Macroscopic footprint of the glenoid labrum

Objectives: Glenoid labrum lesions are one of the main causes of traumatic shoulder dislocations. Arthroscopic or open repair using suture anchors is commonly used to treat labral lesions. Proper placement of suture anchors in order to replace the normal ligamentous restraint is essential to restore normal anatomy that determines the final location of the repaired labrum. Yet, the most efficient and safest location of the glenoid bone has not been precisely described. Therefore, this study aimed to describe the macroscopic footprint of the glenoid labrum in order to depict the ideal anchor placement location precisely. Methods: Twenty-two shoulders from 11 cadavers were dissected to reveal glenoid labrum. Clock positions were determined on glenoid labrum circumferentially to evaluate the footprint of the glenoid labrum. The distance between the bony edge of the glenoid rim and the edge of the labrum was measured. Results: The mean distance from the glenoid labrum to the bony glenoid rim was measured as 5.1 mm (3 o’clock position), 6.2 mm (6 o’clock position), 5.1 mm (9 o’clock position) and 4.1 mm (12 o’clock position) in the anterior, inferior, posterior and superior aspects, respectively. 29.3% of the specimens had a completely defective anterior labrum. Conclusion: Location of the labrum with respect to the bony glenoid rim should be considered for proper suture placements in treatment of labral tears. It is suggested that the most important step in the stabilization of joint laxity is appropriate placement of the sutures in the anterior and inferior aspects of the glenoid labrum.

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  • Referans1 Cooper, D.E., et al., Anatomy, histology, and vascularity of the glenoid labrum. An anatomical study. J Bone Joint Surg Am, 1992. 74(1): p. 46-52.
  • Referans2 Barthel, T., et al., [Anatomy of the glenoid labrum]. Orthopade, 2003. 32(7): p. 578-85.
  • Referans3 Tischer, T. and R. Putz, [Anatomy of the superior labrum complex of the shoulder]. Orthopade, 2003. 32(7): p. 572-7.
  • Referans4 Alashkham, A., et al., Histology, vascularity and innervation of the glenoid labrum. J Orthop Surg (Hong Kong), 2018. 26(2): p. 2309499018770900.
  • Referans5 Sailer, J. and H. Imhof, [Shoulder instability]. Radiologe, 2004. 44(6): p. 578-90.
  • Referans6 Antonio, G.E., et al., First-time shoulder dislocation: High prevalence of labral injury and age-related differences revealed by MR arthrography. J Magn Reson Imaging, 2007. 26(4): p. 983-91.
  • Referans7 Valis, P. and M. Nydrle, [Arthroscopic stabilization of the shoulder using anchors]. Acta Chir Orthop Traumatol Cech, 2003. 70(4): p. 233-6.
  • Referans8 Zarzycki, W., [Arthroscopic Bankart repair]. Chir Narzadow Ruchu Ortop Pol, 2006. 71(4): p. 309-11.
  • Referans9 Lehtinen, J.T., et al., Anatomy of the superior glenoid rim. Repair of superior labral anterior to posterior tears. Am J Sports Med, 2003. 31(2): p. 257-60.
  • Referans10 Rowe, C.R., B. Zarins, and J.V. Ciullo, Recurrent anterior dislocation of the shoulder after surgical repair. Apparent causes of failure and treatment. J Bone Joint Surg Am, 1984. 66(2): p. 159-68.
  • Referans11 Zhu, W., et al., Arthroscopic findings in the recurrent anterior instability of the shoulder. Eur J Orthop Surg Traumatol, 2014. 24(5): p. 699-705.
  • Referans12 Lehtinen, J.T., et al., Variations in glenoid rim anatomy: implications regarding anchor insertion. Arthroscopy, 2004. 20(2): p. 175-8.
  • Referans13 Wiedemann, E., A. Jager, and W. Nebelung, [Pathomorphology of shoulder instability]. Orthopade, 2009. 38(1): p. 16-20, 22-3.
  • Referans14 Slabaugh, M.A., et al., Restoring the labral height for treatment of Bankart lesions: a comparison of suture anchor constructs. Arthroscopy, 2010. 26(5): p. 587-91.
  • Referans15 Koulalis, D., et al., Freehand versus navigated glenoid anchor positioning in anterior labral repair. Knee Surg Sports Traumatol Arthrosc, 2011. 19(9): p. 1554-7.
  • Referans16 Gartsman, G.M., T.S. Roddey, and S.M. Hammerman, Arthroscopic treatment of anterior-inferior glenohumeral instability. Two to five-year follow-up. J Bone Joint Surg Am, 2000. 82-A(7): p. 991-1003.
  • Referans17 Mazzocca, A.D., et al., Arthroscopic anterior shoulder stabilization of collision and contact athletes. Am J Sports Med, 2005. 33(1): p. 52-60.
  • Referans18 Yamamoto, N., et al., Does the "bumper" created during Bankart repair contribute to shoulder stability? J Shoulder Elbow Surg, 2013. 22(6): p. 828-34.
  • Referans19 Thal, R., A Knotless Suture Anchor: Technique for use in arthroscopic Bankart repair. Arthroscopy, 2001. 17(2): p. 213-8.
  • Referans20 Wolf, E.M., Arthroscopic capsulolabral repair using suture anchors. Orthop Clin North Am, 1993. 24(1): p. 59-69.
  • Referans21 McNickle, A.G., et al., Postsurgical glenohumeral arthritis in young adults. Am J Sports Med, 2009. 37(9): p. 1784-91.
  • Referans22 Dines, J.S. and N.S. Elattrache, Horizontal mattress with a knotless anchor to better recreate the normal superior labrum anatomy. Arthroscopy, 2008. 24(12): p. 1422-5.
  • Referans23 Kaar, T.K., et al., Complications of metallic suture anchors in shoulder surgery: A report of 8 cases. Arthroscopy, 2001. 17(1): p. 31-7.
  • Referans24 Athwal, G.S., S.M. Shridharani, and S.W. O'Driscoll, Osteolysis and arthropathy of the shoulder after use of bioabsorbable knotless suture anchors. A report of four cases. J Bone Joint Surg Am, 2006. 88(8): p. 1840-5.
  • Referans25 Ekelund, A., et al., Neuropeptides in heterotopic bone induced by bone matrix in immunosuppressed rats. Clin Orthop Relat Res, 1997(345): p. 229-38.