Source/Disclosures
Published by:
McCarthy CF, et al. Paper 4. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 12-16, 2023; Washington, D.C.
Disclosures:
McCarthy reports no relevant financial disclosures.
Key takeaways:
- Results showed failed labral repair may be associated with lower acromial tilt and higher posterior acromial height than successful repair.
- There were no differences in glenoid bone loss or retroversion.
WASHINGTON — Patients with shoulder instability who failed primary posterior labral repair had lower acromial tilt and higher posterior acromial height than patients with successful primary repair, according to results presented here.
“In patients who had failure of their posterior stabilization surgery, their index acromial tilt was lower or flatter and the posterior acromial height was higher than in patients who had successful primary surgery,” Conor F. McCarthy, MD, said in his presentation at the American Orthopaedic Society for Sports Medicine Annual Meeting. “This is consistent that a potentially high and flat at-risk acromion morphology puts patients at risk vs. a steeper protective Swiss chalet roof.”
Patients with shoulder instability who failed primary posterior labral repair had lower acromial tilt and higher posterior acromial height than patients with successful primary repair. Image: Adobe Stock
To investigate the impact of acromion morphology on the risk of failure in posterior labral repair, McCarthy and colleagues retrospectively identified 58 active-duty military patients with shoulder instability who underwent primary posterior labral repair between 2005 and 2019, of which 41 had successful primary posterior stabilization and 17 had failed their initial surgery and went on to revision.
Conor F. McCarthy
“We collected basic demographics and looked at their preoperative pre-index surgery MRIs to measure glenoid and scapular acromion morphology,” McCarthy said.
Results showed both the successful surgery group and the failed surgery group had no differences in glenoid bone loss (both 4.5%) or glenoid retroversion (both 8°), according to McCarthy. However, McCarthy said patients were more likely to have lower acromial tilt and higher posterior acromial height if they had a failed primary labral repair vs. a successful primary labral repair.
“The immediate potential clinical impact of these findings is that if you identify a patient with a high and flat acromion, you want to ensure robust, soft tissue labral repair,” McCarthy said. “You may want to consider slowing the rehabilitation and counseling them on the potentially higher risk of failure of their soft tissue repair. Supplemental techniques to minimize failure risk in these patients with high and flat acromion morphology may be justified.”
American Orthopaedic Society for Sports Medicine Annual Meeting