2025 ISAKOS Biennial Congress Paper
Long-Term Clinical Outcomes of Glenoid Labral Articular Disruption (Glad) Lesions in the Setting of First Time Anterior Shoulder Instability Events
Jenna L Dvorsky, BS, MS, Pittsburgh, PA UNITED STATES
Ryan T. Lin, MS, Pittsburgh, PA UNITED STATES
Confidence Njoku Austin, MD, minneapolis, Minnesota UNITED STATES
Zachary J Herman, MD, Pittsburgh, Pennsylvania UNITED STATES
Ehab M Nazzal, MD, Pittsburgh UNITED STATES
Logan Finger, MD, Aliquippa, PA UNITED STATES
Elizabeth Octavia Clayton, MS, Cordova , TN UNITED STATES
Matthew Como, BS, Allison Park, PA UNITED STATES
Fritz Steuer, BS, Pittsburgh UNITED STATES
Emily Lau, MD, Pittsburgh, PA UNITED STATES
Albert Lin, MD, Pittsburgh, PA UNITED STATES
University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, UNITED STATES
FDA Status Not Applicable
Summary
The aim of this study was to compare clinical outcomes of patients with and without GLAD lesions in the setting of first-time anterior instability events, and determine whether such lesions influence rates of recurrent instability following arthroscopic stabilization.
Abstract
Introduction
Anterior instability is the most common type of shoulder instability with the classic injury pattern being a Bankart lesion. However, there are other variants of the Bankart lesion that may influence clinical outcomes and surgical management, including glenolabral articular disruption (GLAD) lesions. GLAD lesions are defined as concomitant tears of the anteroinferior labrum and adjacent articular cartilage. Given their relative rarity, there is limited literature of the long-term prognosis of such injuries and whether these lesions increase the risk of failure following arthroscopic Bankart repair. The aim of this study was to compare clinical outcomes of patients with and without GLAD lesions in the setting of first-time anterior instability events. A secondary aim was to determine the rates of recurrent instability following surgical stabilization in both groups. We hypothesized those with GLAD lesions would exhibit worse range of motion (ROM) and patient-reported outcomes (PROs) postoperatively with increased rates of recurrent instability compared to those without GLAD lesions.
Methods
This was a retrospective comparative case series of consecutive patients with GLAD lesions in the setting of first-time anterior instability events who underwent arthroscopic Bankart repair. Patients aged 14 to 50 years between 2012-2020 were included. Those with a history of recurrent or chronic anterior instability, posterior instability, multidirectional instability, or incomplete medical records were excluded. A total of 54 patients were included for analysis. 14 patients with GLAD lesions (cases) were matched in a 1:3 ratio for age and BMI to those without GLAD lesions (controls). Additional demographic data collected included laterality of injury, contact sport, and overhead sport participation. Primary outcomes included postoperative ROM (forward elevation and external rotation) and PROs: Subjective Shoulder Value (SSV), Visual Analog Scale (VAS), and Western Ontario Shoulder Instability Index (WOSI). Recurrent instability following primary arthroscopic stabilization was also collected.
Results
The mean age was 24.00±7.07 and 24.34±8.16 years in the control and GLAD groups respectively (p=0.88). Average follow-up from surgery to final clinic visit was 1.37 years, while the average time from surgery to final PROs collection was 8.00 years for both groups. There were no significant differences between groups regarding BMI, laterality of injury, contact sport participation, or overhead sport participation (p=0.80, p=0.87, p=0.95, p=0.65). There were no differences in postoperative forward flexion or external rotation (p=0.99, p=0.18), and no difference in SSV, VAS, or WOSI scores (p=0.88, p=0.90, p=0.82). Comparable rates of recurrent instability were found in both groups (7.5% vs. 7.14% respectively, p=0.15).
Conclusions
Patients with GLAD lesions in the setting of first-time anterior instability had comparable PROs, forward flexion, and external rotation postoperatively to controls. Additionally, the presence of a GLAD lesion did not influence the rate of recurrent instability. Although larger prospective studies are necessary to draw firmer conclusions, this study can guide clinical decision making, especially as it pertains to return to sports and postoperative rehabilitation. Given similar outcomes and rates of recurrent instability, our results support similar rehabilitation protocol for those with and without GLAD lesions following arthroscopic stabilization after a first-time anterior instability event.