Anatomic Analysis of the Attachment of the Posteroinferior Labrum and Capsule to the Glenoid: A Cadaveric Study


      To measure the height of the posteroinferior glenohumeral ligament (PIGHL) attachment to the labrum and the depth of the posteroinferior labrum to the glenoid, macroscopically, and to investigate the morphology of the attachment of the posteroinferior labrum to the glenoid, histologically.


      Fifty cadaveric shoulders without exposed subchondral bone on the glenoid and detached posterior labrum were used. We examined the frequency of the heights of the PIGHL attachments to the labrum and the length of the labral attachment on the glenoid rim at the 7, 8, 9, and 10 o’clock positions, macroscopically. According to morphology of the histological labral attachments, it was divided into 3 groups. Labra attached on the articular surface and the glenoid neck were defined as the SN type, while labra attached only to the glenoid neck constituted labra attached to the bone and side of the articular cartilage (Nc type) and labra attached only to bone (Nb type).


      The PIGHL attached from 7 o’clock to 9 o’clock in 48 shoulders (96%). The mean labral attachment at the 7 o’clock position was 6.3 ± 1.0 mm (range, 4.6-9.4 mm), which was significantly longer than at the other positions (P < .05). Histologically, the frequency of SN type attachment was 49 (98%) shoulders at the 7 o’clock position.


      The PIGHL attached between 7 and 9 o’clock in 96% of the shoulders. In 98% of the shoulders, the labrum did not attach to the articular surface, but attached to both the articular cartilage and the bone of the glenoid neck at 7 o’clock.

      Clinical Relevance

      The posteroinferior labrum should be repaired widely at the 7 o'clock position and not on the articular surface because the labrum attached anatomically to the glenoid neck.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bottoni C.R.
        • Franks B.R.
        • Moore J.H.
        • DeBerardino T.M.
        • Taylor D.C.
        • Arciero R.A.
        Operative stabilization of posterior shoulder instability.
        Am J Sports Med. 2005; 33: 996-1002
        • Owens B.D.
        • Duffey M.L.
        • Nelson B.J.
        • DeBerardino T.M.
        • Taylor D.C.
        • Mountcastle S.B.
        The incidence and characteristics of shoulder instability at the United States Military Academy.
        Am J Sports Med. 2007; 35: 1168-1173
        • DeLong J.M.
        • Jiang K.
        • Bradley J.P.
        Posterior instability of the shoulder: A systematic review and meta-analysis of clinical outcomes.
        Am J Sports Med. 2015; 43: 1805-1817
        • Smark C.T.
        • Barlow B.T.
        • Vachon T.A.
        • Provencher M.T.
        Arthroscopic and magnetic resonance arthrogram features of Kim's lesion in posterior shoulder instability.
        Arthroscopy. 2014; 30: 781-784
        • Blasier R.B.
        • Soslowsky L.J.
        • Malicky D.M.
        • Palmer M.L.
        Posterior glenohumeral subluxation: Active and passive stabilization in a biomechanical model.
        J Bone Joint Surg Am. 1997; 79: 433-440
        • Kim S.H.
        • Ha K.I.
        • Yoo J.C.
        • Noh K.C.
        Kim's lesion: An incomplete and concealed avulsion of the posteroinferior labrum in posterior or multidirectional posteroinferior instability of the shoulder.
        Arthroscopy. 2004; 20: 712-720
        • Kim S.H.
        • Kim H.K.
        • Sun J.I.
        • Park J.S.
        • Oh I.
        Arthroscopic capsulolabroplasty for posteroinferior multidirectional instability of the shoulder.
        Am J Sports Med. 2004; 32: 594-607
        • Radkowski C.A.
        • Chhabra A.
        • Baker 3rd, C.L.
        • Tejwani S.G.
        • Bradley J.P.
        Arthroscopic capsulolabral repair for posterior shoulder instability in throwing athletes compared with nonthrowing athletes.
        Am J Sports Med. 2008; 36: 693-699
        • Provencher M.T.
        • LeClere L.E.
        • King S.
        • et al.
        Posterior instability of the shoulder: Diagnosis and management.
        Am J Sports Med. 2011; 39: 874-886
        • Burt D.M.
        Arthroscopic repair of inferior labrum from anterior to posterior lesions associated with multidirectional instability of the shoulder.
        Arthrosc Tech. 2014; 3: e727-e730
        • Bey M.J.
        • Hunter S.A.
        • Kilambi N.
        • Butler D.L.
        • Lindenfeld T.N.
        Structural and mechanical properties of the glenohumeral joint posterior capsule.
        J Shoulder Elbow Surg. 2005; 14: 201-206
        • Itoigawa Y.
        • Itoi E.
        Anatomy of the capsulolabral complex and rotator interval related to glenohumeral instability.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 343-349
        • Itoigawa Y.
        • Itoi E.
        • Sakoma Y.
        • Yamamoto N.
        • Sano H.
        • Kaneko K.
        Attachment of the anteroinferior glenohumeral ligament-labrum complex to the glenoid: an anatomic study.
        Arthroscopy. 2012; 28: 1628-1633
        • Yoshida M.
        • Goto H.
        • Nozaki M.
        • et al.
        Quantitative analysis of attachment of the labrum to the glenoid fossa: A cadaveric study.
        J Orthop Sci. 2015; 20: 823-829
        • Momma D.
        • Nimura A.
        • Muro S.
        • et al.
        Anatomic analysis of the whole articular capsule of the shoulder joint, with reference to the capsular attachment and thickness.
        J Exp Orthop. 2018; 5: 16
        • O'Brien S.J.
        • Neves M.C.
        • Arnoczky S.P.
        • et al.
        The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder.
        Am J Sports Med. 1990; 18: 449-456
        • Pouliart N.
        • Somers K.
        • Gagey O.
        Arthroscopic glenohumeral folds and microscopic glenohumeral ligaments: The fasciculus obliquus is the missing link.
        J Shoulder Elbow Surg. 2008; 17: 418-430
        • Cooper D.E.
        • Arnoczky S.P.
        • O'Brien S.J.
        • Warren R.F.
        • DiCarlo E.
        • Allen A.A.
        Anatomy, histology, and vascularity of the glenoid labrum. An anatomical study.
        J Bone Joint Surg Am. 1992; 74: 46-52