Prospective Magnetic Resonance Imaging Assessment of Capsulolabral Repair in Athletes With Anterior Glenohumeral Instability: Does Cicatrization Exist?

Background: Descriptive parameters for the evaluation of the labrum's appearance on magnetic resonance imaging (MRI) after capsulolabral repair are not well established. Purpose: To assess the morphology and structural appearance of the postoperative glenoid labrum on MRI in athletic patients with anterior glenohumeral instability. Study Design: Case series; Level of evidence, 4. Methods: This prospective study examined MRI scans of the involved shoulder in a population of 27 athletic patients with traumatic anterior instability before arthroscopic capsulolabral repair and at 3 and 6 months after surgery. The morphology, axial height, coronal height, axial angle, coronal angle, integrity, and homogeneity of repaired capsulolabral tissue were evaluated. The labrum was considered healed if it was integrated or intact (ie, if there was no discontinuity between the labrum and the glenoid). For each of these variables, a comparison was made between the MRI scans preoperatively and at 3 and 6 months after surgery to verify significant differences in these measures. Linear and logistic regression models were built to verify the associations between exposure variables and outcome variables. For all analyses, a significance level of .05 was used. Results: Each continuous outcome variable (ie, morphology, angle, and height) showed statistically significant differences across the 3 different MRI time points, indicating that we observed an increase in height and angle as well as an improvement in morphology throughout the follow-up period. Integrity was not significantly different on MRI between 3 and 6 months. Homogeneity was not significantly different between preoperative and 3-month MRI but significantly differed between preoperatively and 6 months postoperatively. The difference between postoperative and preoperative coronal height (increase in height) was associated with the occurrence of multiple dislocation episodes. Advanced age or multiple dislocations reduced the improvement in morphology. At 6 months, the integrity of the labrum on MRI was observed in all patients; however, 17 patients (63%) still had a heterogeneous labrum. Patients who underwent surgery within 90 days or those with a first dislocation episode had better integrity and homogeneity of labral tissue. Conclusion: There were statistically significant differences in the morphology, height, and angle of the labrum between the preoperative and postoperative periods in patients who underwent arthroscopic repair for glenohumeral instability. Although a 6-month MRI revealed labral integrity in all the athletes, 63% still had heterogeneous labral tissue.