Spectrum of Childhood Intra-articular Shoulder Pathology

OBJECTIVES: With increased sports participation and awareness on behalf of the medical community, there appears to be an increase in childhood musculoskeletal injuries. The spectrum of intra-articular shoulder pathology in this skeletally immature population has not been well described. The purpose of this study was to identify the intra-articular injury pattern seen within the childhood shoulder. METHODS: A retrospective review was performed at two tertiary-care children’s hospitals between 2008 and 2011 of all patients who underwent MR imaging and subsequent shoulder arthroscopy. Exclusion criteria included: girls > 14 years old, and boys > 16 years old. Demographics, MR and arthroscopic findings were recorded. Labral pathology was grouped into zones: Zone I (Bankart lesions) - 3 to 6 o’clock for right shoulder, Zone II (posterior labral lesions - 6 to 11 o’clock, Zone III (SLAP lesions) - 11 to 1 o’clock, and Zone IV (anatomic variants) - 1 to 3 o’clock. RESULTS: 115 children met criteria with a mean age of 14.4 years (range 8-16 years). There were 24 girls and 91 boys with 45 left and 70 right shoulders. Football and baseball were the most common activities at the time of shoulder injury. Of 112 children with labral pathology, 72 were Zone I with 14 isolated anterior, 56 were Zone II with 15 isolated posterior, 38 were Zone III with 4 isolated superior, and 2 had an isolated Buford complex. Seventy-six of these children had more than one labral zone injured; moreover, 31 (27%) had injuries to more than two zones. Pathology in Zone 1 included: anterior labral periosteum sleeve avulsions (ALPSA), glenolabral articular disruptions (GLAD), soft and bony Bankart lesions. Non-labral intra-articular pathology included 27 children with partial articular supraspinatus tendon avulsions (PASTA), humeral avulsions of the glenohumeral ligament (HAGL), and greater tuberosity fracture. CONCLUSION: The childhood incidence of intra-articular pathology is different than the adult population. Although, a quarter of our cohort had partial rotator cuff tears, there were no complete tears. In contrast to adults, the primary intra-articular pathology (97.4%) was labral tearing; moreover, 24% of those involved only the posterior labrum ± superior labrum. Sixty-eight percent had labral pathology that involved at least 2 zones and treating surgeons should be prepared to find anterior tears of the glenoid labrum that extend beyond the zone of a classic Bankart lesion.