Outcomes in surgical and conservative treatment of symptomatic non-traumatic shoulder labrum tears in the paediatric population: a systematic review
Bibliographic record
Abstract
Importance The glenoid labrum is an important static stabiliser of the glenohumeral joint. Consensus is lacking with regards to both conservative and surgical management options for non-traumatic labral tears in the paediatric population. Objective The questions that this review aims to answer are as follows: (1) What are the treatment options available for non-traumatic glenoidlabrum tears in the paediatric population? and (2) What are the patient-important outcomes following non-operative and operative treatment modalities? Evidence review In addition to published abstracts from 2011 to 2016 from the American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America and Pediatric Orthopaedic Society of North America, three electronic databases (MEDLINE, PubMed and EMBASE) were searched from inception to 19 January 2017 for studies on non-traumatic labral tears in the paediatric population. A systematic screen and data abstraction of titles, abstracts and full-text manuscripts were performed in duplicate, with descriptive statistics provided. The Methodological Index for Non-Randomised Studies was used to rate the quality of the included studies. Findings Six studies from an initial 587 retrieved were included, and they examined 12 patients (12 shoulders) with median age of 17 years (range 11–18.6 years), 7 of which were males, who were followed for a median duration of 29.5 months (range 6–48 months). The most common location of the labrum tears was superior labrum anterior to posterior in six patients. Overall, 11 patients were managed arthroscopically, with the most common surgical technique being an isolated arthroscopic labrum debridement in five patients. Furthermore, 9 of the 11 patients treated surgically returned to sports, typically by 6–7 months postoperatively. Moreover, the single patient treated non-operatively also returned to sports and experienced significant improvements in the European Quality of Life measure, American Shoulder and Elbow Surgeons score and function score. There were no complications or revision procedures reported. Conclusions and relevance In the paediatric population, literature investigating non-traumatic labral tears of the shoulder is scarce. However, based on the available data, patients are most frequently managed with arthroscopic labrum debridement. Furthermore, patients managed operatively and non-operatively experience good outcomes, including high rates of return to sports and no occurrence of complications and revision procedures. Level of evidence Level IV.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.025 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.008 |
| Bibliometrics | 0.008 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".