The effect of isolated labrum resection on shoulder stability.
The present study was initiated to determine whether glenohumeral instability and dislocation can result from isolated lesions of the glenoid labrum in an arthroscopic cadaver model. Adjacent combinations of four zones of the labrum (superior, anterosuperior, anteroinferior and inferior) were sequentially removed with a motorised shaver, taking great care to leave the capsule intact in 24 cadaver shoulders. Stability was tested before and after inserting the scope and after each resection step. Inferior stability was examined by performing an inferior drawer test. Anterior stability was evaluated with an anteroposterior drawer test in 0 degrees of abduction and with a load-and-shift test in external rotation and 90 degrees abduction. Labral resection of all four zones maximally resulted in a grade 1 inferior instability (<10 mm inferior translation). When two adjacent labral zones were resected, a grade 2 anterior drawer (>10 mm anterior but no medial translation) was seen in 17% of the specimens. This was seen in one more specimen after the addition of a third zone. There were no differences in the stability of the load-and-shift test after any amount of labral resection. Total labral debridement increased inferior and anterior translation, but did not allow the humeral head to dislocate. The degree of stability in the cocked-arm position, which is the most prone to dislocation, is not altered. In patients, isolated labral tears, that is, without evidence of capsuloligamentous damage, can probably be safely debrided without risking glenohumeral instability to the point of dislocation. Nevertheless, anterior translation may significantly increase when two or more zones are resected.
Pouliart
Nicole
N
Department of Orthopaedics and Traumatology, Academic Hospital Vrije Universiteit Brussel, Belgium. izvptn@az.vub.ac.be
Gagey
Olivier
O
D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy; D002102:Cadaver; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology*; D012783:Shoulder Dislocation / Q000503:physiopathology*; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D013314:Stress, Mechanical