- Email: [email protected]
Editorial Commentary: Are Shoulder Glenoid Labral Teardrop Lesions Reasons for Surgeons to Cry?
Editorial Commentary: Are Shoulder Glenoid Labral Teardrop Lesions Reasons for Surgeons to Cry? David Altchek, M.D.
Abstract: In the world of glenoid labral chondral injuries, perhaps the most recognizable by magnetic resonance imaging is the “teardrop” version, and the glenoid labral teardrop lesion is the glenoid chondral lesion most frequently associated with shoulder instability.
See related article on page 407
T
he glenoid labral articular teardrop lesion is a chondrolabral injury with distinct magnetic resonance imaging (MRI) findings as shown in the study “The Glenoid Labral Articular Teardrop (GLAT) Lesion: A Chondrolabral Injury with Distinct MRI Findings”1 by Lederman, Flores, Stevens, Richardson, and Lund. The authors describe a distinctly recognizable subset of anterior inferior capsulolabral pathology in the spectrum of shoulder instability. Traumatic chondral injuries occurring on the glenoid surface in athletes are an important and concerning injury. The authors have subcategorized one type of these lesions, the “GLAT” or teardrop variety, which always occurs in a characteristic location, the anterior far-inferior glenoid. The most striking aspect of this lesion is its appearance on coronal MRI images as an inferiorly directed teardrop pointing toward the axillary pouch. In my experience, of all glenoid chondral injuries, this version has perhaps the best prognosis for recovery after surgery. Typically, these occur in patients with anterior instability, and the size of chondral defect on the glenoid is relatively small and easily covered by a robust labral repair.2-8 This is in contrast to equatorlevel posterior lesions or anterior lesions, which I
New York, NY The author reports that he has no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material. Ó 2017 Published by Elsevier on behalf of the Arthroscopy Association of North America 0749-8063/171225/$36.00 https://doi.org/10.1016/j.arthro.2017.10.013
412
have found to be more difficult to “cover” with the labral repair. The issue with this study is limited clinical follow-up information. It is a retrospective review of MRIs with actual confirmation by arthroscopy in only 9 of 36 patients. The authors have at a minimum categorized the MRI appearance of this distinctive labral injury. More study is needed to discern how best to treat this injury, and to explain how these findings relate to the patient’s prognosis, when compared with its sister anterior and posterior glenoid labral articular disruption lesions.
References 1. Lederman ES, Flores S, Stevens C, Richardson D, Lund P. The glenoid labral articular teardrop (GLAT) lesion: A chondrolabral injury with distinct MRI findings. Arthroscopy 2018;34:407-411. 2. Galano GJ, Weisenthal BM, Altchek DW. Articular shear of the anterior-inferior quadrant of the glenoid: A glenolabral articular disruption lesion variant. Am J Orthop (Belle Mead NJ) 2013;42:41-43. 3. Tian CY, Cui GQ, Zheng ZZ, Ren AH. The added value of ABER position for the detection and classification of anteroinferior labroligamentous lesions in MR arthrography of the shoulder. Eur J Radiol 2013;82: 651-657. 4. Seybold D, Schliemann B, Heyer CM, Muhr G, Gekle C. Which labral lesion can be best reduced with external rotation of the shoulder after a first-time traumatic anterior shoulder dislocation? Arch Orthop Trauma Surg 2009;129: 299-304. 5. Waldt S, Burkart A, Imhoff AB, Bruegel M, Rummeny EJ, Woertler K. Anterior shoulder instability:
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 34, No 2 (February), 2018: pp 412-413
EDITORIAL COMMENTARY Accuracy of MR arthrography in the classification of anteroinferior labroligamentous injuries. Radiology 2005;237:578-583. 6. Amrami KK, Sperling JW, Bartholmai BJ, Sundaram M. Radiologic case study. Glenolabral articular disruption (GLAD) lesion. Orthopedics 2002;25:29, 95-96.
413
7. Sanders TG, Tirman PF, Linares R, Feller JF, Richardson R. The glenolabral articular disruption lesion: MR arthrography with arthroscopic correlation. AJR Am J Roentgenol 1999;172:171-175. 8. Neviaser TJ. The GLAD lesion: Another cause of anterior shoulder pain. Arthroscopy 1993;91:22-23.
Abstract: In the world of glenoid labral chondral injuries, perhaps the most recognizable by magnetic resonance imaging is the “teardrop” version, and the glenoid labral teardrop lesion is the glenoid chondral lesion most frequently associated with shoulder instability.
See related article on page 407
T
he glenoid labral articular teardrop lesion is a chondrolabral injury with distinct magnetic resonance imaging (MRI) findings as shown in the study “The Glenoid Labral Articular Teardrop (GLAT) Lesion: A Chondrolabral Injury with Distinct MRI Findings”1 by Lederman, Flores, Stevens, Richardson, and Lund. The authors describe a distinctly recognizable subset of anterior inferior capsulolabral pathology in the spectrum of shoulder instability. Traumatic chondral injuries occurring on the glenoid surface in athletes are an important and concerning injury. The authors have subcategorized one type of these lesions, the “GLAT” or teardrop variety, which always occurs in a characteristic location, the anterior far-inferior glenoid. The most striking aspect of this lesion is its appearance on coronal MRI images as an inferiorly directed teardrop pointing toward the axillary pouch. In my experience, of all glenoid chondral injuries, this version has perhaps the best prognosis for recovery after surgery. Typically, these occur in patients with anterior instability, and the size of chondral defect on the glenoid is relatively small and easily covered by a robust labral repair.2-8 This is in contrast to equatorlevel posterior lesions or anterior lesions, which I
New York, NY The author reports that he has no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material. Ó 2017 Published by Elsevier on behalf of the Arthroscopy Association of North America 0749-8063/171225/$36.00 https://doi.org/10.1016/j.arthro.2017.10.013
412
have found to be more difficult to “cover” with the labral repair. The issue with this study is limited clinical follow-up information. It is a retrospective review of MRIs with actual confirmation by arthroscopy in only 9 of 36 patients. The authors have at a minimum categorized the MRI appearance of this distinctive labral injury. More study is needed to discern how best to treat this injury, and to explain how these findings relate to the patient’s prognosis, when compared with its sister anterior and posterior glenoid labral articular disruption lesions.
References 1. Lederman ES, Flores S, Stevens C, Richardson D, Lund P. The glenoid labral articular teardrop (GLAT) lesion: A chondrolabral injury with distinct MRI findings. Arthroscopy 2018;34:407-411. 2. Galano GJ, Weisenthal BM, Altchek DW. Articular shear of the anterior-inferior quadrant of the glenoid: A glenolabral articular disruption lesion variant. Am J Orthop (Belle Mead NJ) 2013;42:41-43. 3. Tian CY, Cui GQ, Zheng ZZ, Ren AH. The added value of ABER position for the detection and classification of anteroinferior labroligamentous lesions in MR arthrography of the shoulder. Eur J Radiol 2013;82: 651-657. 4. Seybold D, Schliemann B, Heyer CM, Muhr G, Gekle C. Which labral lesion can be best reduced with external rotation of the shoulder after a first-time traumatic anterior shoulder dislocation? Arch Orthop Trauma Surg 2009;129: 299-304. 5. Waldt S, Burkart A, Imhoff AB, Bruegel M, Rummeny EJ, Woertler K. Anterior shoulder instability:
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 34, No 2 (February), 2018: pp 412-413
EDITORIAL COMMENTARY Accuracy of MR arthrography in the classification of anteroinferior labroligamentous injuries. Radiology 2005;237:578-583. 6. Amrami KK, Sperling JW, Bartholmai BJ, Sundaram M. Radiologic case study. Glenolabral articular disruption (GLAD) lesion. Orthopedics 2002;25:29, 95-96.
413
7. Sanders TG, Tirman PF, Linares R, Feller JF, Richardson R. The glenolabral articular disruption lesion: MR arthrography with arthroscopic correlation. AJR Am J Roentgenol 1999;172:171-175. 8. Neviaser TJ. The GLAD lesion: Another cause of anterior shoulder pain. Arthroscopy 1993;91:22-23.