Arthroscopic Characterization, Treatment and outcomes of Glenoid Labral Articular Disruption (GLAD) Lesions

Authors:

Ernat JJ, Rakowski DR, Johnson DW, Casp A, Ruzbarsky JJ, Peebles A, Hanson JA, Horan MP, Katthagen JC, Provencher MT, Millett PJ

Abstract:

Background:

The pathoanatomy of glenoid labral articular disruption (GLAD) lesions has been inconsistently and poorly defined in the literature.

Purpose/hypothesis:

The purpose was to characterize GLAD lesions as they pertain to the pathoanatomy of labrum, cartilage, and bony structures, and to correlate findings with patient-reported outcomes (PROs). We hypothesized that greater degrees of bony and cartilaginous involvement would correlate with worse outcomes.

Study design:

Case series; Level of evidence, 4.

Methods:

All patients with a diagnosis of a GLAD lesion or a reverse GLAD (RGLAD) lesion at the time of diagnostic arthroscopy (January 2006-February 2019) were included in this study. Patients with ≥13.5% bone loss or previous ipsilateral shoulder surgery were excluded. Patient charts and operative reports/photos were used to identify the location of injury, extent of injury (labral, chondral, and bony), associated injuries, demographic factors, and treatment performed. Three injury patterns were identified: small (type 1), with no chondral defect after labral repair; large (type 2), with residual chondral defect after labral repair; and bony (type 3), with associated glenoid bone loss amenable to labral repair. Characterizations were cross-referenced to PROs at a mean follow-up of 5.5 years (range, 2.6-10.5 years): American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation, shortened version of Disabilities of the Arm, Shoulder and Hand, and patient satisfaction.

Results:

In total, 50 patients were included, with 40 having GLAD and 10 having RGLAD lesions (mean age, 34.7 and 33.2 years, respectively). There were 14 (35%) type 1, 22 (55%) type 2, and 4 (10%) type 3 GLAD injuries. All PROs improved without any differences in the 3 subgroups postoperatively (ASES, 95.1 vs 91.3 vs 98.8, type 1, 2, and 3, respectively). RGLAD injuries were majority type 2 (7/10; 70%) with the remainder being type 1 (3/10; 30%).

Conclusion:

With GLAD and RGLAD injuries, 3 distinct injury patterns can be observed correlating with the presence/absence of chondral loss after labral repair or the presence of associated bone loss. This descriptive characterization can facilitate arthroscopic treatment decisions. Future large studies are needed to determine if this is prognostic in nature.

You may request a copy of the study: Arthroscopic Characterization, Treatment and outcomes of Glenoid Labral Articular Disruption (GLAD) Lesions

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!