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Knapik DM, Kolaczko JG, Gillespie RJ, Salata MJ, Voos JE. Complications and Return to Activity After Arthroscopic Repair of Isolated Type II SLAP Lesions: A Systematic Review Comparing Knotted Versus Knotless Suture Anchors. Orthop J Sports Med 2020; 8:2325967120911361. [PMID: 32341926 PMCID: PMC7171991 DOI: 10.1177/2325967120911361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 10/04/2019] [Indexed: 01/02/2023] Open
Abstract
Background: Superior labral anterior to posterior (SLAP) tears are one of the most common injuries to the shoulder, with the type II variant representing the most frequently encountered subtype. Purpose: To systematically review the literature to better understand outcomes after arthroscopic repair of isolated type II SLAP lesions using knotted versus knotless anchors based on implant number, implant location, patient position, and portal position. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review investigating all studies in the literature between January 2000 and June 2019 reporting on patients undergoing arthroscopic repair for isolated type II SLAP lesions using knotted versus knotless suture anchors was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the PubMed, BIOSIS Previews, SPORTDiscus, PEDro, and Embase databases. Results: A total of 234 patients undergoing isolated arthroscopic repair of type II SLAP lesions using suture anchors were identified, with 76% (179/234) treated using knotted anchors versus 24% (55/234) treated using knotless anchors. Complications were reported in 12% of patients treated using knotted anchors versus no patients treated using knotless anchors (P = .008). The incidence of complications for knotted anchor repair was not significantly affected by patient position (P = .22) or portal position (P = .19). Using multiple regression analysis, we found no significant association with the incidence of complications when analyzing for anchor design (R2 = 0.02; P = .06) or anchor position (R2 = 0.02; P = .92). No significant difference in return-to-activity timing was appreciated based on anchor type (P = .28), patient position (P = .98), or portal position (P = .97) in patients treated using knotted anchors. Conclusion: Patients treated using knotted anchors were significantly more likely to experience a postoperative complication compared with patients treated using knotless anchors after arthroscopic repair of isolated type II SLAP lesions. Despite the increased incidence of a postoperative complication after knotted anchor fixation compared with knotless anchor fixation, multiple regression analysis showed that anchor design and anchor position were not significantly predictive of the incidence of complications. Given the increasing popularity of knotless anchor fixation, further study on the long-term outcomes after knotless repair for isolated type II SLAP lesions is warranted.
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Affiliation(s)
- Derrick M Knapik
- Sports Medicine Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jensen G Kolaczko
- Sports Medicine Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Robert J Gillespie
- Sports Medicine Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Michael J Salata
- Sports Medicine Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Cleveland Browns, Cleveland, Ohio, USA
| | - James E Voos
- Sports Medicine Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Cleveland Browns, Cleveland, Ohio, USA
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Labral Repair Versus Biceps Tenodesis for Primary Surgical Management of Type II Superior Labrum Anterior to Posterior Tears: A Systematic Review. Arthroscopy 2019; 35:1927-1938. [PMID: 31053457 DOI: 10.1016/j.arthro.2018.12.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/05/2018] [Accepted: 12/09/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the outcomes of SLAP repair versus biceps tenodesis (BT) for the index treatment of isolated type II SLAP tears. METHODS A search of PubMed, MEDLINE, and EMBASE was performed in April 2018 for English-language studies that presented outcomes data on patients with isolated type II SLAP tears treated with either SLAP repair or BT at the primary surgical time point. RESULTS Twenty-three studies (i.e., 2 randomized control trials, 7 retrospective cohort, 3 prospective cohort, 4 case-control, and 7 case series) were included. Isolated type II SLAP tears were treated via SLAP repair in 781 patients with a mean age of 35 years (range, 22-58 years) and a mean postoperative follow-up of 35 months (range, 3-63 months). BT was performed in 100 patients with a mean age of 44 years (range, 18-64 years) and a mean postoperative follow-up of 32 months (range, 24-75 months). Similar postoperative scores were noted in both the SLAP repair and BT groups for American Shoulder and Elbow Surgeons, Constant, University of California, Los Angeles, and visual analog scale pain scores. The rate of return to sports was 20% to 95% for SLAP repair and 73% to 100% for BT. Reoperation rates for SLAP repair and BT were 2.9% to 40% and 0% to 15.3%, respectively. CONCLUSIONS This study suggests that SLAP repair and BT are both acceptable as index treatment for isolated type II SLAP tears. SLAP repair remains the most commonly performed index procedure; however, BT appears equally efficacious and may represent an attractive alternative. LEVEL OF EVIDENCE Level IV, systematic review of Level I through IV studies.
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Arroyo W, Misenhimer J, Cotter EJ, Wang KC, Heida K, Pallis MP, Waterman BR. Effect of Anterior Anchor on Clinical Outcomes of Type II SLAP Repairs in an Active Population. Orthopedics 2019; 42:e32-e38. [PMID: 30403826 DOI: 10.3928/01477447-20181102-04] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/16/2018] [Indexed: 02/03/2023]
Abstract
This study evaluated the role of anchor position in persistence of pain and/or revision biceps tenodesis after arthroscopic repair of type II superior labrum anterior and posterior (SLAP) lesions and assessed for patient- and injury-specific variables influencing clinical outcomes. Active-duty service members who underwent arthroscopic repair of type II SLAP lesions between March 1, 2007, and January 23, 2012, were identified. Patients with less than 2-year clinical follow-up; type I, III, and IV SLAP lesions; and primary treatment with biceps tenodesis and/or rotator cuff repair at the time of index surgery were excluded. Demographic, preoperative, and operative variables, including anchor positions, were reviewed and evaluated for association with outcomes. Total failure rate (defined as either surgical and/or clinical failure), anchor position, and return to military function were the primary outcomes of interest. Forty-nine patients underwent type II SLAP repairs with a mean follow-up of 52.3 months. Forty-eight (97.9%) were men, and mean age was 35.2 years. Eleven patients (22%) underwent subsequent subpectoral biceps tenodesis. Forty patients (82%) returned to military function, whereas 9 patients (18%) had medical discharge for significant, rate-limiting, shoulder pain. Age was a significant predictor of surgical failure. Patients with anchor position anterior to the biceps attachment had no increased risk of clinical or surgical failure compared with patients with only posterior-based anchors. Anchor placement anterior to the biceps tendon was not associated with inferior outcomes. Younger age was shown to be a poor prognostic factor in patients' ability to return to active duty. Revision with biceps tenodesis showed significant utility in achieving good clinical outcomes and return to duty in more than 90% of patients. Patient-, injury-, and surgery-specific variables need to be identified as prognostic indicators so that clinical outcomes can continue to be improved. [Orthopedics. 2019; 42(1):e32-e38.].
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Alashkham A, Alraddadi A, Felts P, Soames R. Blood supply and vascularity of the glenoid labrum: Its clinical implications. J Orthop Surg (Hong Kong) 2018; 25:2309499017731632. [PMID: 28920546 DOI: 10.1177/2309499017731632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Tears of the glenoid labrum are common after dislocation of the glenohumeral joint. The outcome for healing or surgical reconstruction of the glenoid labrum relies on the extent of its vascularization. This study aims to evaluate the glenoid labrum blood supply and to determine its regional vascularity. MATERIALS AND METHODS A total of 140 shoulders (30 male and 40 female cadavers) were examined: mean age 81.5 years, range 53-101 years. All blood vessels around the glenohumeral joint were dissected and recorded. Ten specimens with the glenoid labrum and fibrous capsule attached were randomly selected and detached at the glenoid neck and subjected to decalcification. Sections (10-20 μm) were cut through the whole thickness of each specimen from the centre of the glenoid fossa perpendicular to the glenoid labrum at 12 radii corresponding to a clock face superimposed on the glenoid. Sections were stained using haematoxylin and eosin and then examined. RESULTS The blood supply to the glenoid labrum is by direct branches from the second part of the axillary artery, subscapular, circumflex scapular and anterior circumflex humeral and posterior circumflex humeral arteries, as well as branches of muscular arteries supplying the surrounding muscles. CONCLUSION This study shows that the glenoid labrum has a rich blood supply suggesting that, regardless of the types of the glenoid labrum lesions or their management, an excellent outcome for glenoid labrum healing and joint stability is possible. The observations also suggest that the blood supply to the glenoid labrum is sufficient, enabling its reattachment.
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Affiliation(s)
- Abduelmenem Alashkham
- 1 Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK.,2 Human Anatomy Department, Faculty of Medicine, University of Zawia, Zawia, Libya.,3 Centre for Human Anatomy, School of Biomedical Sciences, University of Edinburgh, Edinburgh, UK
| | - Abdulrahman Alraddadi
- 1 Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK.,4 King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Paul Felts
- 1 Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK
| | - Roger Soames
- 1 Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK
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A new anatomic technique for type II SLAP lesions repair. Knee Surg Sports Traumatol Arthrosc 2016; 24:456-63. [PMID: 25413594 DOI: 10.1007/s00167-014-3440-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 11/11/2014] [Indexed: 12/15/2022]
Abstract
PURPOSE A new and more anatomical technique for SLAP II lesions repair is described. It consists in the reattachment of the medial aspect of the biceps anchor to the superior glenoid neck with a mattress stitch posterior and medial to the biceps anchor and a simple stitch placed anteriorly to the biceps. METHODS From 2011 to 2012, 14 patients matching the inclusion criteria were selected for the study. A visual analogic scale, ROWE, UCLA, ASES and Constant scores were used to make evaluation. The passive ROM before surgery, at final follow-up, and the resumption of sports activities were analysed. RESULTS The Constant, ASES, UCLA and ROWE scores passed from 64.6 (SD 13.9), 76.9 (SD 22.4), 28.4 (SD 23.8) and 53.6 (SD 20.6) to, respectively, 92.6 (SD 11.8), 108.3 (SD 8.5), 33.6 (SD 2.7) and 96.5 (SD 7.2) at final follow-up. Of the four patients who had participated in agonistic overhead athletics preoperatively, all of them were able to return to their preinjury level. No complications were observed in the present study. CONCLUSION In our technique, the anatomy is respected leaving the articular aspect of the superior labrum loose and reinforcing the medial side. The clinical relevance of this work is that probably this technique could improve clinical results, giving a better mobility of the shoulder and a return to the same preoperative level in overhead athletes.
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External rotation and active supination CT arthrography for the postoperative evaluation of type II superior labral anterior to posterior lesions. Knee Surg Sports Traumatol Arthrosc 2016; 24:134-40. [PMID: 25274092 DOI: 10.1007/s00167-014-3350-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 09/22/2014] [Indexed: 01/02/2023]
Abstract
PURPOSE To evaluate the effectiveness of external rotation and active supination CT arthrography in postoperative evaluation by comparing it with neutral CT arthrography and analyzing its agreement with postoperative clinical results after the repair of type II superior labral anterior to posterior (SLAP) lesions. MATERIALS AND METHODS A total of 25 patients who had undergone CT arthrography in neutral, external rotation and active supination position at least 1 year after the arthroscopic repair of SLAP lesions were enrolled. Two radiologists independently evaluated the status of the repaired SLAP lesions with neutral CT arthrography and then with external rotation and active supination CT arthrography. RESULTS Five patients had residual symptoms and positive findings upon SLAP-specific examinations. Agreements between the presence of symptoms and radiologic diagnoses based on neutral CT arthrography were insignificant for reader 1 (κ = 0.138, p = n.s.) and significant for reader 2 (κ = 0.328, p = 0.027). However, agreements were highly significant in the analysis following the evaluation of external rotation and active supination CT arthrography for both readers (κ = 0.694, p < 0.001 in reader 1; κ = 0.783, p < 0.001 in reader 2). CONCLUSIONS The presence of contrast-filled gaps between the labrum and glenoid on neutral CT arthrography after SLAP repair is frequent with satisfactory clinical outcomes. Gaps without additional widening upon external rotation and active supination CT arthrography may suggest postoperatively stable biceps anchors, so this new method could minimize the overdiagnosis of recurrent SLAP lesions. Additional gap widening on external rotation and active supination CT arthrography could be related to a true recurrent SLAP lesion and the symptoms of the patients. LEVEL OF EVIDENCE Case series, Level IV.
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Simple versus horizontal suture anchor repair of Bankart lesions: which better restores labral anatomy? Arthroscopy 2013; 29:325-9. [PMID: 23290185 DOI: 10.1016/j.arthro.2012.08.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 08/17/2012] [Accepted: 08/22/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The goal of this study was to determine which suture repair technique better restores glenoid labrum height: horizontal sutures or simple sutures. METHODS Sixteen cadaveric glenoids, 8 per repair technique, were used to measure native labral height at the 3:00 to 6:00 positions in half-hour increments. A Bankart lesion was then created from 3:00 to 6:30. Height measurements at each time point were again taken after creation of the Bankart lesion. Repair with a 3-mm knotted suture anchor was then performed at 3:30, 4:30, and 5:30 with either a simple or horizontal suture technique, and postrepair heights were measured across all time points. RESULTS Significant decreases in height, as compared with native height, were observed at 3:30, 4:30, and 5:30 in the simple repair group. Decreases in height of 1.4 mm (P = .044), 2.1 mm (P = .030), and 1.1 (P = .034) were observed at 3:30, 4:30, and 5:30. There was no significant decrease in height at these respective time points in the horizontal repair group. CONCLUSIONS The in vitro horizontal mattress suture technique better restores labral height and anatomy when compared with a simple suture technique in the repair of acute Bankart lesions. CLINICAL RELEVANCE Compared with the simple suture technique, horizontal suture repair may provide increased stability to the glenohumeral construct.
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