PMC6387695_01
Preoperative MRI that was initially read as a Buford complex, but after failed conservative management, the lesion was reevaluated as an anterior inferior labral tear.
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While the official report described a Buford complex, the abnormal-appearing labrum was located more inferior than the typical Buford complex:consistent with an anterior labral tear (Figure 1).
Anterior inferior labral injury at the 3 o'clock (a) and 6 o'clock (b) positions.
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Diagnostic arthroscopy was significant for complete disruption of the labral tissue between the 3 o'clock and 6 o'clock positions (Figures 2(a) and 2(b), respectively).
Identification of a 6 mm x 8 mm glenolabral articular defect (GLAD).
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It was also revealed that there was an articular glenoid cartilage lesion measuring 6 mm x 8 mm anteroinferiorly (Figure 3).
GLAD lesion following arthroscopic debridement of the underlying bony surface.
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Before the labral repair, the calcified cartilage layer along the anterior-inferior glenoid, beneath the cartilage flap, was gently debrided and removed with an arthroscopic shaver and an arthroscopic curette (Figure 4).
Primary repair of the GLAD lesion. #2 suture is passed through the cartilage (a) with the fixation being incorporated into anchor constructs of the labral repair.
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The Nitinol wire was used to shuttle #2 FiberWire though the cartilage flap, around the labrum, and through the capsular tissues to establish 3 fixation points (Figures 5(a) and 5(b)).
Final repair of the anterior inferior labrum and GLAD lesion.
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This construct restored tension to the anterior band of the inferior glenohumeral ligament, recreated the anteroinferior labral bumper, and effectively reduced the cartilage flap/GLAD lesion to the anterior inferior glenoid (Figures 6(a) and 6(b)).
Coronal (a) and axial (b) MRI performed 5 months postoperative due to traumatic injury reveals a Hill-sachs lesion. After nonconservative treatment resulted in improvement, the patient was instructed to follow-up only as needed.
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An MRI was performed which revealed an intact GLAD lesion repair and labral repair (Figures 7(a) and 7(b), respectively).