Evaluation of glenoid capsulolabral complex insertional anatomy and restoration with single- and double-row capsulolabral repairs.

BACKGROUND: The purpose of this study was to evaluate the normal glenoid insertional anatomy of the anterior-inferior capsulolabral complex and to compare the ability of a single-row repair and a double-row suture bridge repair to restore the insertional anatomy. METHODS: Eight fresh frozen cadaver shoulders were dissected and the native glenoid insertion of the anterior-inferior capsulolabral complex was digitized. Bankart lesions were created, the shoulders were randomized to receive either the standard single-row suture anchor repair or a double-row suture bridge repair, and the insertion repair sites were then digitized. RESULTS: The single-row repair recreated 42.3% of the native footprint surface area while the double-row repair recreated 85.9%. The double-row repair was significantly larger and recreated significantly more of the native footprint compared with single-row repair (P < .01). CONCLUSION: Double-row repair of the capsulolabral complex reestablishes the native insertional footprint on the anterior inferior glenoid better than a single-row repair. LEVEL OF EVIDENCE: Basic science study.

Multidirectional instability: evaluation and treatment options.

Multidirectional instability of the shoulder is a condition defined by symptoms of shoulder instability in more than one direction. Patients typically have generalized ligamentous laxity and may be involved in repetitive overhead activities. Initial treatment is with a physical therapy program. Patients who fail non-operative treatment are candidates for arthroscopic or open stabilization procedures.

Partial-thickness rotator cuff tears.

Partial-thickness rotator cuff tears are not a single entity; rather, they represent a spectrum of disease states. Although often asymptomatic, they can be significantly disabling. Overhead throwing athletes with partial-thickness rotator cuff tears differ with respect to etiology, goals, and treatment from older, nonathlete patients with degenerative tears. Pathogenesis of degenerative partial-thickness tears is multifactorial, with evidence of intrinsic and extrinsic factors playing key roles. Diagnosis of partial-thickness rotator cuff tears should be based on the patient's symptoms together with magnetic resonance imaging studies. Conservative treatment is successful in most patients. Surgery generally is considered for patients with symptoms of sufficient duration and intensity. The role of acromioplasty has not been clearly delineated, but it should be considered when there is evidence of extrinsic causation for the partial-thickness rotator cuff tear.