Labrum and Cartilage Injuries

Dr. Vasavada illustrates associated injuries in patients with traumatic anterior shoulder instability (shoulder dislocation) or TUBS as seen on Orthobullets. 

Soft tissue bankart:

• avulsion of the anterior labrum and anterior band of the IGHL from the anterior inferior glenoid
• present in 80-90% of patients with TUBS

Bony bankart:

• is a fracture of the anterior inferior glenoid
• present in up to 49% of patients with recurrent dislocations
• higher risk of failure of arthroscopic treatment if not addressed
• defect >20-25% is considered “critical bone loss” and is biomechanically highly unstable; although recent studies suggest critical bone loss may be as low as 13.5%. These require bony procedure to restore bone loss (Latarjet-Bristow, other sources of autograft or allograft)
• each dislocation event causes, on average, 6.8% bone loss
• glenoid takes on an inverted-pear appearance as bone loss increases
• 89% failure rate following arthroscopic repair in patients with this glenoid morphology

ALPSA (anterior labral periosteal sleeve avulsion)

• can cause torn labrum to heal medially along the medial glenoid neck
• associated with higher failure rates following arthroscopic repair 
• common finding in patients with recurrent instability managed nonoperatively
• 97% of patients with recurrent instability have either a Bankart or ALPSA lesion

GLAD (glenoid labral articular cartilage defect)

• sheared off portion of articular cartilage along with the labrum
• presence is a risk factor for failure following arthroscopic stabilization procedures