measure the distance between the axillary nerve and the free edge of a HAGL lesion on preoperative magnetic resonance imaging (MRI) and compare these findings to the actual intraoperative distance measured during open HAGL repair. Study Design: Case series; Level of evidence, 4. Methods: A total of 25 patients with anterior instability were diagnosed as having a HAGL lesion on MRI and proceeded to open repair. The proximity of the axillary nerve to the free edge of the HAGL lesion was measured intraoperatively at the 6-o’clock position relative to the glenoid face. Preoperative MRI was then used to measure the distance between the axillary nerve and the free edge of the HAGL lesion at the same position. Distances were compared using paired t tests and Bland-Altman analyses. Results: The axillary nerve lay, on average, 5.60 ± 2.51 mm from the free edge of the HAGL lesion at the 6-o’clock position on preoperative MRI, while the mean actual intraoperative distance during open HAGL repair was 4.84 ± 2.56 mm, although this difference was not significant ( P = .154). In 52% (13/25) of patients, the actual intraoperative distance of the axillary nerve to the free edge of the HAGL lesion was overestimated by preoperative MRI. In 36% (9/25), this overestimation of distance was greater than 2 mm. Conclusion: The observed overestimations, although not significant in this study, suggest a smaller safety margin than might be expected and hence a substantially higher risk for potential damage. We recommend that shoulder surgeons exercise caution in placing capsular sutures in the lateral edge when contemplating arthroscopic repair of HAGL lesions, as the proximity of the nerve to the free edge of the HAGL tear is small enough to be injured by arthroscopic suture-passing instruments.

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Prospective Evaluation of Surgical Treatment of Humeral Avulsions of the Glenohumeral Ligament

The American Journal of Sports Medicine ◽

10.1177/0363546516680608 ◽

2016 ◽

Vol 45 (5) ◽

pp. 1134-1140 ◽

Cited By ~ 8

Author(s):

Matthew T. Provencher ◽

Frank McCormick ◽

Lance LeClere ◽

George Sanchez ◽

Petar Golijanin ◽

...

Keyword(s):

Case Series ◽

Clinical History ◽

Recurrent Instability ◽

Level Of Evidence ◽

Glenohumeral Ligament ◽

Shoulder Dysfunction ◽

Patient Reported ◽

Subscapularis Tenotomy ◽

Hagl Lesion

Background: Humeral avulsion of the glenohumeral ligament (HAGL) is an infrequent but significant contributor to shoulder dysfunction, instability, and functional loss. Purpose: To prospectively identify patients with HAGL lesions and then conduct retrospective evaluation of the clinical history, examination findings, and surgical outcomes of these patients. Study Design: Case series; Level of evidence, 4. Methods: Over a 6-year period (2006-2011), patients with shoulder dysfunction and a HAGL lesion that was confirmed via magnetic resonance arthrogram (MRA) were prospectively evaluated with a minimum 2-year follow-up. Patient demographics, presentation, examination, and surgical findings were documented. Outcomes of return to activity as well as Western Ontario Shoulder Instability Index (WOSI) and Single Assessment Numeric Evaluation (SANE) scores were recorded at final follow-up. Anterior HAGL (aHAGL) lesions were repaired with a partial subscapularis tenotomy approach, while reverse (rHAGL) lesions were repaired arthroscopically. Results: Of 28 patients, 27 (96%) completed the study requirements at a mean of 36.2 months (range, 24-68 months). The sample contained 12 females (44%) and 15 males (56%), who had a mean age of 24.9 years (range, 18-34 years). The chief complaint reported was pain in 23 patients (85%), while only 4 (15%) patients complained primarily of recurrent instability symptoms. Fourteen patients (52%) had aHAGL lesions, 10 patients (37%) had rHAGL lesions, and 3 patients (11%) had combined aHAGL and rHAGL lesions. Ten patients (37%) had concomitant HAGL lesions and labral tears, whereas 17 patients (63%) had isolated HAGL lesion without labral tear. The 17 patients (63%) with aHAGL lesions or combined lesions underwent a partial subscapularis tenotomy approach, while the remaining 10 patients (37%) with rHAGL lesions underwent arthroscopic surgical repair. After surgery, WOSI outcomes improved from 54% to 88% and SANE outcomes improved from 50% to 91% ( P < .01 for both), with no reports in recurrence of instability symptoms at final follow-up. Conclusion: This study demonstrated that patients with symptomatic HAGL lesions predominantly report shoulder pain and dysfunction, with few chief complaints of recurrent instability complaints. After surgery, patients showed predictable return to full activity, improvement in objective and patient-reported outcomes, and satisfaction with treatment outcome.

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Postarthroscopy Imaging in Femoroacetabular Impingement: Persistent Pain May Be Due to an Insufficient Correction of Preoperative Abnormalities

Joints ◽

10.1055/s-0037-1601411 ◽

2017 ◽

Vol 05 (01) ◽

pp. 021-026 ◽

Cited By ~ 1

Author(s):

Cosimo Tudisco ◽

Salvatore Bisicchia ◽

Sandro Tormenta ◽

Amedeo Taglieri ◽

Ezio Fanucci

Keyword(s):

Case Series ◽

Persistent Pain ◽

Retrospective Case ◽

Level Of Evidence ◽

Mean Values ◽

Center Edge ◽

Patient Groups ◽

The Mean ◽

Magnetic Resonance Imaging Mri

Purpose The purpose of this study was to evaluate the effect of correction of abnormal radiographic parameters on postoperative pain in a group of patients treated arthroscopically for femoracetabular impingement (FAI). Methods A retrospective study was performed on 23 patients affected by mixed-type FAI and treated arthroscopically. There were 11 males and 12 females with a mean age of 46.5 (range: 28–67) years. Center-edge (CE) and α angles were measured on preoperative and postoperative radiographic and magnetic resonance imaging (MRI) studies and were correlated with persistent pain at follow-up. Results The mean preoperative CE and α angles were 38.6 ± 5.2 and 67.3 ± 7.2 degrees, respectively. At follow-up, in the 17 pain-free patients, the mean pre- and postoperative CE angle were 38.1 ± 5.6 and 32.6 ± 4.8 degrees, respectively, whereas the mean pre- and postoperative α angles at MRI were 66.3 ± 7.9 and 47.9 ± 8.9 degrees, respectively. In six patients with persistent hip pain, the mean pre- and postoperative CE angles were 39.8 ± 3.6 and 35.8 ± 3.1 degrees, respectively, whereas the mean pre- and postoperative α angles were 70.0 ± 3.9 and 58.8 ± 2.6 degrees, respectively. Mean values of all the analyzed radiological parameters, except CE angle in patients with pain, improved significantly after surgery. On comparing patient groups, significantly lower postoperative α angles and lower CE angle were observed in patients without pain. Conclusion In case of persistent pain after arthroscopic treatment of FAI, a new set of imaging studies must be performed because pain may be related to an insufficient correction of preoperative radiographic abnormalities. Level of Evidence Level IV, retrospective case series.

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Inferior Glenohumeral Ligament (IGHL) Injuries: A Case Series of Magnetic Resonance (MR) Imaging Findings and Arthroscopic Correlation

Kansas Journal of Medicine ◽

10.17161/kjm.vol13.13546 ◽

2020 ◽

Vol 13 ◽

pp. 275-279

Author(s):

Michael Glass ◽

Vafa Behzadpour ◽

Jessica Peterson ◽

Lauren Clark ◽

Shelby Bell-Glenn ◽

...

Keyword(s):

Magnetic Resonance ◽

Case Series ◽

Inclusion Criteria ◽

Glenohumeral Ligament ◽

Radiology Reports ◽

Labral Tears ◽

Tissue Edema ◽

Cortical Irregularity ◽

Inferior Glenohumeral Ligament ◽

Magnetic Resonance Imaging Mri

The inferior glenohumeral ligament (IGHL) complex is commonly assessed by both magnetic resonance imaging (MRI) and magnetic resonance (MR) arthrogram. Our study aimed to compare the accuracy of MR arthrogram compared to MRI using arthroscopic correlation as the gold standard. A retrospective review of cases reporting an IGHL injury was performed. 77 cases met inclusion criteria, while 5 had arthroscopic reports that directly confirmed or refuted the presence of IGHL injury. Two arthroscopic reports confirmed concordant IGHL injuries, while 3 arthroscopic reports mentioned discordant findings compared to MR. Interestingly, all three discordant cases involved MR arthrogram. Findings included soft tissue edema, fraying of the axillary pouch fibers, and cortical irregularity of the humeral neck. Of the two concordant cases, one was diagnosed by MRI, revealing an avulsion of the anterior band, while the second was diagnosed by MR arthrogram showing ill-defined anterior band fibers. Many cases involved rotator cuff or labral tears, which may have been the focus of care for providers, given their importance for shoulder stability. Additionally, a lack of diagnostic confidence in MR reports may have influenced surgeons in the degree to which they assessed the IGHL complex during arthroscopy. In conclusion, radiologists seemed more likely to make note of IGHL injuries when MR arthrograms were performed; meanwhile, all three discordant cases involved MR arthrogram reads. Therefore, additional larger studies are needed with arthroscopic correlation to better elucidate MR findings that confidently suggest injury to the IGHL complex, in order to avoid false positive radiology reports.

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Pediatric Scaphoid Nonunions: A Case Series, Review of the Literature, and Evidence-Based Guidelines

Journal of Wrist Surgery ◽

10.1055/s-0039-3401035 ◽

2019 ◽

Vol 09 (01) ◽

pp. 002-012 ◽

Cited By ~ 1

Author(s):

Kerstin Oestreich ◽

Tatiana Umata Yoko Jacomel ◽

Sami Hassan ◽

Maxim David Horwitz ◽

Tommy Roger Lindau

Keyword(s):

Nonoperative Management ◽

Pediatric Population ◽

Scaphoid Fracture ◽

Case Series ◽

Fracture Site ◽

X Rays ◽

Review Of The Literature ◽

Level Of Evidence ◽

Scaphoid Fractures ◽

Magnetic Resonance Imaging Mri

Abstract Background Scaphoid fractures represent less than 3% of hand and wrist fractures in the pediatric population. Nonunions are very rare. We present a case series (n = 18) of nonunions in skeletally immature children and adolescents. We further present a review of the literature on pediatric scaphoid nonunions. Materials and Methods We reviewed the literature by searching the main databases on pediatric scaphoid nonunions, but to identify factors that lead to nonunion, we also searched for databases on scaphoid fractures. Seventy articles were found for the period between 1961 and 2019, all with level 4/5 evidence. Results The nonunion rate of pediatric scaphoid fractures in the literature is on average 1.5%, occurring mostly as a result of missed or underdiagnosed injuries, similar to our presented case series. Half (n = 9) of the injuries in our case series were missed initial injuries, leading to scaphoid nonunions and half developed nonunions after initial treatment. We found excellent outcomes and with surgical and nonoperative management, with few complications. Not surprisingly, the duration of immobilization is longer with nonoperative management. Conclusions Based on the literature, we recommend a period of nonoperative management before surgery in undisplaced nonunions. In displaced nonunions, open reduction and internal fixation ± bone grafting is necessary. In pediatric scaphoid fractures, similar to adult cases, we identified that suspicious scaphoid fractures should be considered for initial immobilization, and repeat X-rays and early magnetic resonance imaging (MRI) or computed tomography (CT) scans should be considered at follow-up. Immobilization time and type of plaster should be appropriate in relation to the fracture site, similar to the adult scaphoid fracture. Level of Evidence This is a Level IV study.

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Ulnar Collateral Ligament Tear Location May Affect Return-to-Sports Rate but Not Performance Upon Return to Sports After Ulnar Collateral Ligament Reconstruction Surgery in Professional Baseball Players

The American Journal of Sports Medicine ◽

10.1177/0363546520947090 ◽

2020 ◽

Vol 48 (11) ◽

pp. 2608-2612 ◽

Cited By ~ 1

Author(s):

Brandon J. Erickson ◽

James Carr ◽

Peter N. Chalmers ◽

Evan Vellios ◽

David W. Altchek

Keyword(s):

Ulnar Collateral Ligament ◽

Nonoperative Treatment ◽

Professional Baseball ◽

Return To Sports ◽

Collateral Ligament ◽

Level Of Evidence ◽

Baseball Players ◽

Preoperative Magnetic Resonance ◽

Magnetic Resonance Imaging Mri ◽

And Performance

Background: The number of ulnar collateral ligament (UCL) tears in professional baseball players is increasing. UCL reconstruction (UCLR) is the treatment of choice in players with failed nonoperative treatment who wish to return to sports (RTS). It is unknown if UCL tear location influences the ability of players to RTS or affects their performance upon RTS. Purpose/Hypothesis: The purpose was to compare the RTS rate and performance upon RTS in professional baseball players who underwent UCLR based on UCL tear location (proximal vs distal). It was hypothesized that no difference in RTS rate or performance upon RTS will exist between players with proximal or distal UCL tears. Study Design: Cohort study; Level of evidence, 3. Methods: All professional baseball players who underwent primary UCLR by a single surgeon between 2016 and 2018 were eligible for inclusion. Players with purely midsubstance tears or revision UCLR were excluded. Tear location was determined based on preoperative magnetic resonance imaging (MRI) and intraoperative findings. RTS rate and performance were compared between players with proximal versus distal UCL tears. Results: Overall, 25 pitchers (15 proximal and 10 distal tears) and 5 position players (2 proximal and 3 distal) underwent primary UCLR between 2016 and 2018. Of the 25 pitchers, 84% were able to RTS. Of the 5 position players, 80% were able to RTS. Among the total cohort of pitchers and position players, 12 out of 17 (71%) players with proximal tears were able to RTS, while of the 13 distal tears, 13 out of 13 (100%) players were able to RTS ( P = .05). With regard to performance data, pitchers with distal tears had higher utilization postoperatively and, as such, allowed statistically more hits ( P = .03), runs ( P = .015), and walks ( P = .021) postoperatively. However, the WHIP ([walks + hits]/innings pitched) was not different between players with proximal or distal tears, indicating that efficacy in games was not significantly different between groups. Conclusion: Professional baseball players who sustain a distal UCL tear and undergo UCLR may be more likely to RTS than those who sustain a proximal UCL tear and undergo UCLR. Players with distal UCL tears who underwent UCLR saw higher utilization postoperatively than those with proximal UCL tears. Further work is needed in this area to confirm this result.

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Cartilage Morphological and Histological Findings After Reconstruction of the Glenoid With an Iliac Crest Bone Graft

The American Journal of Sports Medicine ◽

10.1177/0363546517749813 ◽

2018 ◽

Vol 46 (5) ◽

pp. 1039-1045 ◽

Cited By ~ 8

Author(s):

Alexander Auffarth ◽

Herbert Resch ◽

Nicholas Matis ◽

Martin Hudelmaier ◽

Wolfgang Wirth ◽

...

Keyword(s):

Soft Tissue ◽

Bone Graft ◽

Iliac Crest ◽

Histological Analysis ◽

Case Series ◽

Bone Grafts ◽

Iliac Crest Bone Graft ◽

Level Of Evidence ◽

Biopsy Specimens ◽

Magnetic Resonance Imaging Mri

Background: The J-bone graft is presumably representative of iliac crest bone grafts in general and allows anatomic glenoid reconstruction in cases of bone defects due to recurrent traumatic anterior shoulder dislocations. As a side effect, these grafts have been observed to be covered by some soft, cartilage-like tissue when arthroscopy has been indicated after such procedures. Purpose: To evaluate the soft tissue covering of J-bone grafts by use of magnetic resonance imaging (MRI) and histological analysis. Study Design: Case series; Level of evidence, 4. Methods: Patients underwent MRI at 1 year after the J-bone graft procedures. Radiological data were digitally processed and evaluated by segmentation of axial images. Independent from the MRI analysis, 2 biopsy specimens of J-bone grafts were harvested for descriptive histological analysis. Results: Segmentation of the images revealed that all grafts were covered by soft tissue. This layer had an average thickness of 0.87 mm compared with 1.96 mm at the adjacent native glenoid. Of the 2 biopsy specimens, one exhibited evident hyaline-like cartilage and the other presented patches of chondrocytes embedded in a glycosaminoglycan-rich extracellular matrix. Conclusion: J-bone grafts are covered by soft tissue that can differentiate into fibrous and potentially hyaline cartilage. This feature may prove beneficial for delaying the onset of dislocation arthropathy of the shoulder.

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Early Outcomes and Complications of Synthetic Cartilage Implant for Treatment of Hallux Rigidus in the United States

Foot & Ankle International ◽

10.1177/1071100719855049 ◽

2019 ◽

Vol 40 (10) ◽

pp. 1140-1148 ◽

Cited By ~ 14

Author(s):

Spenser J. Cassinelli ◽

Stephanie Chen ◽

Timothy P. Charlton ◽

David B. Thordarson

Keyword(s):

Patient Satisfaction ◽

Case Series ◽

Retrospective Chart Review ◽

The United States ◽

Reoperation Rate ◽

Hallux Rigidus ◽

Level Of Evidence ◽

Physical Dysfunction ◽

Magnetic Resonance Imaging Mri

Background: The aim of this study was to determine the early outcomes and complications following the implantation of a hydrogel synthetic cartilage implant (SCI, Cartiva) for the treatment of hallux rigidus by a single surgeon. Methods: A retrospective chart review was performed of consecutive patients who underwent treatment for hallux rigidus with an SCI between August 2016 and April 2018 by a single surgeon. Demographic information, radiographic assessment, and concomitant operative procedures performed were evaluated for all patients. Postoperatively, PROMIS physical function (PF) and pain interference (PI) scores, patient satisfaction, reoperation, conversion to arthrodesis, and need for further clinical treatment were collected. Sixty-four SCIs were implanted in 60 patients. Follow-up averaged 18.5 months (range 12-30 months). Results: 14% (9/64) of patients were very satisfied, 28% (18/64) satisfied, 20% (13/64) neutral, 11% (7/64) unsatisfied, and 27% (17/64) very unsatisfied with their outcome. In addition, 45% of patients underwent additional procedures at the time of SCI, and 23% had a history of surgery on the hallux before implantation. PROMIS PF scores averaged 42 and PROMIS PI scores averaged 60. Overall, 63% completed PROMIS PI, 66% completed PROMIS PF, and 100% completed a satisfaction survey. In addition, 30% (19/64) underwent magnetic resonance imaging (MRI) postoperatively due to pain. There was a 20% reoperation rate, which included an 8% rate of conversion to arthrodesis. Conclusion: Synthetic cartilage implantation yielded neutral patient satisfaction, mild pain, and physical dysfunction at early follow-up. We believe patient selection and counseling regarding early postoperative limitations are important before proceeding with SCI. Level of Evidence: Level IV, case series.

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Acute Tears of the Tibialis Posterior Tendon Following Ankle Sprain

Foot & Ankle International ◽

10.1177/1071100717701686 ◽

2017 ◽

Vol 38 (7) ◽

pp. 752-759 ◽

Cited By ~ 3

Author(s):

Lyle T. Jackson ◽

Linda J. Dunaway ◽

Gregory A. Lundeen

Keyword(s):

Ankle Sprain ◽

Case Series ◽

Tibialis Posterior ◽

Mri Findings ◽

Tendon Tear ◽

Level Of Evidence ◽

Ligament Instability ◽

Magnetic Resonance Imaging Mri ◽

Poor Outcomes ◽

American Orthopaedic

Background: Traumatic tears of the tibialis posterior (TP) tendon following an ankle sprain are rare. The purpose of this study was to report our case series of TP tendon tears following an ankle sprain. Methods: Patients with persistent TP tendon pain after an ankle sprain were retrospectively identified over a 4-year period and reviewed. A comparison of magnetic resonance imaging (MRI) interpretations by a radiologist and surgeon was made. Patients failing conservative management underwent operative repair of the TP tendon tear and concomitant pathology. Failure of the index surgery was defined as TP tendinosis, which was treated with excision and flexor digitorum longus tendon transfer. Outcomes were measured with the Foot Function Index (FFI) and American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scores. Results: Thirteen patients were found to have a TP tendon tear following an ankle sprain. The incidence for TP tears with sprains presented to our clinic was 1.04%. MRI identified TP tendon pathology in 4 patients by a radiologist review and in 11 patients by a surgeon review. The most common concomitant pathology was a talar osteochondral defect in 13 of 13 patients and ligament instability in 12 of 13 patients (5/13 lateral, 3/13 medial, 4/13 multidirectional instability). Four of 13 patients failed the index surgery. Of the 9 remaining patients, 4 had clinical follow-up at an average of 4.6 years postoperatively. The average FFI subscale scores were the following: pain, 40.4; disability, 28.9; and activity, 23.6. The average AOFAS hindfoot score was 68.8. Conclusion: Despite being rare, a TP tendon tear should be included in the differential diagnosis for persistent medial-sided pain following an ankle sprain. MRI findings can be subtle. Associated pathology was very common and likely confounded the diagnosis and outcomes. Patients should be counseled on the possibility of poor outcomes and long-term pain. Level of Evidence: Level IV, case series.

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THORACOLUMBAR EPIDURAL ARACHNOID CYST OF DIFFICULT CLINICAL MANAGEMENT: CASE REPORT

Coluna/Columna ◽

10.1590/s1808-185120181701177954 ◽

2018 ◽

Vol 17 (1) ◽

pp. 63-65

Author(s):

FRANCISCO ALVES DE ARAÚJO JÚNIOR ◽

DAFNE LUANA BAYER ◽

HUGO AKIO HASEGAWA ◽

TALITA RIBEIRO DA SILVA ◽

JOHNNI ZAMPONI JR. ◽

...

Keyword(s):

Arachnoid Cyst ◽

Lower Limb ◽

Case Series ◽

Clinical Treatment ◽

Lumbar Pain ◽

Level Of Evidence ◽

Capacity Level ◽

Lower Limb Pain ◽

Study Case ◽

Magnetic Resonance Imaging Mri

ABSTRACT Introduction: Among the primary lesions occupying the spinal space, only 1% corresponds to the epidural arachnoid cyst (EAC). This condition is usually asymptomatic, and identified accidentally in imaging tests. In symptomatic cases, total surgical resection is recommended. Objective: To describe a case of EAC refractory to clinical treatment. Methods: A 45-year-old woman had lumbar pain for six years and increased pain in the last months, with irradiation to the left lower limb (corresponding to L1). No other alterations found in the physical examination. Magnetic resonance imaging (MRI) of the spine revealed an intravertebral cystic lesion at T12-L1 level, in the left posterolateral position, causing enlargement of the foramen, and suggesting an epidural arachnoid cyst. Results: Due to failure of the initial clinical treatment, the patient underwent left T12-L1 hemilaminectomy, resection of the cyst and correction of dural failure. The patient progressed with effective pain control and MRI confirmed absence of residual lesion. Conclusion: EAC is more common in men (4:1) and may be congenital or acquired. The most common topography is thoracic (65%). Its clinical presentation is low back pain, lower limb pain and paresthesia. MRI is the method of choice for diagnosis and surgical intervention is restricted to cases that are symptomatic or refractory to clinical treatment, and the prognosis tends to be excellent. We conclude that, in addition to being a rare and commonly asymptomatic condition, an adequate therapeutic approach is essential for complete cure, avoiding intense pain and manifestations that bring about a drastic reduction of functional capacity. Level of evidence: IV. Type of study: Case series.

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High Prevalence of Superior Labral Anterior-Posterior Tears Associated With Acute Acromioclavicular Joint Separation of All Injury Grades

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120941850 ◽

2020 ◽

Vol 8 (8) ◽

pp. 232596712094185

Author(s):

Sarav S. Shah ◽

Eric Ferkel ◽

Kai Mithoefer

Keyword(s):

Acromioclavicular Joint ◽

Case Series ◽

Low Grade ◽

Level Of Evidence ◽

Glenohumeral Ligament ◽

Labral Tears ◽

High Prevalence ◽

Inferior Glenohumeral Ligament ◽

Grade Separation ◽

Anterior Posterior

Background: Despite the relatively high number of cases of acromioclavicular joint (AC) separation in the athletic population, optimal clinical outcomes are not achieved in every case. Limited data exist regarding the prevalence of intra-articular glenohumeral pathologies (IAPs) associated with acute AC separation of all injury grades. Purpose: To determine the prevalence of IAPs associated with AC separation, regardless of severity. Study Design: Case series; Level of evidence, 4. Methods: A total of 62 patients (mean age, 37.6 years) with acute AC separation were included in this study; 41 were nonoverhead recreational athletes. All patients underwent magnetic resonance arthrography (MRA) to evaluate for IAPs. Arthroscopic data from patients undergoing surgical treatment were correlated with MRA results. Results: Patients sustained acute AC separation of Rockwood grade 1 (16.1%), grade 2 (46.8%), grade 3 (25.8%), and grade 4 (11.3%). A concomitant IAP was present in 48 of 62 (77.4%) patients and included superior labral anterior-posterior tears (72.6%), anterior labral tears (24.2%), posterior labral tears (4.8%), supraspinatus tears (3.2%), and inferior glenohumeral ligament ruptures (1.6%). There were 18 (29.0%) patients who had a concomitant pathology in >1 intra-articular structure (combined IAPs). Additionally, 71.8% of patients with grade 1 and 2 AC separation had associated IAPs, and 23.1% had combined IAPs. Furthermore, in patients younger than 40 years, 64.0% of those with grade 1 to 3 AC separation demonstrated associated labral pathologies. There was no difference when comparing age or severity of AC separation and the prevalence of concomitant labral tears ( P = .36 and .22, respectively). Conclusion: There was a high prevalence of IAPs among patients undergoing MRA after AC separation. While an IAP has been described in association with high-grade AC separation previously, the high prevalence of IAPs in low-grade separation in our study was unexpected and suggests that a thorough evaluation and clinical follow-up for patients with all grades of AC separation may be beneficial.

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