First and foremost, I just want to acknowledge and thank my co-authors for their significant contributions. Our disclosures can be found on the AAOS website. GLAD lesions were first described by Neviser to result from a forced adduction injury to the shoulder, generally presenting without clinical signs of instability. However, numerous authors have since described these lesions in the setting of traumatic shoulder instability. The senior surgeon and colleagues recently found GLAD lesions to be a risk factor for recurrent instability after arthroscopic Bankart repair. However, the sample size is relatively small, necessitating follow-up in a larger cohort. Therefore, the purpose of our study was to compare the outcomes between patients with and without GLAD lesions after undergoing arthroscopic Bankart surgery. Additionally, the study evaluated potential risk factors for inferior outcomes in those with GLAD injury. It was hypothesized that patients with GLAD lesions would have worse clinical outcomes than higher recurrent instability due to more severe joint damage and a potentially less stable glenoid due to cartilage loss. Additionally, increasing lesion size was hypothesized to be associated with inferior patient-reported outcomes or pros. This was a retrospective single-surgeon series. We included those with primary or recurrent instability who underwent arthroscopic Bankart repair, had an intraoperatively confirmed GLAD lesion, and were minimum two-year follow-up. Surgeon criteria included those with concomitant procedures other than slap repair or bicep stenodesis, as well as those with multidirectional or posterior instability. Finally, we matched the patients with GLAD lesions to controls by age, sex, and number of anchors. Arthroscopic treatment in GLAD patients included chondroplasty, as well as microfracture and capsule labral advancement into the defect for larger full-thickness lesions. Arthroscopic Bankart repair was performed in all patients, and slap repair and bicep stenodesis were performed as indicated. Demographic and treatment characteristics were collected and compared between the groups. Additionally, outcome scores, satisfaction, recurrent instability, and reoperations were evaluated. GLAD lesion size was measured on preoperative MR and was calculated by multiplying the greatest dimension of the defect in both the axial and the coronal planes. A total of 27 patients were included in each group, with a mean age of 28.9. Comparison of demographic variables, as well as concomitant pathology and treatments, revealed no statistical difference between the groups. Looking at patient-reported outcomes, comparison of pre- and postoperative pros between the groups revealed no statistical differences. Additionally, all pros improved significantly from pre- to postoperative for both groups, with a high satisfaction, a median 10 out of 10. Four patients in each group suffered recurrent dislocation. Two patients in the GLAD group and one patient in the control group reported subjective feelings of postoperative instability. And one patient in the GLAD group and one patient in the control group underwent reoperation. Overall, the revision rates and recurrent instability did not significantly differ between these two groups. Subgroup analysis of GLAD patients showed no difference in outcomes based on microfracture or labral advancement into the defect. Additionally, GLAD lesion size was not correlated with outcomes. Notably, however, reliability between raters for GLAD MRI assessment was poor. The most important finding of this study was that patients with and without GLAD lesions experienced similarly improved pros without differences in recurrent instability or revision rates at mean 4.5-year follow-up. In contrast to Pogoshevsky et al., these results do not support GLAD lesions as a risk factor for recurrent instability. However, these results do corroborate the recent findings of Davy et al., who reported no difference in outcomes or recurrent instability in a similarly matched cohort. Limitations of the current study include the relatively small sample size, although to the best of the author's knowledge, this is the largest cohort of GLAD patients investigated to date, as well as poor reliability between the raters for GLAD morphologic assessment and potential lack of generalizability to larger populations. In conclusion, our findings support that arthroscopic bang cart repair in patients with GLAD lesions results in significantly improved outcomes with high satisfaction, which is similar to those without GLAD lesions. Thank you.

GLAD lesions

shoulder instability

arthroscopic Bankart surgery

outcomes

risk factors