Title : Pan-labral (circumferential) tears of the shoulder
Abstract:
Pan-labral tears, also known as circumferential (360°) labral tears, represent an uncommon but clinically significant cause of shoulder pain and instability. These lesions involve detachment of the labrum around the entire glenoid circumference, and they are often misdiagnosed pre-operatively as isolated SLAP lesions or Bankart lesions. Because MRI and MR-arthrograms may underestimate the true extent of labral injury, many cases are only correctly identified during diagnostic arthroscopy. This diagnostic difficulty has been highlighted in multiple prospective studies, which show that circumferential tears remain rare but clinically important findings in shoulder instability workups. The glenoid labrum plays a central role in maintaining joint stability, and circumferential disruption can lead to multidirectional instability, recurrent subluxation, and persistent pain. Tokish et al. conducted one of the largest prospective multicenter evaluations of pan-labral tears, reporting significant postoperative improvement in pain, instability scores, and functional outcome measures following arthroscopic repair. Their cohort of 41 shoulders demonstrated reliable restoration of stability, although a subset required revision surgery for recurrent instability, postoperative tightness, or persistent biceps-related symptoms.
Arthroscopic repair of a 360° labral tear is technically demanding. The surgeon must use strategic anchor placement, accessory portals, and careful capsulolabral tensioning to restore the anatomic contour of the labrum. Rao et al. describe a detailed technique emphasizing the importance of sequential repair, proper anchor trajectory, and the use of percutaneous portals particularly at the 5- and 7-o'clock positions-to achieve secure fixation of the inferior and posterior labrum. Their work reinforces that complete visualization and structured planning are essential for successful outcomes. Although pan-labral tears remain rare in daily arthroscopic practice, awareness of this pathology is crucial. Surgeons should maintain a high index of suspicion in patients with persistent instability symptoms that do not correlate with imaging findings. Early recognition and a systematic arthroscopic approach can lead to favorable outcomes, but the complexity of these lesions requires careful technique and attention to patient safety throughout the procedure.
