Lesions of the glenoid labrum and their medical-legal interpretation.

Aim: Development of criteria for the medical-legal interpretation of differ ent patterns of labral lesions according to the labrum pathology and mechan ism of injury. Methods: A metaanalysis of the literature concerning injurie s and diseases of the shoulder involving the glenoid labrum was performed. Results: Lesions of the superior, anterior and posterior labrum are rare an d of different severity. Arthroscopically they are divided into distinct ty pes. They develop either spontaneously together with intraarticular disease s, due to chronic fatigue or by injury. In this field the stability of the shoulder joint and the tension of the long head of the biceps tendon play a n important role. There is no correlation between the type of lesion and me chanism of injury. With respect to medical-legal interpretation, the curren tly used classification of labral lesions is not very helpful or is even co nfusing. We therefore propose a new classification according to the meniscu s pathology which shows a striking similarity to labral pathology. There ar e two types of labral lesions: Type one shows degenerative defects, which m ay be influenced by mechanical loading; type two follows from shoulder inst ability. Conclusions: Medical-legal interpretation of labral lesions should follow the same principles that were shown to be useful in knee joint inst ability and meniscal tears. Only traumatic luxations of the shoulder joint may lead to labral tears without any other alterations.