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Gregori P, Maffulli N, Abboud J, Za P, Giurazza G, Papalia GF, Ferrini A, Franceschetti E. Return to Sport at Preinjury Level is Common After Surgical Treatment of SLAP Lesions: A Systematic Review and a Meta-analysis. Sports Med Arthrosc Rev 2024; 32:2-11. [PMID: 38695497 DOI: 10.1097/jsa.0000000000000383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
BACKGROUND Patients undergoing surgery for Superior-Labrum-anterior-to-posterior (SLAP) lesions are often worried about their return to sport performance. This systematic review determined the rate of return to sport and return to sport at the previous level (RTSP) after surgery for SLAP lesion. MATERIALS AND METHODS The PRISMA guidelines were followed. Meta-analysis of data through forest plot projections was conducted. Studies were divided and analyzed according to the type of interventions (isolated slap repair or SLAP repair with rotator cuff debridement and biceps tenodesis). RESULTS The mean overall rate of return to sport after the procedures was 90.6% and the mean overall rate of return to sport at the previous level after the procedures was 71.7%. RTSP rates of the whole population were 71% (95% CI: 60%-80%), 66% (95% CI: 49%-79%), and 78% (95% CI: 67%-87%) for isolated SLAP repair, SLAP repair with the rotator cuff debridement and biceps tenodesis, respectively. A lack of subgroup analysis for the specific performance demand or type of lesion related to the surgical technique used might induce a high risk of bias. DISCUSSION Return to sports at the previous level after surgically treated superior labrum anterior to posterior lesion is possible and highly frequent, with the highest rates of RTSP in patients treated with biceps tenodesis. More studies and better-designed trials are needed to enrich the evidence on indications of SLAP surgical treatment in relation to specific sports-level demand. LEVEL OF EVIDENCE Level-IV.
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Affiliation(s)
- Pietro Gregori
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, Italy
- Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Salerno, Italy
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, England
| | | | - Pierangelo Za
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, Italy
- Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, Italy
| | - Giancarlo Giurazza
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, Italy
- Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, Italy
| | - Giuseppe Francesco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, Italy
- Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, Italy
| | - Augusto Ferrini
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, Italy
- Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, Italy
| | - Edoardo Franceschetti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, Italy
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Migliorini F, Asparago G, Cuozzo F, Oliva F, Hildebrand F, Maffulli N. Patient outcomes and return to play after arthroscopic rotator cuff repair in overhead athletes: a systematic review. J Orthop Traumatol 2023; 24:3. [PMID: 36656423 PMCID: PMC9852377 DOI: 10.1186/s10195-023-00683-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Rotator cuff tear injuries in overhead athletes are common and may lead to chronic pain and joint disability, impairing sport participation and leading to premature retirement. The improvement of the patient reported outcome measures (PROMs) was evaluated, as were the time and level of return to sport and the rate of complication in overhead athletes who had undergone arthroscopic rotator cuff repair. METHODS This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the 2020 PRISMA statement. In September 2022, the following databases were accessed: Pubmed, Web of Science, Google Scholar and Embase. No time constraints were used for the search. All the clinical trials investigating arthroscopic rotator cuff repair in overhead athletes were accessed. RESULTS Data from 20 studies were collected. The mean length of the follow-up was 40 months. All PROMs improved at last follow-up: Kerlan-Jobe Orthopaedic Clinic score (P = 0.02), visual analogue scale (P = 0.003), Constant score (P < 0.0001), University of California Los Angeles Shoulder score (P = 0.006) and American Shoulder and Elbow Surgeons' score (P < 0.0001). Elevation also improved (P = 0.004). No difference was found in external and internal rotation (P = 0.2 and P = 0.3, respectively). In total, 75.4% (522 of 692 of patients) were able to return to play within a mean of 6.4 ± 6.0 months. Of 692 patients, 433 (62.5%) were able to return to sport at pre-injury level. Fourteen out of 138 patients (10.1%) underwent a further reoperation. The overall rate of complications was 7.1% (20 of 280). CONCLUSION Arthroscopic reconstruction of the rotator cuff is effective in improving function of the shoulder in overhead athletes, with a rate of return to sport in 75.4% of patients within an average of 6.4 months. LEVEL OF EVIDENCE III, systematic review. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Filippo Migliorini
- grid.412301.50000 0000 8653 1507Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Giovanni Asparago
- grid.11780.3f0000 0004 1937 0335Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA Italy
| | - Francesco Cuozzo
- grid.11780.3f0000 0004 1937 0335Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA Italy
| | - Francesco Oliva
- grid.11780.3f0000 0004 1937 0335Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA Italy
| | - Frank Hildebrand
- grid.412301.50000 0000 8653 1507Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Nicola Maffulli
- grid.11780.3f0000 0004 1937 0335Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA Italy ,grid.9757.c0000 0004 0415 6205Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, ST4 7QB Stoke On Trent, England ,grid.4868.20000 0001 2171 1133Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, E1 4DG London, England
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Recker AJ, Waters TL, Bullock G, Rosas S, Scholten DJ, Nicholson K, Waterman BR. Biceps Tenodesis Has Greater Expected Value Than Repair for Isolated Type II SLAP Tears: A Meta-analysis and Expected-Value Decision Analysis. Arthroscopy 2022; 38:2887-2896.e4. [PMID: 35662668 DOI: 10.1016/j.arthro.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/04/2022] [Accepted: 05/13/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To use an expected-value decision analysis to determine the optimal treatment decision between repair and biceps tenodesis (BT) for an isolated type II SLAP injury. METHODS An expected-value decision analysis with sensitivity analysis was performed to systematically quantify the clinical decision. To determine outcome probabilities, a decision tree was constructed (repair vs BT) and a meta-analysis was conducted. To determine outcome utilities, we evaluated 70 patients with a chief complaint of shoulder pain regarding age, sex, Shoulder Activity Level, and visual analog scale score in terms of potential outcome preferences. Statistical fold-back analysis was performed to determine the optimal treatment. One-way sensitivity analysis determined the effect of changing the reinjury rate on the expected value of BT. RESULTS The overall expected value was 8.66 for BT versus 7.19 for SLAP repair. One-way sensitivity analysis showed that BT was the superior choice if reinjury rates were expected to be lower than 28%. Meta-analysis of 23 studies and 908 patients revealed that the probability of a "well" outcome was significantly greater for BT (87.8%; 95% confidence interval [CI], 74.9%-94.6%; I2 = 0.0%) than for SLAP repair (62.9%; 95% CI, 55.9%-69.3%; I2 = 65.9%; P = .0023). The rate of reinjury was 1.5% for BT (95% CI, 0.05%-33.8%; I2 = 0.0%) and 6.4% for repair (95% CI, 4.2%-9.6%; I2 = 24%), which was not statistically significantly different (P = .411). A total of 50 participants (mean age, 25.4 years [standard deviation, 8.9 years]; 76% male patients; 50% overhead athletes) met the inclusion criteria. Forty-six percent of participants had a high Shoulder Activity Level score. CONCLUSIONS Decision analysis showed that BT is preferred over repair for an isolated type II SLAP tear based on greater expected value of BT versus repair. Meta-analysis showed more frequent favorable outcomes with BT. Surgeons can use this information to tailor discussions with patients. LEVEL OF EVIDENCE Level IV, meta-analysis of Level I-IV studies.
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Affiliation(s)
- Andrew J Recker
- Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Timothy L Waters
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Garrett Bullock
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A.; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, England
| | - Samuel Rosas
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Donald J Scholten
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Kristen Nicholson
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Brian R Waterman
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A..
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Cavalcante MLC, Fernandes EG, Pinheiro Júnior JA, Jamacaru FVF, Coelho JVDV, Leite JAD. Análise de terminações nervosas no complexo labrum-bíceps superior usando imunohistoquímica de fluorescência e microscopia a laser confocal. Rev Bras Ortop 2021; 57:863-867. [PMID: 36226223 PMCID: PMC9550355 DOI: 10.1055/s-0040-1722579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/16/2020] [Indexed: 11/02/2022] Open
Abstract
Resumo
Objetivos As estruturas capsulo-ligamentares do ombro funcionam como estabilizadores estáticos, juntamente com os músculos do bíceps e do manguito rotador, aumentando a superfície de contato da cavidade glenoide. Terminações nervosas livres e mecanorreceptores foram identificados no ombro; no entanto, existem alguns estudos que descrevem a presença desses nervos na inserção do bíceps. Este estudo teve como objetivo descrever a morfologia e distribuição de terminações nervosas utilizando imunofluorescência com protein gene product 9.5 (PGP 9.5) e microscopia confocal.
Métodos Foram estudados seis complexos labrum-bíceps de seis cadáveres congelados frescos. Os espécimes foram cortados coronalmente e preparados pelo método de imunofluorescência. Tanto em hematoxilina e eosina (H&E) quanto em imunofluorescência, foi descrita a organização do tecido conjuntivo com fibras paralelas de colágeno.
Resultados No estudo de H&E, foram visualizadas estruturas vasculares e algumas estruturas nervosas, que foram identificadas pela presença alongada da célula nervosa. Todas as amostras analisadas com imunofluorescência e microscopia confocal demonstraram baixa ocorrência de morfotipos de corpúsculos sensoriais e terminações nervosas livres. Identificamos terminações nervosas livres localizadas no labrum, inserção bicipital e terminações nervosas esparsas ao longo do tendão. Terminais corpusculares com aspecto fusiforme, cuneiforme e oval foram identificados no tendão.
Conclusão Esses achados corroboram a hipótese de que a geração de dor nas lesões labrais superiores de anterior a posterior (SLAP, na sigla em inglês) deriva da parte mais proximal do cabo longo do bíceps e ainda mais do labrum superior. Estudos quantitativos futuros com um número maior de espécimes podem fornecer mais informações sobre esses sistemas sensoriais.
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Affiliation(s)
- Maria L. C. Cavalcante
- Departamento de Ortopedia, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, CE, Brasil
| | - Eduardo G. Fernandes
- Departamento de Ortopedia, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, CE, Brasil
| | - José A. Pinheiro Júnior
- Departamento de Ortopedia, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, CE, Brasil
| | | | - José Victor de V. Coelho
- Departamento de Ortopedia, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, CE, Brasil
| | - José Alberto Dias Leite
- Departamento de Ortopedia, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, CE, Brasil
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THE SUCCESS OF RETURN TO SPORT AFTER SUPERIOR LABRUM ANTERIOR TO POSTERIOR (SLAP) TEARS: A SYSTEMATIC REVIEW AND META-ANALYSIS. Int J Sports Phys Ther 2020; 15:659-670. [PMID: 33110685 DOI: 10.26603/ijspt20200659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Reviews on superior labral anterior to posterior (SLAP) injuries have been reported in the literature. However, current reviews have not focused on the success of athletes return to their previous level of sport or athletic performance. Hypothesis/Purpose Systematically review return to sport (RTS) and return to sport at previous level (RTSP) proportions after SLAP injury while reporting any additional performance metrics and outcome measures. Study Design Systematic Review & Meta-Analysis. Methods A computer assisted literature search of MEDLINE, CINAHL, Embase and SportDiscus databases utilizing keywords related to RTS post-surgery for SLAP tear was implemented. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were utilized for study methodology. Quality assessment utilized the MINORS scale. Results Twenty-two studies (617 athletes) qualified for analysis. Based on limited evidence from level 3b to 4 studies, athletes RTS post intervention for SLAP injury occurred at a rate of 93% (95% CI:87 to 98%) and overall RTSP rate was 72% (95% CI:60 to 83%). The mean time to RTS post intervention was reported in 59% of studies at 6.9 ± 2.9 months. Patient reported outcome measures (PROM's) were reported in 86% of studies. There was limited reporting of performance statistics, rehabilitation guidelines, return to sport criteria, and information regarding SLAP diagnosis in the available studies. None of the included studies reported post-surgical athletic performance or career longevity. Conclusions Limited evidence suggests that less than three in four athletes return to their previous level of sport participation after SLAP injury intervention. Treatment success for an athlete with SLAP injury remains relatively unknown as only 59% of included studies clearly delineate RTS from RTSP and neither athletic performance nor career longevity were reported in any included studies. Future studies of higher quality are required for this determination. Level of Evidence Level 1a.
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Fanning E, Maher N, Cools A, Falvey EC. Outcome Measures After Shoulder Stabilization in the Athletic Population: A Systematic Review of Clinical and Patient-Reported Metrics. Orthop J Sports Med 2020; 8:2325967120950040. [PMID: 32984424 PMCID: PMC7498977 DOI: 10.1177/2325967120950040] [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: 03/21/2020] [Accepted: 04/07/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Athletic endeavor can require the “athletic shoulder” to tolerate significant
load through supraphysiological range and often under considerable
repetition. Outcome measures are valuable when determining an athlete’s safe
return to sport. Few data are available to guide a clinician’s choice from
the variety of measures available. Purpose: To describe the use of quantifiable objective outcome measures and
patient-reported outcome tools after glenohumeral joint stabilization,
specifically in an athletic population. The secondary aim of our study was
to assess whether the method of measurement used was clearly described and
standardized to aid clinical interpretation. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of MEDLINE, Scopus, SPORTDiscus, and Web of Science
databases was performed in December 2018 based on the PRISMA (Preferred
Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. After
the application of selection criteria, a full review of identified papers,
and screening of reference lists, a total of 62 studies were included in the
review. All studies were independently appraised for quality, predefined
data fields were populated and cross-checked for accuracy, and results were
then summarized from these data fields. Results: Of the 62 included studies, 94% used a quantifiable objective clinical
outcome. A majority (85%) of the studies measured range of motion, 21%
recorded muscle strength, 5% measured electromyographic activity, 5%
examined shoulder kinematics, and 3% assessed joint proprioception after
surgery. However, only 18% of the studies clearly described a standardized
method of measuring the outcome. Nearly all (95%) of the studies used at
least 1 patient-reported outcome measure. The Rowe score was most commonly
used (35%). Conclusion: We must standardize and clearly describe the use of quantifiable objective
outcome measures to aid clinical interpretation. A concerted effort should
also be made to standardize the use of patient-reported outcome tools after
shoulder stabilization in the athletic population.
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Affiliation(s)
- Edel Fanning
- Sports Surgery Clinic, Sports Medicine, Dublin, Ireland.,University College Cork, Cork, Ireland
| | - Natasha Maher
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, West Yorkshire, UK
| | - Ann Cools
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Gent, Belgium
| | - Eanna C Falvey
- Sports Surgery Clinic, Sports Medicine, Dublin, Ireland.,University College Cork, Cork, Ireland
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Molecular Pattern and Density of Axons in the Long Head of the Biceps Tendon and the Superior Labrum. J Clin Med 2019; 8:jcm8122129. [PMID: 31816921 PMCID: PMC6947398 DOI: 10.3390/jcm8122129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 11/24/2019] [Accepted: 11/26/2019] [Indexed: 01/02/2023] Open
Abstract
The type II superior labrum anterior to posterior (SLAP) repair is a viable option in young and demanding patients, although a prolonged period of pain after surgery is described in the literature. The reason for this fact remains unknown. Thus, the purpose of this study was to investigate the molecular pattern of the biceps tendon anchor, where the sutures for repair are placed. The long head of the biceps tendon (LHBT), including the superior labrum, was dissected in the setting of reverse total shoulder arthroplasty. Immunohistochemical staining was performed using neurofilament (NF) and protein gene product (PGP) 9.5 as general markers for axons and calcitonin gene-related peptide (CGRP) and substance P for nociceptive transmission. A quantitative assessment was performed according to the two regions of interest (ROIs), i.e., the anterosuperior (ROI I) and the posterosuperior labrum (ROI II). Eleven LHBTs with a mean age of 73 years (range: 66–87 years) were harvested intraoperatively. Six LHBTs were gained in osteoarthrosis and five in fractures. We found an inhomogeneous distribution of axons in the anterosuperior and posterosuperior parts of the labrum in all the specimens irrespective of the age, gender, and baseline situation. There was a significantly higher number (p < 0.01) as well as density (p < 0.001) of NF-positive axons in ROI I compared to ROI II. Nociceptive fibers were always found along the NF-positive axons. Thus, our results indicate that the biceps tendon anchor itself is a highly innervated region comprising different nerve qualities. The anterosuperior labrum contains a higher absolute number and density of axons compared to the posterosuperior parts. Furthermore, we were able to prove the presence of nociceptive fibers in the superior labrum. The results obtained in this study could contribute to the variability of pain after SLAP repair.
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8
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Reinig Y, Welsch F, Hoffmann R, Müller D, Gramlich S, Fischer S, Schüttler KF, Zimmermann E, Stein T. Assessments of activities of daily living after arthroscopic SLAP repair with knot-tying versus knotless suture anchors. Arch Orthop Trauma Surg 2019; 139:981-990. [PMID: 30820694 DOI: 10.1007/s00402-019-03151-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Indexed: 01/02/2023]
Abstract
PURPOSE The clinical influence of knot-tying or knotless anchor systems for the arthroscopic repair of SLAP lesions (superior labrum lesion from anterior to posterior) remain unclear. MATERIALS AND METHODS In a retrospective cohort analysis, 61 of 78 (78.2%) patients with isolated symptomatic SLAP II lesions were examined with a minimum of 24 months after arthroscopic SLAP repair compared to a control group: 28 patients with knot-tying anchors (group I, G1; 28.95 ± 9.48 years, 23 male/5 female), 33 with knotless anchors (group II, G2; 31 ± 10.09 years, 26 male/7 female) and 140 healthy volunteers (group III, G3; 30.9 ± 8.9 years, 109 male/31 female). The clinical assessment included an examination and estimated parameters of ADL (activities of daily living), the CS (Constant score), ASES (American Shoulder and Elbow score), DASH (disability of arm-shoulder hand) and the RS (Rowe score). RESULTS The ROM analysis recorded no significant differences for the external rotation in 0° abduction (G1 63.75° ± 15.55° versus = vs G2 65.30° ± 18.15°; pERG1 vs G2 = 0.72). The clinical outcomes revealed significantly decreased pain status in G1 for the O'brien test and in G2 for the Palm-up test, whereas Yergason test showed similar pain levels (pO'brien = 0.03; ppalm up = 0.02; pyergason > 0.5). The pulley associated rotator cuff tests revealed a significantly inferior force status in G2 compared to G1 (plift-off = 0.005, pJobe = 0.02) whereas the further rotator cuff assessments were equal. In general, the intervention group showed increased pain level and functional deficits compared to the G3. The score analysis detected no significant differences with PCSG1 vs G2, PASESG1 vs G2, PDASHG1 vs G2 and PRSG1 vs G2 all > 0.05 and significant impairments compared to G3 in all scores pG1/G2 vs G3 < 0.05 (CSG1 = 88.28 ± 14.42, CSG2=92.73 ± 9.24, CSG3 = 96.2 ± 4.96; ASESG1 = 81.10 ± 21.69, ASESG2 = 85.35 ± 17.12, ASESG3 = 94.95 ± 10.39,; DASHG1= 35.75 ± 13.44, DASHG2 = 36.03 ± 17.55, DASHG3 = 27.13 ± 6.52; RSG1 = 90.71 ± 9.88, RSG2 = 88.33 ± 11.22, RSG3= 92.96 ± 11.27). CONCLUSIONS The clinical assessment revealed for both anchor systems similar outcomes but showed general underestimated impairments after the SLAP repair surgery compared to the healthy control. The clinical status only marginally differed between both techniques, wherefore the present assessment of ADL allowed no recommendation of one of these two specific surgery technique for SLAP repair.
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Affiliation(s)
- Y Reinig
- Department of Sporttraumatology-Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - F Welsch
- Department of Sporttraumatology-Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany
| | - R Hoffmann
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - D Müller
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - S Gramlich
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - S Fischer
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - K F Schüttler
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Marburg, Germany
| | - E Zimmermann
- Department of Sports Science, University of Bielefeld, Bielefeld, Germany
| | - Thomas Stein
- Department of Sporttraumatology-Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany.
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany.
- Department of Sports Science, University of Bielefeld, Bielefeld, Germany.
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Abdul-Rassoul H, Defazio M, Curry EJ, Galvin JW, Li X. Return to Sport After the Surgical Treatment of Superior Labrum Anterior to Posterior Tears: A Systematic Review. Orthop J Sports Med 2019; 7:2325967119841892. [PMID: 31106221 PMCID: PMC6506928 DOI: 10.1177/2325967119841892] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background: Controversy exists as to the optimal treatment of superior labrum anterior to
posterior (SLAP) tears in athletes. There are no systematic reviews
evaluating return-to-sport (RTS) rates after arthroscopic SLAP repair and
biceps tenodesis. Purpose: To compare the overall RTS rates in patients with primary type 2 SLAP tears
who were managed with arthroscopic SLAP repair versus biceps tenodesis. Study Design: Systematic review; Level of evidence, 4. Methods: A review was performed according to the PRISMA (Preferred Reporting Items for
Systematic Reviews and Meta-Analyses) guidelines by searching the MEDLINE
(PubMed), Embase (Elsevier), and Cochrane Library databases. Inclusion
criteria were clinical studies that evaluated RTS rates after arthroscopic
SLAP repair, arthroscopic SLAP repair with partial rotator cuff debridement,
and biceps tenodesis. The studies were analyzed for quality and inclusion in
the final analysis. Data relevant to RTS rates were then extracted and
compiled, and outcomes were compared. Results: Of the 337 studies initially identified, 15 (501 patient-athletes) met
inclusion criteria. These consisted of 195 patients who underwent isolated
arthroscopic SLAP repair (mean age, 31 years; mean follow-up, 3.2 years),
222 patients who underwent arthroscopic SLAP repair with partial rotator
cuff debridement (mean age, 22 years; mean follow-up, 5.1 years), and 84
patients who underwent biceps tenodesis (mean age, 42 years; mean follow-up,
3.3 years). The overall RTS rates were high for all 3 procedures (SLAP
repair, 79.5%; SLAP repair with rotator cuff debridement, 76.6%; biceps
tenodesis, 84.5%), with biceps tenodesis having the highest overall rate.
Biceps tenodesis also had the highest RTS rate at the preinjury level
(78.6%) compared with SLAP repair (63.6%) and SLAP repair with rotator cuff
debridement (66.7%). Conclusion: Primary arthroscopic SLAP repair, arthroscopic SLAP repair with partial
rotator cuff debridement, and biceps tenodesis all provide high RTS rates.
Biceps tenodesis as an operative treatment of primary SLAP lesions may
demonstrate an overall higher RTS rate when compared with traditional SLAP
repair in older athletes. More, higher level studies are needed that control
for age, level of activity, and type of sport (overhead vs nonoverhead) to
determine the efficacy of biceps tenodesis as a primary alternative to
arthroscopic SLAP repair in young athletes who present with type 2 SLAP
tears.
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Affiliation(s)
- Hussein Abdul-Rassoul
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Matthew Defazio
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Emily J Curry
- Boston University School of Public Health, Boston, Massachusetts, USA
| | - Joseph W Galvin
- Department of Orthopedics, Blanchfield Army Community Hospital Orthopedic Clinic, Fort Campbell, Kentucky, USA
| | - Xinning Li
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
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10
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Boesmueller S, Nógrádi A, Heimel P, Albrecht C, Nürnberger S, Redl H, Fialka C, Mittermayr R. Neurofilament distribution in the superior labrum and the long head of the biceps tendon. J Orthop Surg Res 2017; 12:181. [PMID: 29166912 PMCID: PMC5700685 DOI: 10.1186/s13018-017-0686-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 11/14/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The postoperative course after arthroscopic superior labrum anterior to posterior (SLAP) repair using suture anchors is accompanied by a prolonged period of pain, which might be caused by constriction of nerve fibres. The purpose was to histologically investigate the distribution of neurofilament in the superior labrum and the long head of the biceps tendon (LHBT), i.e. the location of type II SLAP lesions. METHODS Ten LHBTs including the superior labrum were dissected from fresh human specimen and immunohistochemically stained against neurofilament (NF). All slides were scanned at high resolution and converted into tagged image file format, and regions of interest (ROIs) were defined as follows: ROI I-superior labrum anterior to the LHBT origin, ROI II-mid-portion of the superior labrum at the origin of the LHBT, ROI III-superior labrum posterior to the LHBT origin and ROI IV-the most proximal part of the LHBT before its attachment to the superior labrum. The entire images were automatically segmented according to the defined ROIs and measured using a programmed algorithm specifically created for this purpose. The NF-positive cells were counted, and their total size and the area of other tissue were measured separately for the different ROIs. RESULTS Distribution of NF-positive cells in absolute numbers revealed a clear but insignificantly higher amount in favour of ROI I, representing the superior labrum anterior to the LHBT origin. Setting ROI I at 100%, a significant difference could be seen compared to ROI III, representing the superior labrum posterior to the LHBT origin (ROI I vs. ROI III with a p value < 0.05). CONCLUSIONS Summarizing, the density of neurofilament is inhomogeneously distributed throughout the superior labrum with the highest number of neurofilament in the anterior superior labrum. Thus, suture placement in type II SLAP repair could play an important role for the postoperative pain-related outcome.
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Affiliation(s)
- Sandra Boesmueller
- AUVA Trauma Center Meidling, Kundratstraße 37, 1120, Vienna, Austria. .,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstraße 13, 1200, Vienna, Austria.
| | - Antal Nógrádi
- Department of Anatomy, Histology and Embryology, University of Szeged, Kossuth L. sgt 40, Szeged, 6724, Hungary
| | - Patrick Heimel
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstraße 13, 1200, Vienna, Austria.,Bernhard Gottlieb University Clinic of Dentistry, Sensengasse 2A, 1090, Vienna, Austria
| | - Christian Albrecht
- Department of Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Sylvia Nürnberger
- Department of Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstraße 13, 1200, Vienna, Austria
| | - Christian Fialka
- AUVA Trauma Center Meidling, Kundratstraße 37, 1120, Vienna, Austria.,Medical School, Department of Trauma, Sigmund Freud University, Freudplatz 1, 1020, Vienna, Austria
| | - Rainer Mittermayr
- AUVA Trauma Center Meidling, Kundratstraße 37, 1120, Vienna, Austria
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11
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Boesmueller S, Tiefenboeck TM, Hofbauer M, Bukaty A, Oberleitner G, Huf W, Fialka C. Progression of function and pain relief as indicators for returning to sports after arthroscopic isolated type II SLAP repair-a prospective study. BMC Musculoskelet Disord 2017; 18:257. [PMID: 28610563 PMCID: PMC5470215 DOI: 10.1186/s12891-017-1620-3] [Citation(s) in RCA: 9] [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: 10/20/2016] [Accepted: 06/06/2017] [Indexed: 01/02/2023] Open
Abstract
Background One of the currently used surgical techniques in isolated type II SLAP lesions is arthroscopic SLAP repair. Postoperatively, patients tend to suffer from a prolonged period of pain and are restricted in their sports activities for at least 6 months. The aim of this study was to prospectively evaluate the clinical outcome as well as the postoperative course of pain after arthroscopic type II SLAP repair. Methods Outcome measures were assessed using the Individual Relative Constant Score (CSindiv), the American Shoulder and Elbow Surgeons (ASES) Score, the Visual Analogue Scale (VAS), and the Short Form 36 (SF-36). Data were collected preoperatively, as well as at 3, 6, 12 and >24 months postoperatively. Results Eleven patients with an average age of 31.8 years (range: 22.8-49.8 years) underwent arthroscopic repair of isolated type II SLAP lesions. Mean follow-up time was 41.9 months (range: 36.1–48.4 months). 6 months after surgery, there was a statistically significant improvement of function according to the CSindiv (p = 0.004), the ASES Score (p = 0.006), and the SF-36 subscale “physical functioning” (p = 0.014) and a statistically significant decrease of pain according to the VAS (p = 0.007) and the SF-36 subscale “bodily pain” (p = 0.022) compared to preoperative levels. Conclusions Arthroscopic repair of isolated type II SLAP lesions with suture anchors leads to a satisfactory functional outcome and return to pre-injury sports levels, with delayed, but significant pain relief observed 6 months after surgery. Thus, a return to sports should not be allowed earlier than 6 months after surgery, when patients have reached pain-free function and recovered strength. Trial registration Researchregistry1761 (UIN).
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Affiliation(s)
- Sandra Boesmueller
- AUVA Trauma Center Vienna Meidling, Kundratstraße 37, 1120, Vienna, Austria.
| | - Thomas M Tiefenboeck
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Marcus Hofbauer
- Department of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Adam Bukaty
- Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gerhard Oberleitner
- Department of Trauma Surgery, Wilhelminen Hospital Vienna, Montleartstraße 37, 1160, Vienna, Austria
| | - Wolfgang Huf
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christian Fialka
- AUVA Trauma Center Vienna Meidling, Kundratstraße 37, 1120, Vienna, Austria
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12
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Clinical outcome of arthroscopic SLAP repair: conventional vertical knot versus knotless horizontal mattress sutures. Knee Surg Sports Traumatol Arthrosc 2016; 24:464-9. [PMID: 25427975 DOI: 10.1007/s00167-014-3449-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 11/17/2014] [Indexed: 12/15/2022]
Abstract
PURPOSE Arthroscopic repair of type II superior labrum anterior to posterior (SLAP) tears yields variable results. In this study, the clinical outcomes of arthroscopic knotless horizontal mattress repair were compared to those of conventional vertical knot repair. METHODS Forty-six patients treated arthroscopically for isolated SLAP lesions were assessed. Forty-one of those patients underwent follow-up evaluations for a minimum of 2 years: 21 received vertical knot (group 1), while 20 received horizontal mattress (group 2). In group 1, an anchor was inserted at the superior glenoid. After relaying the sutures, knotting over the labral tissue was performed. In group 2, two strands were passed through the labrum and fixed into the glenoid with a bioabsorbable knotless anchor. Functional scores were evaluated preoperatively and at the final follow-up assessment. A visual analogue scale (VAS) for pain and range of motion (ROM) were assessed preoperatively, 2 months postoperatively and at the last follow-up visit. RESULTS There were no significant differences in functional scores between groups (n.s.). However, external rotation at the side, internal rotation at abduction and total ROM were better in group 2 at the last follow-up visit. At 2 months postoperatively, the VAS for pain and ROM of internal rotation at abduction were better in group 2. CONCLUSION At the final assessment, there were no significant differences in functional scores between the two groups. However, external rotation at the side, internal rotation at abduction and total ROM were better in group 2. LEVEL OF EVIDENCE Case-control study, Level III.
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13
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Boesmueller S, Fialka C, Pretterklieber ML. The arterial supply of the tendon of the long head of the biceps brachii in the human: A combined anatomical and radiological study. Ann Anat 2014; 196:449-55. [DOI: 10.1016/j.aanat.2014.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 08/12/2014] [Accepted: 08/18/2014] [Indexed: 12/29/2022]
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14
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Arthroscopic reconstruction of shoulder's labrum with extensive tears. Int J Surg 2013; 11:876-81. [PMID: 23917210 DOI: 10.1016/j.ijsu.2013.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 06/26/2013] [Accepted: 07/22/2013] [Indexed: 01/02/2023]
Abstract
BACKGROUND With the continuous development of arthroscopic techniques, the majority of superior labrum anterior-posterior (SLAP) lesions can be treated with minimally invasive endoscopic repair. The aim of this study was to determine the efficacy of arthroscopic capsulolabral reconstruction of SLAP lesions with extensive tears. METHODS Eighteen patients with SLAP lesions with extensive tears (median age, 27.50 years) were included in this study. Twelve patients had type-V SLAP lesions, 4 patients had type-VIII SLAP lesions, and 2 patients had deeply located SLAP lesions. The average duration of follow-up was 15.83 months (range, 11-22 months). Outcome measures included shoulder range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) and Constant-Murley scores, and visual analogue scale (VAS) pain score. RESULTS After arthroscopic surgery, shoulder forward flexion, shoulder external rotation, and external rotation in 90° of abduction were significantly greater than before surgery (169.5° vs. 165.5°, P = 0.001), (90° vs. 63.5°, P < 0.001), and (90° vs. 81.5°, P = 0.004), respectively. Median ASES and Constant-Murley scores after surgery were both 94 as compared to 77.0 and 77.5, respectively, before surgery (both, P < 0.001). The median VAS score decreased to 1.5 after surgery as compared to 6 before surgery (P < 0.001). CONCLUSIONS Arthroscopic repair of SLAP lesions with extensive tears can achieve good outcomes.
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