Minimum 10-Year Clinical Outcomes After Arthroscopic 270° Labral Repair in Traumatic Shoulder Instability Involving Anterior, Inferior, and Posterior Labral Injury

Background: Current literature reports highly satisfactory short- and midterm clinical outcomes in patients with arthroscopic 270° labral tear repairs. However, data remain limited on long-term clinical outcomes and complication and redislocation rates in patients with traumatic shoulder instability involving anterior, inferior, and posterior labral injury. Purpose: To investigate, at a minimum follow-up of 10 years, the clinical outcomes, complications, and recurrent instability in patients with 270° labral tears involving the anterior, inferior, and posterior labrum treated with arthroscopic stabilization using suture anchors. Study Design: Case series; Level of evidence, 4. Methods: A retrospective outcomes study was completed for all patients with a minimum 10-year follow-up who underwent arthroscopic 270° labral tear repairs with suture anchors by a single surgeon. Outcome measures included pre- and postoperative Rowe score, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test, visual analog scale for pain, and Single Assessment Numeric Evaluation (SANE). Western Ontario Shoulder Instability Index (WOSI) scores were collected postoperatively. Complication data were collected, including continued instability, subluxation or dislocation events, and revision surgery. Failure was defined as any cause of revision surgery. Results: In total, 21 patients (mean ± SD age, 27.1 ± 9.6 years) with 270° labral repairs were contacted at a minimum 10-year follow-up. All outcome measures showed statistically significant improvements as compared with those preoperatively: Rowe (53.9 ± 11.4 to 88.7 ± 8.9; P = .005), ASES (72.9 ± 18.4 to 91.8 ± 10.8; P = .004), Simple Shoulder Test (8.7 ± 2.4 to 11.2 ± 1.0; P = .013), visual analog scale (2.5 ± 2.6 to 0.5 ± 1.1; P = .037), and SANE (24.0 ± 15.2 to 91.5 ± 8.3; P = .043). The mean postoperative WOSI score at minimum follow-up was 256.3 ± 220.6. Three patients had postoperative complications, including a traumatic subluxation, continued instability, and a traumatic dislocation, 2 of which required revision surgery (14.2% failure rate). Conclusion: Arthroscopic repairs of 270° labral tears involving the anterior, inferior, and posterior labrum have highly satisfactory clinical outcomes at 10 years, with complication and redislocation rates similar to those reported at 2 years. This suggests that repairs of extensile labral tears are effective in restoring and maintaining mechanical stability of the glenohumeral joint in the long term.

Hypermobile Disorders and Their Effects on the Hip Joint

Hypermobility, or joint hyperlaxity, can result from inherited connective tissue disorders or from micro- or macrotrauma to a joint. The supraphysiologic motion of the hip joint results in capsuloligamentous damage, and these patients have a propensity to develop femoroacetabular impingement syndrome (FAIS) and labral injury. In this review, the recent literature evaluating the definitions, history, incidence, genetics, and histology of hypermobile disorders is investigated. We then review the clinical evaluation, natural history, and resulting instability for patients presenting with a hypermobile hip. Lastly, treatment options and outcomes will be highlighted.

A rare case of osteoblastoma in the femoral head combined with cam-type femoroacetabular impingement: A case report

Osteoblastoma is a relatively rare benign bone-forming tumor accounting for less than 1% of all bone tumors. This report describes a patient with an osteoblastoma in the femoral head complicated by coexistence of femoroacetabular impingement. A 25-year-old male rugby football player complained of severe right hip pain after an injury during rugby practice. The pain became progressively worse despite resting from sports activity and rehabilitation for 4 months. The image inspection revealed bone tumor complicated by cam-type femoroacetabular impingement and a labral injury. Hip arthroscopic surgery was planned using a navigation system and a three-dimensional model for both complete debridement and cam resection. The tumor was resected by open surgery using a posterior approach. The bone tumor was diagnosed histopathologically as an osteoblastoma. The patient’s symptoms improved markedly after surgery, with no evidence of local tumor recurrence or hip arthritis 1 year later.

Imaging of the Shoulder Bankart Lesion and its Variants

The glenoid labrum is an important soft tissue structure that provides stability to the shoulder joint. When the labrum is injured, affected patients may present with chronic shoulder instability and future recurrent dislocation. The Bankart lesion is the most common labral injury, and is often accompanied by a Hill-Sachs lesion of the humerus. Various imaging techniques are available for detection of the Bankart lesion and its variants, such as anterior labroligamentous periosteal sleeve avulsion and Perthes lesion. Direct magnetic resonance (MR) arthrography is currently the imaging modality of choice for evaluation of the various types of labral tears. As normal anatomical variants of glenoid labrum are not uncommonly encountered, familiarity with appearances of this potential pitfall helps avoid misdiagnosis.

Hip Arthrography

Chapter 101 describes the indications, technique, and imaging findings of hip arthrography. Hip arthrography is selectively performed in routine clinical practice for MRA, typically in younger patients. Indications include hip pain thought to be caused by acetabular labral injury, femoroacetabular impingement syndromes, as well as therapeutic steroid injections. Contrast should easily inject and disperse throughout the joint away from the needle, opacifying the femoral head and neck recesses and outlining the zona orbicularis. The technique can also be used for arthrocentesis with suspected infection, but contrast should not be injected. Contrast extension into the acetabular labral substance may be occasionally depicted on the standard arthrography images. However, it is nowadays evaluated by MRA or sometimes CTA. Complications include infection, bleeding (especially if arterial puncture), and femoral nerve injury.

Concurrent Primary Repair of a Glenoid Labrum Articular Disruption and a Bankart Lesion in an Adolescent: A Case Report of a Novel Technique

Glenoid labrum articular disruption (GLAD) lesions are an uncommon concomitant injury associated with labral tears, occurring in 1.5-2.9% of cases. In previous reported cases, the articular lesion is debrided during repair of the labral injury, which may predispose patients to osteoarthritis, a longitudinal complication seen in articular debridement of the hip. We report the case of a 15-year-old healthy adolescent male swimmer who sustained a labral injury with a concomitant GLAD lesion. During operative management, three Polyetheretherketone (PEEK) SutureTaks were placed on the glenoid. #2 FiberWire was used to imbricate capsular tissue, passed beneath the labrum, and was then subsequently advanced through the fibrous rim of the displaced cartilage flap/GLAD lesion at the site of each suture anchor. This construct restored tension to the anterior band of the inferior glenohumeral ligament, recreated the anteroinferior labral bumper, and effectively reduced the cartilage flap/GLAD lesion to the anterior inferior glenoid. By six months postoperatively, the patient demonstrated near-normal function with full range of motion and evidence of a stable construct on MRI. Unlike previously described cases, this is the first report of a hybrid technique that simultaneously performed a primary repair of both labral and articular injuries without the use of additional implants for the articular lesion. Primary repair of the labral and articular lesions should provide longitudinal benefit to the patient by reducing the risk of developing glenohumeral osteoarthritis.

Patient-Reported Outcomes Within the First Year After Hip Arthroscopy and Rehabilitation for Femoroacetabular Impingement and/or Labral Injury: The Difference Between Getting Better and Getting Back to Normal

Background: The Copenhagen Hip and Groin Outcome Score (HAGOS) was recently found valid, reliable, and responsive for patients undergoing hip arthroscopy. However, it is currently unknown to what degree patients undergoing hip arthroscopy improve and/or normalize their HAGOS result within the first year after surgery. Purpose: First, to use HAGOS to evaluate clinical outcomes at 3, 6, and 12 months after hip arthroscopy for femoroacetabular impingement (FAI) and/or labral injury and compare the HAGOS results with the modified Harris Hip Score (mHHS). Second, to explore how many patients would (a) improve to a degree of minimal clinical importance (MIC) and (b) obtain scores within the reference intervals of healthy controls. Study Design: Cohort study; Level of evidence, 2. Methods: From September 2011 to March 2014, 97 consecutive patients [56 females (mean age, 38 years; range, 17-60 years) and 41 males (mean age, 37 years; range, 19-59 years)] underwent first-time hip arthroscopy for FAI and/or labral injury. Standardized postoperative rehabilitation instructions were provided. HAGOS (0-100 points) and mHHS (0-100 points) values were obtained preoperatively and again postoperatively at 3, 6, and 12 months. Furthermore, 158 healthy controls, matched on age and sex, were included to obtain HAGOS and mHHS reference values for comparison. Minimal important change was determined by using the 0.5 SD of the baseline values for HAGOS and mHHS. Results: Improvements for all HAGOS subscales and mHHS results were seen at 3 months ( P < .001). Further improvements were seen only for HAGOS Sport and Recreation (Sport/Rec) and Participation in Physical Activities (PA) subscales between 3 and 12 months ( P < .05) but not for HAGOS Pain, Symptoms, Activities of Daily Living (ADL), or Hip-Related Quality of Life (QOL) subscales or the mHHS. Furthermore, on HAGOS Sport/Rec, PA, and QOL subscales, patients reached scores of only 54 to 70 points 1 year after surgery. At the individual level, up to 70% of the patients experienced minimal important improvements during the first year after surgery, but only up to 38% and 36% of patients reached a score within the reference interval of HAGOS and mHHS, respectively. Conclusion: Statistically and clinically relevant improvements in HAGOS and mHHS results after hip arthroscopy and rehabilitation can be seen at 3 months and up to 1 year. However, specific HAGOS subscales suggest that a patient’s ability to function and participate in sport and physical activity is still markedly reduced 1 year after surgery. Furthermore, the majority of patients undergoing hip arthroscopy cannot expect to reach the level of the healthy population on self-reported pain and function within the first year after surgery.