Preoperative factors associated with 180-, 270- and 360-degree labral tears.

BACKGROUND: Large, circumferential glenoid labral tears are an uncommon injury affecting young, athletic patients. There is limited data describing the clinical presentation of patients with larger tears, especially 270- and 360-degree labral tears. Additionally, exam and imaging findings have poor reliability in diagnosing these tears. The purpose of this study is to determine the clinical presentation among patients presenting with small (less than 180 degrees), medium (180-270 degrees), and large (270-360 degrees) labral tears.

METHODS: This is a retrospective comparative study of consecutive patients surgically managed by a single shoulder surgeon for all glenoid labral tears from 2018-2022. The primary outcome was demographic and preoperative clinical risk factors. Demographic data including age, sex, hand dominance, BMI, as well as clinical presentation (subluxation vs dislocation, instability history, and participation in contact sports) were recorded.

RESULTS: A total of 188 patients met inclusion criteria: 101/188 (53.70%) patients with small tears, 43/188 (22.90%) patients with medium tears, and 44/188 (23.40%) patients with large tears. Individuals with large and medium-sized labral tears were more likely to have participated in contact sports compared to those with smaller labral tears (p=0.003). Medium and smaller tears were more likely to present as dominant side injury (p=0.02). Furthermore, medium and large tears were more likely to present with anterior instability symptoms compared to smaller tears, which more frequently presented with posterior instability and pain (p=0.003).

CONCLUSION: Males participating in contact sports were the most common demographic population presenting with large, 270 to 360-degree labral tears. Instability was the primary complaint rather than pain, and compared to small tears, medium and large sized tears were more likely to present with primary anterior instability. While arthroscopic repair of 270 to 360-degree labral tears can yield excellent clinical outcomes similar to smaller tears, identifying factors associated with larger glenoid labral tears may help in surgical planning and patient counseling.