Evolution of lesions of the labrum-ligament complex in posttraumatic anterior shoulder instability: A prospective study

The aim of this study was to evaluate the evolution of intraarticular disea se in posttraumatic shoulder instability Ninety-one patients with posttraum atic shoulder instability were examined arthroscopically. The intraarticula r disease was recorded on a special documentation sheet (containing 67 desc riptive items). The patients were divided into 5 sub-groups: first-time dis location (n = 9); First or second recurrence (n = 12); 3 to 5 recurrences ( n = 23); 6 or more recurrences (n = 32); and chronic subluxations (n = 15). All data were examined statistically Each lesion was correlated with stage of evolution, age, and number of recurrences. The most frequent lesions we re regrouped into "lesion families." The initial and most constant lesion w as the periosteal disinsertion of the anteroinferior labrum (single lesion) . The labral detachment was succeeded in a second stage by the disinsertion of the glenohumeral ligament complex (double lesion). With additional recu rrences, stress mechanisms altered the detached structures through tissue d amage (triple lesion). The fourth stage saw the extension of the degenerati ve process, which led to failure at the insertion site and destruction of t he labrum-ligament complex (quadruple lesion). This study reveals that recu rrences progressively damage stabilizing structures. A pathophysiological c lassification into 4 stages is proposed, however, that would permit a preci se therapeutic strategy for arthroscopic shoulder stabilization.