Purpose: The purpose of this article is to describe the pathology and operative treatment of triple labral lesions.
Type of study: Retrospective review.
Methods: From June 1998 to June 2001, 297 patients underwent surgery by the senior author for lesions of the glenoid labrum. Of these, 7 patients (2.4%) had combined lesions of the anterior, posterior, and superior labrum. All patients were male with a mean age of 25 +/- 7.3 years. All had a traumatic onset of symptoms. There were 4 dominant and 3 nondominant shoulders. Two patients had previously undergone surgery for instability. Each patient's primary complaint was instability and apprehension in the abducted and externally rotated position. No patient complained of posterior instability, although 3 patients had physical examinations suggestive of excessive posterior laxity. All patients underwent arthroscopic surgery following failure of conservative management.
Results: All patients had distinct anterior labrum, posterior labrum, and type II SLAP lesions. All anterior and posterior labrum injuries were Bankart type except one. Two patients had complete circumferential detachment of the labrum and the other 5 patients had a small portion of the labrum still attached. Six patients had a Hill-Sachs lesion and 1 patient had a reverse Hill-Sachs lesion. All were nonengaging Hill-Sachs lesions. All patients were treated with suture anchor fixation of the torn labrum to bone. The median number of anchors used for fixation was 7 (range, 5 to 9 anchors). All patients were treated with a standardized postoperative rehabilitation protocol. At latest follow-up, 6 of 7 patients were satisfied with the procedure. There were no cases of recurrent instability. One patient developed post-traumatic osteoarthritis and underwent a second arthroscopic procedure and subsequently required hemiarthroplasty. This patient was dissatisfied with his result.
Conclusions: Triple labral lesions represent an uncommon combination of lesions of the glenoid labrum. The majority of cases are likely secondary to primary anterior instability. Arthroscopic repair of triple labral lesions using suture anchor fixation to bone, although difficult and time consuming, can restore normal stability to the glenohumeral joint. The long-term outcome of these severe labral lesions remains to be determined, particularly with respect to the development of post-traumatic osteoarthritis.
Level of evidence: Level IV. Case series, no or historical control group.