Circumferential Labral Tears: Instability History and Outcomes of Arthroscopic Repair.

Abstract

Background: Circumferential labral tears are characterized by complete detachment of the labrum from the glenoid rim, and studies have reported significant improvements in patient-reported outcome measures (PROMs) after arthroscopic repair. However, patients' perspectives on the meaningfulness of these outcomes remain unknown, and debate continues regarding whether circumferential tears can occur after a single instability event.

Purpose: To investigate the number of preoperative instability events in patients with circumferential tears and evaluate their clinical outcomes after arthroscopic repair according to the minimal clinically important difference (MCID), Substantial Clinical Benefit (SCB), and Patient Acceptable Symptom State (PASS) parameters.

Study design: Case series; Level of evidence, 4.

Methods: This study was retrospective review of a consecutive series of patients who underwent shoulder arthroscopy for instability between February 2015 and July 2023. Patients with primary circumferential tears repaired using arthroscopic suture anchors, glenoid bone defects <13.5%, and a minimum 24-month follow-up were included. Analysis was conducted of patient demographics, clinical characteristics, and PROMs, including American Shoulder and Elbow Surgeons (ASES), Western Ontario Shoulder Instability Index (WOSI), and visual analog scale (VAS) scores. Patients who achieved the MCID, SCB, and PASS thresholds for these scores were determined.

Results: Circumferential tears were identified in 3.6% (n = 41) of 1147 patients undergoing arthroscopic procedures for shoulder instability. Of these, 31 patients (mean age, 29.5 ± 9.3 years; 90% male; mean instability events, 5.5 ± 6.9; mean follow-up, 60.4 ± 30.1 months) meeting the inclusion criteria were analyzed. Overall, 39% (n = 12) had a single instability event, with 6 participating in contact sports and 4 in overhead or throwing sports, 9 of them at a competitive level. The proportions of patients who achieved MCID, PASS, and SCB thresholds were as follows: ASES (100, 80.6, and 80.6, respectively), WOSI total (100, 90.3, and 80.6, respectively), and VAS (90.3, 87.1, and 80.6, respectively).

Conclusion: Circumferential labral tears are rare. One-third of them may occur even after a single instability event and, therefore, should be considered during clinical evaluation, regardless of the number of prior instability events. Reassuringly, most patients who underwent arthroscopic repair of circumferential tears using suture anchors achieved successful clinically meaningful outcomes at a mean follow-up of approximately 5 years.