Preoperative Diagnostic Rates and Clinical Outcomes After Arthroscopic Stabilization Procedures for Panlabral Tear of the Glenohumeral Joint

摘要

Purpose: To evaluate preoperative diagnostic rates for panlabral tear using imaging studies or physical examinations and to evaluate clinical outcomes after arthroscopic stabilization procedures with 2 different patient surgical positions. Methods: Patients who underwent arthroscopic stabilization for recurrent anterior shoulder instability with panlabral tear and were followed up for at least 2 years were included. A panlabral tear was defined as labral tear involving at least 270 degrees of the glenoid surface on arthroscopic examination. All patients underwent preoperative magnetic resonance (MR) imaging or MR arthrography and physical examinations including anterior apprehension, posterior jerk, and compressive rotation tests. The clinical outcomes were assessed by the American Shoulder and Elbow Surgeons, Rowe, and visual analog scale for pain scores, and recurrence rate. According to patient position during surgery, patients were divided into group I (beach chair position) and group II (lateral decubitus position). Results: Forty-eight patients (24 in group I and 24 in group II) were enrolled. Preoperative MR imaging or MR arthrography detected only 18.8% of panlabral tears. No patient had positive findings on all 3 physical examination tests for panlabral tear. Clinical outcomes were significantly improved after operation (American Shoulder and Elbow Surgeons score: 58.4 +/- 6.2 preoperatively, 85.2 +/- 6.4 at the final, P < .001; Rowe score: 49.0 +/- 12.2 preoperatively, 86.8 +/- 9.1 at the final, P < .001) and postoperative recurrence was occurred in 1patient (2%). No differences were found in clinical outcomes and recurrence rate (4% vs 0%) according to patient positioning, despite the larger number of suture anchors used in group II (6.2 +/- 1.5 in group I, 7.6 +/- 1.1 in group II, P < .001). Conclusions: It remained difficult to preoperatively diagnose panlabral tear using standard physical examinations and imaging studies. Nevertheless, arthroscopic stabilization procedures for patients with panlabral tear provided satisfactory clinical outcomes with a low recurrence rate. Patient position during surgery did not alter clinical outcomes and recurrence rate, despite the use of different numbers of suture anchors.