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Posterior Chondrolabral Cleft: Clinical Significance and Associations with Shoulder Instability

  • Current topics, advances and innovations in musculoskeletal imaging
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HSS Journal ®

Abstract

Background

A high signal intensity cleft between the labrum and articular cartilage of the posterior glenoid is commonly visible on MRI and has been suggested to be anatomic variation [3, 10, 23]. The association of a posterior cleft with variations in glenoid morphology or with shoulder instability is unknown.

Questions/Purposes

The purposes of this study were to determine if posterior chondrolabral clefts are associated with variations in glenoid morphology, and to determine if they are associated with shoulder instability.

Patients and Methods

Shoulder MRI was performed in 1,264 shoulders, 1,135 male (89.8%), and 129 female (10.2%). A musculoskeletal radiologist blinded to history and outcomes evaluated the MR images for linear high signal intensity at the posterior chondrolabral junction and a rounded or truncated contour of the posterior glenoid. Glenoid version and depth were measured. Patients were followed prospectively for shoulder instability for 4 years. Univariate and multivariate statistical analysis were performed.

Results

Posterior chondrolabral cleft was present in 114/1,264. Posterior chondrolabral cleft was associated with a rounded or truncated posterior glenoid. There were 9.5° retroversion in shoulders with a posterior cleft, and 7.7° retroversion in shoulders without a cleft. Shoulders with a posterior chondrolabral cleft were more likely to develop shoulder instability.

Conclusions

Posterior chondrolabral clefts are not uncommon on MRI. They are associated with a rounded or truncated posterior glenoid and a small but significant increase in glenoid retroversion. They are associated with shoulder instability.

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References

  1. Bigliani LU, Kelkar R, Flatow EL, Pollock RG, Mow VC. Glenohumeral stability. Biomechanical properties of passive and active stabilizers. Clin Orthop Relat Res. 1996; 330: 13-30.

    Article  PubMed  Google Scholar 

  2. Blasier RB, Guldberg RE, Rothman ED. Anterior shoulder stability: contributions of rotator cuff forces and capsular ligaments in a cadaver model. J Shoulder Elbow Surg. 1992; 1: 140-150.

    Article  PubMed  CAS  Google Scholar 

  3. Cooper DE, Arnoczky SP, O’Brien SJ, Warren RF, DiCarlo E, Allen AA. Anatomy, histology, and vascularity of the glenoid labrum. J Bone Joint Surg Am. 1992; 74A(1): 46-52.

    Google Scholar 

  4. Edelson JG. Localized glenoid hypoplasia: an anatomic variation of possible clinical significance. Clin Orthop Relat Res. 1995; 321: 189-195.

    PubMed  Google Scholar 

  5. Gibb TD, Sidles JA, Harryman DT, McQuade KJ, Matsen FA III. The effect of capsular venting on glenohumeral laxity. Clin Orthop. 1991; 268: 120-127.

    PubMed  Google Scholar 

  6. Harper KW, Helms CA, Haystead CM, Higgins LD. Glenoid dysplasia: incidence and association with posterior labral tears as evaluated by MRI. Am J Roentgenol. 2005; 184: 984-988.

    Article  Google Scholar 

  7. Ikeda H, Tsukanishi S, Nobuhara K. Shoulder instability: its relationship to glenoid dysplasia. Seikeisaigaigeka. 1984; 27: 1757-1765 (in Japanese).

    Google Scholar 

  8. Inui H, Sugamoto K, Miyamoto T, et al. Glenoid shape in atraumatic posterior instability of the shoulder. Clin Orthop. 2002; 403: 87-92.

    Article  PubMed  Google Scholar 

  9. Kim SH, Ha KI, Yoo JC, Noh KC. Kim’s lesion: an incomplete and concealed avulsion of the posteroinferior labrum in posterior or multidirectional posteroinferior instability of the shoulder. Arthroscopy. 2004; 20: 712-720.

    Article  PubMed  Google Scholar 

  10. Lee GY, Choi JA, Oh JH, Choi JH, Hong SH, Kang HS. Posteroinferior labral cleft at direct CT arthrography of the shoulder by using multidetector CT: is this a normal variant? Radiology. 2009; 253: 765-770.

    Article  PubMed  Google Scholar 

  11. Lee SB, Kim KJ, O'Driscoll SW, Morrey BF, An KN. Dynamic glenohumeral stability provided by the rotator cuff muscles in the mid-range and end-range of motion. A study in cadavera. J Bone Joint Surg Am. 2000; 82(6): 849-857.

    PubMed  CAS  Google Scholar 

  12. Legan JM, Burkhard TK, Goff WB II, et al. Tears of the glenoid labrum: MR imaging of 88 arthroscopically confirmed cases. Radiology. 1991; 179: 241-246.

    Article  PubMed  CAS  Google Scholar 

  13. Lippert WC, Mahlman CT, Cornwall R, et al. The intrarater and interrater reliability of glenoid version and glenohumeral subluxation measurements in neonatal brachial plexus palsy. J Pediatr Orthop. 2012; 32(4): 378-384.

    Article  PubMed  Google Scholar 

  14. Lippitt WB, Vanderhooft JE, Harris SL, Sidles JA, Harryman DT, Matsen FA III. Glenohumeral stability from concavity-compression: a quantitative analysis. J Shoulder Elbow Surg. 1993; 2: 27-35.

    Article  PubMed  CAS  Google Scholar 

  15. Mallon WJ, Brown HR, Vogler JB, Martinez S. Radiographic and geometric anatomy of the scapula. Clin Orthop Relat Res. 1992; 277: 142-154.

    PubMed  Google Scholar 

  16. Mohana-Borges AV, Chung CB, Resnick D. Superior labral anteroposterior tear: classification and diagnosis on MRI and MR arthrography. Am J Roentgenol. 2003; 181: 1449-1462.

    Article  Google Scholar 

  17. Nyffeler RW, Jost B, Pfirrmann CWA, Gerber C. Measurement of glenoid version: conventional radiographs versus computed tomography scans. J Shoulder Elbow Surg. 2003; 12(5): 493-496.

    Article  PubMed  Google Scholar 

  18. Owens BD, Campbell SE, Cameron KL. Risk factors for posterior shoulder instability in young athletes. Am J Sports Med. 2013; 41: 2645-2649.

    Article  PubMed  Google Scholar 

  19. Owens BD, Duffey ML, Nelson BJ, DeBerardino TM, Taylor DC, Mountcastle SB. The incidence and characteristics of shoulder instability at the United States Military Academy. Am J Sports Med. 2007;35(7):1168-73.

  20. Owens BD, Nelson BJ, Duffey ML, et al. Pathoanatomy of first-time, traumatic, anterior glenohumeral subluxation events. J Bone Joint Surg Am. 2010; 92: 1605-1611.

    Article  PubMed  Google Scholar 

  21. Randelli M, Gambrioli PL. Glenohumeral osteometry by computed tomography in normal and unstable shoulder. Clin Orthop Rel Res. 1986; 208: 151-156.

    Google Scholar 

  22. Snyder SJ, Karzel RP, Del Pizzo W, et al. SLAP lesions of the shoulder. Arthroscopy. 1990; 6: 274-279.

    Article  PubMed  CAS  Google Scholar 

  23. Tuite MJ, Currie JW, Orwin JF, Baer GS, Munoz del Rio A. Sublabral clefts and recesses in the anterior, inferior, and posterior glenoid labrum at MR arthrography. Skeletal Radiol 2012. doi:10.1007/s00256-012-1496-0.

  24. Warner JJ, Bowen MK, Deng X, Torzilli PA, Warren RF. Effect of joint compression on inferior stability of the glenohumeral joint. J Shoulder Elbow Surg. 1999; 8(1): 31-36.

    Article  PubMed  CAS  Google Scholar 

  25. Warren RF. Subluxation of the shoulder in athletes. Clin Sports Med. 1983; 2(2): 339-354.

    PubMed  CAS  Google Scholar 

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Disclosures

ᅟ

Conflict of Interest:

Scot E. Campbell, MD, Robert M. Dewitt, MD, MPH, ATC, and Adrianne K. Thompson, MD have declared that they have no conflict of interest. Kenneth L Cameron, PhD reports grants from Orthopedic Research and Education Foundation, during the study. Brett D. Owens, MD reports grants from OREF, during the conduct of the study; personal fees from Mitek Sports Medicine and Musculoskeletal Transplant Foundation, outside the work.

Human/Animal Rights:

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 [5].

Informed Consent:

Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Keller Army Hospital, US Military Academy, West Point, NY, USA

    Robert M. Dewitt MD, Kenneth L. Cameron PhD, MPH, ATC, Adrianne K. Thompson MD & Brett D. Owens MD

  2. Department of Radiology, Landstuhl Regional Medical Center, CMR 402, Box 966 APO,, AE 09180, Landstuhl, Rhineland-Pfalz, Germany

    Scot E. Campbell MD

Authors
  1. Scot E. Campbell MD
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  2. Robert M. Dewitt MD
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  3. Kenneth L. Cameron PhD, MPH, ATC
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  4. Adrianne K. Thompson MD
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  5. Brett D. Owens MD
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Corresponding author

Correspondence to Scot E. Campbell MD.

Additional information

Level of Evidence: Level IV: Cohort study.

The views and opinions expressed in this manuscript are those of the author(s) and do not reflect the official policy of the Department of the Army, the US Air Force, the Department of Defense, or the US Government.

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Campbell, S.E., Dewitt, R.M., Cameron, K.L. et al. Posterior Chondrolabral Cleft: Clinical Significance and Associations with Shoulder Instability. HSS Jrnl 10, 208–212 (2014). https://doi.org/10.1007/s11420-014-9404-x

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  • DOI: https://doi.org/10.1007/s11420-014-9404-x

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