Posterior chondrolabral cleft and recurrent shoulder instability

Posterior chondrolabral clefts are associated with glenoid dysplasia and 35% of the time are bilateral according to a study published by the Hospital for Special Surgery (HSS). Although it is difficult to determine whether these lesions are associated with multidirectional, posterior or anterior instability it is recommended to perform examination under anesthesia to evaluate the direction of dislocation or subluxation of the humeral head. The following case is a teenager with a 6 month history of subluxations that were associated with spasms of the anterior shoulder musculature. The patient was treated with 6 months of therapy without improvement of the instability symptoms.

Chondrolabral clefts are located in the posterior inferior labrum, according a HSS study. MRI study studies show that are not normal anatomic variants as there are associated with rounded posterior glenoid rims, glenoid dysplasia and future instability.

Schematic preservation of the rounded posterior glenoid rim

Exam under anesthesia and fluoroscopy demonstrated posterior subluxation of the humeral head on the axillary view with the load and shift test.

Anterior directed force with load and shift test shows no dislocation

Posterior subluxation during load and shift test under anesthesia

MRI demonstrates 1. Round posterior glenoid rim 2. Chondrolabral cleft at the posterior inferior glenoid

Rounded posterior rim of the glenoid and chondrolabral cleft on MRI

Exam under anesthesia demonstrated no dislocation with the load and shift test.

6 o ' clock glenoid 

Chondrolabral cleft posterior

Arthroscopic load and shift test demonstrated posterior subluxation of the humeral head  (+2 on the load and shift test).

Anterior directed force shows no subluxation during load and shift test

Posterior directed force during load and shift test shows posterior subluxation

Capsulolabral repair using three sutures

One suture anteriorly at the bankart area was placed to complete the capsulolabral repair.

Arthroscopic capsulolabral repair was performed at the area of the cleft. An additional suture for reduction of the capsular volume was placed at the Bankart area where the capsulolabral repair was re-enforced. No anchors were used in this case.

It is speculated that the glenoid dysplasia in combination with the loss of the concavity compression and negative suction pressure leads to instability. Closure of the cleft and shoulder joint capsule reduction seems to be an effective method of addressing the problem.