Glenolabral articular disruption (GLAD lesion) with Buford complex and supraspinatus tear

Case contributed by Henry Knipe
Diagnosis certain

Presentation

Recurrent shoulder dislocations.

Patient Data

Age: 30 years
Gender: Female

Full thickness partial width anterior supraspinatus footplate tear extending as a delamination tear into the critical zone. No further rotator cuff tear. 

Small glenohumeral joint effusion with a chondral fragment in the axillary recess. Absent anterior glenoid labrum with a band-like middle glenohumeral ligament reflecting a Buford complex.

Anteroinferior labrum and anterior band inferior glenohumeral ligament are high signal and irregular. Significant anteroinferior glenoid chondral loss. No anteroinferior glenoid bone loss; glenoid track measures 31 mm. Non-acute Hill Sachs defect measuring 26 mm (AP to infraspinatus insertion) and 17 mm (craniocaudal).

Subcoracoid bursal effusion with synovial thickening. No subacromial bursal effusion. 

Mild degenerative changes of the acromioclavicular joint.

Case Discussion

This patient with a history of recurrent shoulder dislocations demonstrates an anatomical variant that is the Buford complex and glenolabral articular disruption (GLAD) lesion with an intra-articular chondral fragment. There is no anteroinferior glenoid bone loss and the Hill-Sachs defect is moderate-sized making this an on-track lesion. In addition, there is a partial supraspinatus tear, which is important to note as rotator cuff repair after shoulder dislocation may lead to better outcomes. 

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