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Outcomes in surgical and conservative treatment of symptomatic non-traumatic shoulder labrum tears in the paediatric population: a systematic review

Abstract

Importance The glenoid labrum is an important static stabiliser of the glenohumeral joint. Consensus is lacking with regards to both conservative and surgical management options for non-traumatic labral tears in the paediatric population.

Objective The questions that this review aims to answer are as follows: (1) What are the treatment options available for non-traumatic glenoidlabrum tears in the paediatric population? and (2) What are the patient-important outcomes following non-operative and operative treatment modalities?

Evidence review In addition to published abstracts from 2011 to 2016 from the American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America and Pediatric Orthopaedic Society of North America, three electronic databases (MEDLINE, PubMed and EMBASE) were searched from inception to 19 January 2017 for studies on non-traumatic labral tears in the paediatric population. A systematic screen and data abstraction of titles, abstracts and full-text manuscripts were performed in duplicate, with descriptive statistics provided. The Methodological Index for Non-Randomised Studies was used to rate the quality of the included studies.

Findings Six studies from an initial 587 retrieved were included, and they examined 12 patients (12 shoulders) with median age of 17 years (range 11–18.6 years), 7 of which were males, who were followed for a median duration of 29.5 months (range 6–48 months). The most common location of the labrum tears was superior labrum anterior to posterior in six patients. Overall, 11 patients were managed arthroscopically, with the most common surgical technique being an isolated arthroscopic labrum debridement in five patients. Furthermore, 9 of the 11 patients treated surgically returned to sports, typically by 6–7 months postoperatively. Moreover, the single patient treated non-operatively also returned to sports and experienced significant improvements in the European Quality of Life measure, American Shoulder and Elbow Surgeons score and function score. There were no complications or revision procedures reported.

Conclusions and relevance In the paediatric population, literature investigating non-traumatic labral tears of the shoulder is scarce. However, based on the available data, patients are most frequently managed with arthroscopic labrum debridement. Furthermore, patients managed operatively and non-operatively experience good outcomes, including high rates of return to sports and no occurrence of complications and revision procedures.

Level of evidence Level IV.

  • shoulder
  • instability
  • evidence based medicine
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