Original Article
Arthroscopic and Magnetic Resonance Arthrogram Features of Kim's Lesion in Posterior Shoulder Instability

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Purpose

The purpose of this study was to describe the anatomic features of the glenoid and labrum for shoulders with and without Kim's lesions, as well as define the sensitivity, specificity, and reliability of magnetic resonance arthrogram for the detection of these lesions and determine the interobserver reliability of Kim's classification for posterior labral tears.

Methods

A retrospective, blinded analysis of 41 shoulders was performed. Twenty-one shoulders composed the Kim's lesion group. Three observers measured glenoid and chondrolabral retroversion and anterior and posterior labral height. The shoulders were classified as 1 of 3 types according to Kim's classification.

Results

There were no differences in glenoid version, chondrolabral version, glenoid depth, and labral height between the groups. The sensitivity, specificity, positive predictive value, and negative predictive value for diagnosing Kim's lesions were 85.7%, 75%, 78.3%, and 83.3%, respectively. The κ values for interobserver reliability for detecting and classifying Kim's lesions were 0.739 (substantial) and 0.329 (fair), respectively.

Conclusions

Patients with incomplete posteroinferior labral tears have similar retroversion (bony and soft tissue) and labral height to patients without posterior shoulder instability. The sensitivity, specificity, and reliability of magnetic resonance arthrogram for detecting these lesions are substantial. The interobserver reliability of Kim's classification is fair.

Level of Evidence

Level IV, retrospective case-control study.

Section snippets

Methods

Our institutional review board reviewed and approved this study. The study was designed as a retrospective case-control study. The senior surgeon treated all patients. The senior surgeon's database was used to identify a cohort of 21 consecutive shoulders (2008-2011) with arthroscopically confirmed Kim's lesions. Twenty consecutive control shoulders with conditions unrelated to posterior pathology, including SLAP tears, rotator cuff disease, and subacromial impingement, were selected from this

Results

We evaluated 41 shoulders in 38 patients. The mean age of the patients in the control group was 38.7 ± 2.33 years (range, 27 to 65 years). The mean age of Kim's lesion patients was 25.7 ± 1.27 years (range, 20 to 37 years). The age ranges were statistically different (P < .05). There were 37 men and 1 woman. The female patient was in the Kim's lesion group.

Glenoid and chondrolabral version was not statistically different between the Kim's lesion group and the control group (Table 2). Glenoid

Discussion

This study found no difference in glenoid version, chondrolabral version, glenoid depth, and labral height between patients with Kim's lesions and posterior instability versus a control group that did not have labral pathology. By use of MRA, the sensitivity, specificity, positive predictive value, and negative predictive value for diagnosing Kim's lesions were 85.7%, 75%, 78.3%, and 83.3%, respectively. The interobserver reliability for detecting Kim's lesions (2 orthopaedic PGY5 residents and

Conclusions

Patients with incomplete posteroinferior labral tears have similar retroversion (bony and soft tissue) and labral height to patients without posterior shoulder instability. The sensitivity, specificity, and reliability of MRA for detecting these lesions are substantial. The interobserver reliability of Kim's classification is fair.

Cited by (18)

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    Because some intact labral tissue superficial to the marginal crack remains attached to cartilage and because the labrum may not be displaced relative to the glenoid, the detachment only becomes apparent upon probing with the arthroscope. The Kim lesion is due to a posteriorly and inferiorly directed force typically experienced in young, active individuals performing overhead activities [1–3]. These forces stress the deep inferior portion of the labrum, where the inferior glenohumeral ligament attaches, and lead to tearing of the posterior labrum and detachment of its deep portion from the glenoid, initially sparing the chondrolabral junction.

  • ACR Appropriateness Criteria <sup>®</sup> Shoulder Pain–Traumatic

    2018, Journal of the American College of Radiology
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    There is no role for bone scintigraphy in assessment of shoulder instability. MR arthrography has been reported to have high sensitivity for detection of labral injury, ranging from 86% to 100% [19,58,61-64]; however, the issue of selection bias is inherent in the design of many of these retrospective studies [59]. For example, patient groups were identified at the time of arthroscopy, which selected patients with proven labral lesions as the study population instead of evaluating all patients with clinically unstable shoulders.

  • Comparison of Glenoid Version and Posterior Humeral Subluxation in Patients With and Without Posterior Shoulder Instability

    2017, Arthroscopy - Journal of Arthroscopic and Related Surgery
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    The average glenoid version was within the range of normal for both the control and the experimental groups in our study. Glenoid version was compared in a review of MRAs of patients with Kim lesions (superficial tearing between the posteroinferior labrum and the glenoid articular cartilage without complete detachment of the labrum5) compared with other shoulder pathology similar to that of our study (SLAP tears [superior labral tear from anterior to posterior], rotator cuff disease, and impingement).21 They found no difference in glenoid or chondrolabral version between groups.

  • Imaging Instability in the Contact Athlete: What to Look For

    2016, Operative Techniques in Sports Medicine
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    In addition, glenoid retroversion greater than −16° was found to be a risk factor for contralateral injury; however, glenoid retroversion was not correlated with increased risk of recurrence after repair (Fig. 11). When evaluating patients with a history of posterior instability resulting only in an incomplete posterior-inferior labral tear, or Kim’s lesion, glenoid version and labral height were similar to patients without a history of posterior shoulder instability.26 Outcomes of the treatment of glenohumeral joint instability have been correlated with a variety of intra-articular pathologies that occur because of instability events.

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The authors report the following potential conflict of interest or source of funding: M.T.P. receives support from AOSSM, OREF, AANA. Metcalf Meeting, AANA Fall Meeting, AAOS Program Committee Meeting.

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