Arthroscopic Management of 270° Labral Tears

Labral tears involving greater than 180° around the glenoid are uncommon. Different combinations of labral lesions have been reported in the literature, indicating that variations exist in the extent of pathology. Current descriptions all include the superior labrum as part of the pathology; however, we have identified a series of young athletic patients with bidirectional instability without injury to the superior labrum. The focus of this review is on a 270° labral repair. Our definition of a 270° labral tear is one that starts anterior to the biceps anchor, extending inferiorly and posteriorly to the level of the posterior midglenoid. In effect, this is a three-quadrant lesion that does not involve the superior labrum and typically results from traumatic athletics. A thorough clinical assessment and appropriate imaging are studied before arthroscopic repair. For those planning on returning to their sport, arthroscopic 270° labral repair is necessary. A systematic surgical approach requires proper positioning, optimal portal placement, and working from posterior to anterior not only repairing the labrum but also retensioning the inferior glenohumeral ligament. Our preliminary results indicate this approach results in significantly improved outcomes.