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Purpose The extent of shoulder instability and the indication for surgery may be determined by the prevalence or size of associated lesions. However, a varying prevalence is reported and the actual values are therefore unclear. In addition, it is unclear whether these lesions are present after the first dislocation and whether or not these lesions increase in size after recurrence. The aim of this systematic review was (1) to determine the prevalence of lesions associated with traumatic anterior shoulder dislocations, (2) to determine if the prevalence is higher following recurrent dislocations compared to first-time dislocations and (3) to determine if the prevalence is higher following complete dislocations compared to subluxations. Methods PubMed, EMBASE, Cochrane and Web of Science were searched. Studies examining shoulders after traumatic anterior dislocations during arthroscopy or with MRI/MRA or CT published after 1999 were included. A total of 22 studies (1920 shoulders) were included. Results The proportion of Hill–Sachs and Bankart lesions was higher in recurrent dislocations (85%; 66%) compared to first-time dislocations (71%; 59%) and this was statistically significant ( P  < 0.01; P  = 0.05). No significant difference between recurrent and first-time dislocations was observed for SLAP lesions, rotator-cuff tears, bony Bankart lesions, HAGL lesions and ALPSA lesions. The proportion of Hill–Sachs lesions was significantly higher in complete dislocations (82%) compared to subluxations (54%; P  < 0.01). Conclusion Higher proportions of Hill–Sachs and Bankart were observed in recurrent dislocations compared to first-time dislocations. No difference was observed for bony Bankart, HAGL, SLAP, rotator-cuff tear and ALPSA. Especially when a Hill–Sachs or Bankart is present after first-time dislocation, early surgical stabilization may need to be considered as other lesions may not be expected after recurrence and to limit lesion growth. However, results should be interpreted with caution due to substantial heterogeneity and large variance. Level of evidence IV.

Purpose of Review To analyze advances in labral reconstruction, and to discuss the literature relating to efficacy, outcomes, and technical considerations of labral reconstruction. Recent Findings The available evidence suggests that labral reconstruction is a safe and effective procedure that can improve pain and function in patients with severe and/or complex labral tears. The superiority of labral reconstruction over labral repair is uncertain, and it remains unclear what graft type and technique should be used in labral reconstructions. Summary Labral reconstruction assists in restoring the function of the labrum of the hip. It consistently restores stability of the hip joint and demonstrates good clinical outcomes at follow-up. The optimal graft type, technique, and extent are still debated, and more research is needed. Ultimately, despite this uncertainty, labral reconstruction is proving to be a valuable tool for hip preservation specialists.

Femoroacetabular impingement syndrome (FAIS) is a motion-related pathology of the hip characterized by pain, morphological abnormalities of the proximal femur, and an elevated risk of joint deterioration and hip osteoarthritis. Activities that require deep flexion are understood to induce impingement in cam FAIS patients, however, less demanding activities such as walking and pivoting may induce pain as well as alterations in kinematics and joint stability. Still, the paucity of quantitative descriptions of cam FAIS has hindered understanding underlying hip joint mechanics during such activities. Previous in silico studies have employed generalized model geometry or kinematics to simulate impingement between the femur and acetabulum, which may not accurately capture the interplay between morphology and motion. In this study, we utilized models with participant-specific bone and articular soft tissue anatomy and kinematics measured by dual-fluoroscopy to compare hip contact mechanics of cam FAIS patients to controls during four activities of daily living (internal/external pivoting and level/incline walking). Averaged across the gait cycle during incline walking, patients displayed increased strain in the anterior joint (labrum strain: p-value = 0.038, patients: 11.7 ± 6.7 %, controls: 5.0 ± 3.6 %; cartilage strain: p-value = 0.029, patients: 9.1 ± 3.3 %, controls: 4.2 ± 2.3). Patients also exhibited increased average anterior cartilage strains during external pivoting (p-value = 0.039; patients: 13.0 ± 9.2 %, controls: 3.9 ± 3.2 %]). No significant differences between patient and control contact area and strain were found for level walking and internal pivoting. Our study provides new insights into the biomechanics of cam FAIS, including spatiotemporal hip joint contact mechanics during activities of daily living.

ObjectivesIn this study, we aimed to compare conventional and T1-weighted volumetric magnetic resonance arthrography (MRA) in the diagnosis and grading of glenoid cartilage defects that accompany labral pathologies.Materials and methodsA total of 79 patients who were prediagnosed with labrum pathologies based on shoulder magnetic resonance imaging (MRI) had MRA and CTA between December 2021 and May 2022. CTA was regarded as reference standard. CTA images were examined by a radiologist experienced in musculoskeletal radiology, and MRA images were examined by two radiologists independently to determine presence, grade, and localization of any glenoid cartilage defect, if present. Sensitivity, specificity, and accuracy were calculated separately for conventional and T1-weighted volumetric MRA. In addition, at the last stage, two observers examined all MRAs together, and the presence of a cartilage defect was decided by consensus, and the overall sensitivity, specificity, and accuracy were calculated.ResultsCartilage defect was detected on CTAs of 48 (60.75%) cases of among 79 patients with labrum pathology. The sensitivity, specificity, and accuracy of conventional MRA for two examiners were 17–19%, 100–100%, and 49–51%, respectively, while those values were 67–65%, 92–97%, and 84–77%, respectively, for T1-weighted volumetric MRA. Inter-examiner agreement was excellent for diagnosis of cartilage defects on all MRAs. The overall sensitivity, specificity, and accuracy for detection of glenoid cartilage lesions by MRA were 69%, 97%, and 80%, respectively.ConclusionT1-weighted volumetric MRA seems to demonstrate cartilage defects accompanied with labrum pathologies accurately with high sensitivity, specificity, and excellent inter-examiner agreement.

Background: Labral eversion has recently been described as an anatomic variation in a nondysplastic patient with impingement-type hip pain and an otherwise intact labrum that is associated with microinstability. Purpose: To compare clinical outcomes after hip arthroscopy between patients with hip microinstability caused by everted labrums and those with femoroacetabular impingement (FAI). Study Design: Cohort study; Level of evidence, 3. Methods: This study included patients who underwent surgery at a tertiary hospital center between 2015 and 2022 after failure of nonoperative treatment for at least 6 months. Data—including demographic characteristics, body mass index, visual analog scale (VAS) scores, and preoperative and long-term follow-up Hip Outcome Score (HOS), lateral center-edge angle (LCEA), and upsloping lateral sourcil—were collected from the clinical records. The same surgical team treated all patients, followed the same rehabilitation protocol, and observed them for a minimum of 24 months. Clinical improvement was evaluated using HOS, VAS, and return to sports outcomes. Patients were organized into 2 groups. Group 1 included patients with an intraoperative diagnosis of everted labrum, whereas group 2 served as the control group, consisting of patients with classic FAI associated with labral tears. Statistical analysis was performed using the t test and 95% CI. Results: A total of 76 patients (n = 88 hips) who underwent hip arthroscopy during the study period were divided into 2 groups. We found a greater presence of upsloping lateral acetabular rim in group 1 (65% vs 11%; P = 4.77 × 10-7). Group 1 demonstrated a significantly greater LCEA compared with group 2 (37.1° vs 34.6°, respectively; P = .010). The HOS scores were 91.6 and 92.2 (P = .226) and 97.8 and 98.1 (P = .575) in groups 1 and 2, respectively, at 6 and 12 months postoperatively. Furthermore, postoperative VAS scores were not significantly different between the 2 groups (P = .574). Conclusion: Our study demonstrated that clinical and functional outcomes are not significantly different between patients operated on for an everted labrum with intra-articular anchor placement technique and those operated on for normal labral tears in FAI. These findings suggest that, when appropriately identified and treated with a technique focused on restoring the labral seal, the everted labrum does not negatively affect long-term postoperative results. Recognition and proper management of this anatomic variant are therefore essential in achieving successful surgical outcomes.

Background: The purpose of this prospective study is to compare and correlate the clinical results of arthroscopic repair of a combined anteroinferior and superior labral lesion with those of an isolated anteroinferior labral lesion or type II superior labral tear from anterior to posterior (SLAP) lesion. Methods: A comparative study involving patients who underwent arthroscopic labral repairs in a tertiary hospital between 2010 and 2014 was conducted. A total of 96 patients were divided into three groups: Group A consisted of 61 patients with the anteroinferior labral lesion, group B consisted of 16 patients with the type II SLAP lesion, and group C consisted of 19 patients with the combined anteroinferior and superior labral lesion. Patient demographics, preoperative and postoperative pain scores, shoulder functional scores (Constant Shoulder Score, UCLA (University of California at Los Angeles) Shoulder Score, and Oxford Instability Score), and shoulder ranges of motion were measured and compared. Results: Except that patients from group B were generally older (28.8 vs. 22.2 for group A and 22.0 for group C, p = 0.04) at the time of surgery, no significant differences exist among the three groups in patient demographics and relevant clinical data. Preoperative and 2-year postoperative clinical outcomes, as well as the improvements, were comparable among the three groups. Low failure rates were observed for all three groups (6% vs. 10% vs. 11%, p = 0.999). Conclusions: Patients with the type II SLAP lesion underwent surgery at an older age. With appropriate surgical procedures, equivalent postoperative results can be expected for combined anteroinferior and superior labral lesion repair compared to isolated labral lesion repair.

Purpose Inferior glenoid labral tears are an uncommon but distinct shoulder injury. Only a small number of studies have reported outcomes following arthroscopic repair. The aim of the current study was to report minimum 2-year outcomes following inferior labral repair and to compare outcomes and risk factors associated with the injury to non-inferior labral tears. Whether preoperative MRI or MRA identified inferior labral tears was also assessed. Methods A prospective study of 162 consecutive patients undergoing arthroscopic glenoid labral repair, excluding isolated superior labral tears, was conducted. Of the 130 patients available for follow-up, 18 (13.7%) had an inferior labral tear (“Down Under lesion”), the remainder had anterior, posterior or mixed anterior/posterior lesions that did not include the inferior pole. Mean follow-up time for the Down Under group was 44 months (SD 10, range 27–57), and 30 months (SD 14, range 4–60) for the non-Down Under group. Postoperative outcomes included the Oxford Shoulder Instability Score and recurrent instability. Associations between Down Under lesions and injury mechanism, instability at presentation, recurrent instability and family history were assessed with multivariable logistic regression. Preoperative MRI or MRA reports by radiologists were examined to determine if Down Under lesions were identified. Results Oxford Shoulder Instability Scores indicated that most patients in both groups had little pain or shoulder problems postoperatively (average Oxford Score 41; 48 = no symptoms). Oxford Scores were not significantly different between the Down Under and non-Down Under groups. Four patients (22.2%) in the Down Under group had recurring symptoms (pain and instability) compared to 12 (10.6%) in the non-Down Under group; this difference was not statistically significant (adjusted OR 1.09, 95% CI 0.19,4.77). Family history of shoulder instability was positively associated with a Down Under lesion (adjusted OR 5.0, 95%CI 1.51,16.7). MRI or MRA identified 52.9% of Down Under lesions. Conclusion Down Under lesions were an infrequent type of glenoid labral injury, yet postoperative outcomes were similar to other labral tears. Patients with Down Under lesions had a significant risk factor due to family history of shoulder instability. MRI and MRA could not reliably identify Down Under lesions. Level of evidence Level III.

Purpose This study aimed to evaluate the outcomes of arthroscopic type 2 superior labrum anterior–posterior (SLAP) lesion repair in the general population and compare clinical outcomes according to patient age and repair site. Methods Between 2005 and 2018, patients who underwent arthroscopic repair for isolated type 2 SLAP lesions were retrospectively reviewed. Baseline characteristics, pre- and postoperative [1-year and > 2-year (final)] shoulder range-of-motion, and functional scores, comprising the pain visual analogue scale (PVAS), functional VAS, and American Shoulder and Elbow Surgeons (ASES) score, were evaluated. Return to overhead activities and subjective satisfaction were assessed at the final follow-up, and patients were divided by age [group YB (< 40 years] and group OB (≥ 40 years)] and repair site [group P (only posterior labrum repair) and group AP (anterior and posterior labrum repair)]. Overall patient outcomes were analysed and compared between groups. Results This study included 54 patients (45 men) with a mean age of 37.1 ± 8.3 years. The mean follow-up was 90.8 ± 51.3 months. Two patients experienced early failure, and one patient had a ruptured biceps tendon during the follow-up period. Final functional scores improved compared to their preoperative scores in all patients, except three (all p  < 0.001). Fifty patients (98.0%) were satisfied, and 39 patients (76.5%) were able to perform overhead sports without restriction. In 25 patients who attended more than 7 years of follow-up (mean, 11.3 ± 2.7 years), 21 patients (84%) had an ASES score ≥ 80, and all patients had PVAS ≤ 2. There was no significant difference in clinical outcomes between groups YB and OB. The final median external rotation was significantly more restricted in group AP than in group P (40 [25–65] vs. 60 [50–70], p  = 0.002). Conclusion Arthroscopic type 2 SLAP repair induced good short- and long-term clinical outcomes, return to overhead activities, and subjective satisfaction in the general population, regardless of age, due to the careful evaluation of patient history, physical examination, and imaging studies. However, performing only posterior repair seems sufficient since anterior labral SLAP lesion repair can limit ER. Isolated type 2 SLAP lesion posterior repair only is, thus, recommended to reduce external rotation deficit risk and increase satisfaction, regardless of patient age. Study design Case series. Level of evidence Level IV.

Background: Anterior labrum periosteal sleeve avulsion (ALPSA) lesion of the shoulder is defined as a labral avulsion with an intact periosteum of the glenoid neck resulting in medial malattachment of the labrum, which is both nonanatomic and nonfunctional. It is relatively rare compared with Bankart lesions, and its results are usually reported in combination with other anterior labroligamentous lesions in the literature. Purpose: To (1) assess the size and scope of the literature on ALPSA lesions, (2) highlight the importance of this lesion, and (3) distinguish between ALPSA and Bankart lesions in diagnostic and treatment strategies. Study Design: Scoping review; Level of evidence, 4. Methods: The PubMed, Scopus, Embase, and Google Scholar databases were searched with the keywords “ALPSA,”“anterior labrum periosteal sleeve avulsion,”“anterior labral periosteal sleeve avulsion,” and “anterior labroligamentous periosteal sleeve avulsion” lesion. Duplicate articles and those that did not meet the inclusion criteria were excluded, resulting in the identification of 42 relevant articles. Their references were analyzed for further data curation. Results: This scoping review demonstrated that ALPSA lesions are difficult to clinically identify. Magnetic resonance angiography in the adduction internal rotation position is the most sensitive and specific imaging modality for identification. Optimal views are the anterosuperior portal for accurate identification and the anteroinferior portal for surgical repair during arthroscopy. Treatment begins with correctly identifying the labrum, in contradistinction to dense reactive fibrous tissue, and reattaching the labrum to the correct anatomic glenoid footprint. Chronic lesions with bone loss require either bone block or soft tissue augmentation procedures. Conclusion: There is paucity of exclusive literature on ALPSA lesions. It is important to distinguish this lesion from the Bankart lesion as it is associated with worse outcomes. The higher failure rates of ALPSA lesion repair indicate that the current repair techniques require further refinement to improve the outcomes to the standard of Bankart lesions.

Purpose The purpose of this study was to evaluate the accuracy of magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) in diagnosing superior labral anterior–posterior (SLAP) lesions. We hypothesized that the accuracy of MRI and MRA was lower than previously reported. Methods Between 2006 and 2008, 444 patients who had both shoulder arthroscopy and an MRI (non-contrast or MR arthrography) for shoulder pain at our institution prior to surgery were identified and included in the study. The radiologic diagnosis and surgical evaluation were compared to determine the accuracy of diagnosing a SLAP lesion by MRI. Using arthroscopy as the standard, sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated for all MRIs, as well as separately for the non-intra-articular contrast MRI group and the MR arthrography group. Results Of the 444 patients having an MRI and arthroscopy for shoulder pain, 121 had a SLAP diagnosis by MRI and 44 had a SLAP diagnosis by arthroscopy. Overall, MRI had an accuracy of 76 %, a PPV of 24 %, and a NPV of 95 %. Sensitivity was 66 %, and specificity was 77 %. MR arthrography had an accuracy of 69 %, sensitivity of 80 %, and a PPV of 29 %. Non-contrast MRI had an accuracy of 85 %, sensitivity of 36 %, and a PPV of 13 %. Conclusions In our retrospective study of 444 patients, sensitivity, specificity, and accuracy were all lower than previously reported in the literature for diagnosing SLAP lesions. Our data indicated that while MRI could exclude a SLAP lesion (NPV = 95 %), MRI alone was not an accurate clinical tool. MR arthrography had a large number of false-positive readings in this study. We concluded that even with intra-articular contrast, MRI had limitations in the ability to diagnose surgically proven SLAP lesions. Level of evidence Diagnostic study, Level II.