Summary

The results of circumferential labral repair in the shoulder are comparable to isolated anterior labral repair.

Abstract

Background

Currently, the clinical outcomes of arthroscopic circumferential labral repair for patients with instability and combined anterior, posterior and superior labral tears are not well known. In addition, little has been reported with regard to how these outcomes compare to a matched group of patients with isolated primary arthroscopic anterior labral repairs.

Hypothesis

Patients treated with arthroscopic circumferential shoulder labral repairs will have inferior clinical outcomes and higher failure rates compared to patients who have isolated arthroscopic anterior labral repairs.

Study Design: Case series

Patients/ Methods: A retrospective cohort study was performed to identify patients 18 years and older who underwent circumferential arthroscopic stabilization for recurrent instability as compared to an age-matched control group of arthroscopic primary labral repairs. Data was collected by validated patient reported questionnaires and chart reviews. Age at surgery, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Simple Shoulder Test (SST) score, SF-12 score (mental and physical), and overall patient satisfaction with the surgery were assessed for each group. Recurrent dislocations and complications requiring further treatment were recorded.

Results

36 consecutive patients who underwent an arthroscopic 360 degree circumferential labral repair were compared to a matched group of 31 patients who underwent an isolated arthroscopic anterior labral repair. No significant difference was found between the results of the arthroscopic circumferential labral repair group and the anterior Bankart repair group in overall satisfaction with the surgery. There was no difference between the two groups in recurrent dislocations (one patient from each group had a recurrent dislocation event). The ASES score was 87.3 in the combined labral repair group and 93.9 in the isolated anterior (P= 0.35), SST score was 10.7 in the combined group and 11.3 in the isolated group (P= 0.70), SF-12 mental score was 54.6 for the combined repairs and 56.8 in anterior alone (P= 0.80), SF-12 physical score was 53.2 in the combined group and 54.2 in anterior alone (P= 0.98), and age at time of surgery was 26.7 in the combined group and 24.6 in the anterior group (P=0.33). In the anterior Bankart group the preoperative mean range of motion was 167 degrees in FF and 67 degrees in ER compared to post-operative ROM which was 168 degrees FF and 60 degrees ER. In the circumferential group there was a mean ROM of 160 degrees in FF and 61 degrees ER compared to a post-operative ROM of 157 degrees in FF and 55 degrees ER.

Conclusion

There was no difference in shoulder stability and function in patients after 360 degree combined labral repairs versus anterior labral repair alone. With proper patient selection, patients treated with an arthroscopic circumferential labral repair for multidirectional instability and pain can expect outcomes similar to an isolated anterior Bankart repair despite the more extensive surgical procedure and complex postoperative rehabilitation protocol.