Minimum 2-Year Clinical Outcomes After Arthroscopic Treatment for Glenolabral Articular Disruption (GLAD) Lesions: A Matched Case-Control Study

Authors:

Justin Arner MD, Joseph Ruzbarsky, Marilee Horan, Travis Dekker MD, Brandon Goldenberg, Peter Millett MD, MSc, Bryant Elrick MD, MS

Abstract:

Objectives:

The presence of glenolabral articular disruption (GLAD) lesions has been shown to be associated with higher rates of recurrent anterior shoulder instability and the need for repeat surgery; however, no series has yet reported clinical outcomes in a GLAD-specific cohort. Further investigation is warranted to characterize the prognosis of GLAD injuries and to identify risk factors associated with inferior outcomes.

Purpose:

The purpose of this study was to compare clinical outcomes between anterior shoulder instability patients with and without GLAD lesions after undergoing arthroscopic anterior shoulder stabilization and to evaluate potential risk factors that may predispose patients with GLAD lesions to inferior outcomes.

Methods:

Prospectively collected data was retrospectively reviewed for patients who underwent arthroscopic anterior shoulder instability repair with and without GLAD lesions at a minimum of 2 year follow-up. Consecutive patients who underwent arthroscopic surgery for GLAD lesion were matched to patients who underwent arthroscopic anterior Bankart repair by age, sex, and number of anchors. Patient reported outcomes (PROs) were evaluated pre- and post-operatively, including American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and satisfaction (10-point scale). Recurrent instability, defined as recurrent dislocation, as well as reoperation were analyzed. Patients were asked to report their subjective shoulder stability compared to preoperatively (much better, better, same, worse, or much worse). Additionally, outcome scores were assessed based on GLAD lesion morphology and surgical treatment including lesion thickness (full vs. partial), size (mm³), anchor placement (in the defect vs. outside the defect), and microfracture (performed vs. not performed). Statistical significance was defined as P < .05.

Results:

A total of 58 patients (29 GLAD, 29 non-GLAD (Bankart only)) with a mean age of 28.5 ± 11.9 years were analyzed at 4.1 ± 1.7 years (range, 2.0-8.2) postoperatively. Seventy-six percent (44/58) of the patients were males and 24% (14/58) were females. Patients in both groups experienced significant improvements in all outcome scores after surgery (P < .05 for all) (Table 1). No significant differences were found in postoperative scores between the GLAD and non-GLAD groups [ASES (94.8 ± 8.5 vs 93.4 ± 14.1), SF-12 PCS (55.5 ± 4.5 vs 54.2 ± 8.5), SANE (90.4 ± 7.7 vs 91.3 ± 15.5), DASH (9.4 ± 15.1 vs 7.0 ± 14.9) ( P > .05 for all)] (Table 2). The median satisfaction for the GLAD and non-GAD groups was 10 (range, 1-10) and 10 (range, 1-10), respectively. Two patients in the GLAD cohort underwent reoperation: 1 for symptoms of instability at 1.5 years and the other for persistent anterior shoulder pain at 1 year post-operatively. No patients in the non-GLAD cohort underwent reoperation. No statistical differences in recurrent dislocation were observed between the GLAD (n=2, 9%) and non-GLAD (n=4, 15%; P = .67) groups; however, a significantly greater proportion of patients in the GLAD group reported worse or much worse (n=11, 50%) shoulder instability after surgery compared to the non-GLAD group (n=1, 3.8%; P=.0004). No significant differences in outcome scores were observed in GLAD patients based on thickness of the lesion, labral advancement into the defect, or treatment with microfracture (P >.05 for all). Additionally, there was no significant association between PROs and GLAD lesion size (P >.05 for all) (Table 3).

Conclusions:

Patients with GLAD lesions had significantly higher subjective shoulder instability when compared with a matched cohort of non-GLAD (Bankart only) patients. No difference between frank shoulder dislocation was seen. All patients had significant improvements in post-operative outcome scores with high satisfaction. There was no difference in outcomes in those with larger GLAD lesions nor if a microfracture or labral advancement was performed. Anterior shoulder instability patients with GLAD lesions were not found to have inferior outcomes but do have higher subjective instability compared with patients with Bankart only lesions. Longer term studies are necessary to evaluate the risk of arthritic change in those with GLAD lesions.

Read the complete study: Minimum 2-Year Clinical Outcomes After Arthroscopic Treatment for Glenolabral Articular Disruption GLAD Lesions A Matched Case-Control Study

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!!!