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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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Green CK, Scanaliato JP, Fares AB, Czajkowski H, Dunn JC, Parnes N. Midterm Outcomes After Arthroscopic Repair of Type VIII SLAP Lesions in Active Duty Military Patients Younger Than 35 Years. Orthop J Sports Med 2022; 10:23259671221095908. [PMID: 35601738 PMCID: PMC9118435 DOI: 10.1177/23259671221095908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background Superior labrum from anterior to posterior (SLAP) lesions represent a significant cause of shoulder pain and disability among active duty members of the US military. However, few data exist regarding the surgical management of type VIII SLAP lesions. Hypothesis We hypothesized that arthroscopic repair would decrease pain and increase function at the midterm follow-up and allow for a high rate of maintenance of active duty status. Study Design Case series; Level of evidence, 4. Methods Consecutive active duty military patients were identified from January 2011 through June 2015 who underwent arthroscopic repair of type VIII SLAP lesions performed by a single surgeon. Patients were excluded if they underwent glenoid microfracture, other capsulolabral repair, or rotator cuff repair. Outcome measures were completed by patients within 1 week before surgery and at latest follow-up: pain visual analog scale, Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons shoulder score, and Rowe instability score. Results A total of 30 patients met the inclusion criteria for the study. The mean ± SD follow-up was 96.60 ± 10.91 months. At final follow-up, the mean visual analog scale score improved from 8.17 ± 1.6 to 1.63 ± 1.90 (P < .0001), the Single Assessment Numeric Evaluation score from 41.65 ± 16.78 to 87.63 ± 13.02 (P < .0001), the American Shoulder and Elbow Surgeons score from 36.47 ± 10.26 to 88.07 ± 13.94 (P < .0001), and the Rowe score from 35.33 ± 6.56 to 90.00 ± 14.68 (P < .0001). Three patients reported postoperative complications, and 1 progressed to further surgery. Overall, 90% of patients remained on active duty military service and were able to return to preinjury levels of work and recreational activity. The failure rate, defined as persistent instability or activity-limiting pain, was 10%. Conclusion The results of this study demonstrated favorable outcomes for the majority of patients after arthroscopic repair of type VIII SLAP lesions at midterm follow-up, supporting repair as a viable treatment option for type VIII SLAP tears in this patient population.
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Affiliation(s)
- Clare K. Green
- School of Medicine, The George Washington University, Washington, DC, USA
| | - John P. Scanaliato
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Austin B. Fares
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Hunter Czajkowski
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York, USA
- Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
| | - John C. Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York, USA
- Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
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Superior labral anterior and posterior (SLAP) lesions of the long bicep insertion on the glenoid: management in athletes. INTERNATIONAL ORTHOPAEDICS 2022; 46:1351-1360. [DOI: 10.1007/s00264-022-05385-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
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Hohmann E, Glatt V, Tetsworth K, Paschos N. Biomechanical Studies for Glenoid Based Labral Repairs With Suture Anchors Do Not Use Consistent Testing Methods: A Critical Systematic Review. Arthroscopy 2022; 38:1003-1018. [PMID: 34506885 DOI: 10.1016/j.arthro.2021.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/20/2021] [Accepted: 08/31/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this systematic review was to investigate variability in biomechanical testing protocols for laboratory-based studies using suture anchors for glenohumeral shoulder instability and SLAP lesion repair. METHODS A systematic review of Medline, Embase, Scopus, and Google Scholar using Covidence software was performed for all biomechanical studies investigating labral-based suture anchor repair for shoulder instability and SLAP lesions. Clinical studies, technical notes or surgical technique descriptions, or studies treating glenoid bone loss or capsulorrhaphy were excluded. Risk of bias (ROB) was assessed with the ROBINS-I tool. Study quality was assessed with the Quality Appraisal for Cadaveric Studies. Heterogeneity was assessed with the I2 statistic. RESULTS A total of 41 studies were included. ROB was serious and critical in 27 studies, moderate in 13, and low in 1; 6 studies had high quality, 21 good quality, 10 moderate quality, 2 low quality, and 2 very low quality. Thirty-one studies used and 22 studies included cyclic loading. Angle of anchor insertion was reported by 33 studies. The force vector for displacement varied. The most common directions were perpendicular to the glenoid (n = 9), and anteroinferior or anterior (n = 8). The most common outcome measures were load to failure (n = 35), failure mode (n = 23), and stiffness (n = 21). Other outcome measures included load at displacement, displacement at failure, tensile load at displacement, translation, energy absorbed, cycles to failure, contact pressure, and elongation. CONCLUSION This systematic review demonstrated a clear lack of consistency in those cadaver studies that investigated biomechanical properties after surgical repair with suture anchors for shoulder instability and SLAP lesions. Testing methods between studies varied substantially with no universally applied standard for preloading, load to failure and cyclic loading protocols, insertion angles of suture anchors, or direction of loading. To allow comparability between studies standardization of testing protocols is strongly recommended.
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Affiliation(s)
- Erik Hohmann
- Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; Department of Orthopaedic Surgery and Sports Medicine, Burjeel Hospital for Advanced Surgery, Dubai, United Arab Emirates.
| | - Vaida Glatt
- University of Texas Health Science Center, San Antonio, Texas
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston; Department of Surgery, School of Medicine, University of Queensland, Brisbane; Limb Reconstruction Centre, Macquarie University Hospital, Sydney, Australia
| | - Nikolaos Paschos
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
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Allegra PR, Greif DN, Desai SS, Yakkanti RR, Muñoz J, Kaplan LD, Baraga MG. The Fifty Most-Cited Articles Regarding SLAP Lesions. Arthrosc Sports Med Rehabil 2021; 3:e135-e147. [PMID: 33615258 PMCID: PMC7879178 DOI: 10.1016/j.asmr.2020.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/10/2020] [Indexed: 01/02/2023] Open
Abstract
Purpose To identify and evaluate the top 50 most-cited articles pertaining to SLAP tears. Methods The ISI Web of Knowledge database was used to conduct a query for articles pertaining to SLAP tears. Our query was conducted in April 2020 with multiple Boolean operative combinations performed by 2 independent reviewers. Articles on the final list were further reviewed to extract the following data: manuscript title, first author, total citation count, year of publication, citation density since publication, current citation rate since 2013, journal, country of origin, and level of evidence. Results Our initial search yielded 2,597 articles. Within this cohort, the top 50 publications pertaining to SLAP tears were identified that met our search criteria. The top article was cited 802 times while the 50th ranked article was cited 46 times. The average number of citations per publication was 131, whereas the average citation density since year of publication was 7.3. No strong correlations were found between citation density and year published. Twelve journals published articles pertaining to SLAP tears, with Arthroscopy accounting for the greatest number (15 articles, 30%). Most articles were graded with a level of evidence (LOE) of IV (n = 24, 48%), followed by review articles without LOE (n = 8, 16%). Only 2 articles achieved an LOE of I (4%). Articles typically addressed the arthroscopic management (n = 11, 22%), whereas anatomy/classification (n =10, 20%), and outcomes (n = 9, 18%) also were reported. Conclusions This review provides a quantitative analysis of the most-referenced literature pertaining to SLAP tears. This body of knowledge helps surgeons search for literature regarding these injuries and identify trends regarding SLAP tear research. Clinical Relevance This research provides practitioners with an easily accessible and comprehensive collection of the major contributions regarding SLAP tears and offers insight into future areas for research.
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Affiliation(s)
- Paul R Allegra
- Department of Orthopedics, University of Miami/Jackson Memorial Hospital, Miami, Florida, U.S.A
| | - Dylan N Greif
- University of Miami Sports Medicine Institute, Miami, Florida, U.S.A.,University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Sohil S Desai
- University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Ramakanth R Yakkanti
- Department of Orthopedics, University of Miami/Jackson Memorial Hospital, Miami, Florida, U.S.A
| | - Julianne Muñoz
- Department of Orthopedics, University of Miami/Jackson Memorial Hospital, Miami, Florida, U.S.A.,University of Miami Sports Medicine Institute, Miami, Florida, U.S.A
| | - Lee D Kaplan
- Department of Orthopedics, University of Miami/Jackson Memorial Hospital, Miami, Florida, U.S.A.,University of Miami Sports Medicine Institute, Miami, Florida, U.S.A
| | - Michael G Baraga
- Department of Orthopedics, University of Miami/Jackson Memorial Hospital, Miami, Florida, U.S.A.,University of Miami Sports Medicine Institute, Miami, Florida, U.S.A
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6
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Arthroscopic treatment of type II superior labral anterior to posterior (SLAP) lesions in a younger population: minimum 2-year outcomes are similar between SLAP repair and biceps tenodesis. Knee Surg Sports Traumatol Arthrosc 2021; 29:257-265. [PMID: 32253479 DOI: 10.1007/s00167-020-05971-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 03/25/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Compared to a relatively older population over 30-40 years of age, the efficacy of biceps tenodesis for type II SLAP lesions in a younger population is not well studied. The purpose of this study was to compare outcomes between biceps tenodesis and labral repair for type II SLAP lesions in a young active population. METHODS Patients aged 15-40 who underwent primary arthroscopic biceps tenodesis or SLAP repair for type II SLAP tears between 2009 and 2016 were included. Shoulders with intraarticular chondral damage, full thickness rotator cuff tear, rotator cuff repair, labral repair outside of the superior labrum, bony subacromial decompression, and acromioclavicular joint resection were excluded. Patient-reported outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) score, Disabilities of the Arm, Shoulder, and Hand Sports/Performing Arts Module (DASH-sport), visual analog scale (VAS) for pain, and satisfaction. Return to sport rates were also recorded. RESULTS Fifty-three patients (20 tenodesis, 33 repair) were available for minimum 2-year follow-up. Postoperatively, there were no significant differences in mean ASES, DASH-sport, VAS, and satisfaction between groups [ASES: tenodesis 86.3 vs. repair 86.4 (n.s.); DASH-sport: 11.0 vs. 22.5 (n.s.); VAS: 1.85 vs. 1.64 (n.s.); satisfaction: 8.50 vs. 8.00 (n.s.)]. Rate of return to pre-injury level of performance/competition in sport/physical activity was also similar between groups [tenodesis 63% vs. repair 50% (n.s.)]. CONCLUSIONS In a young active population, primary arthroscopic biceps tenodesis is a viable surgical alternative to labral repair for type II SLAP lesions. The results of this study suggest that indications for arthroscopic tenodesis can safely be expanded to a younger patient group than has previously been demonstrated in the literature. LEVEL OF EVIDENCE III.
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7
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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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Jo YH, Oh HK, Jeong SY, Lee BG. National Trends in the Repair of Isolated Superior Labral Tear from Anterior to Posterior in Korea. J Korean Med Sci 2020; 35:e285. [PMID: 32864905 PMCID: PMC7458849 DOI: 10.3346/jkms.2020.35.e285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 07/09/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The optimal treatment for superior labral tear from anterior to posterior (SLAP) lesions is controversial. Thus, we aimed to investigate the national surgical trends in isolated SLAP repair in Korea. METHODS We analyzed a nationwide database from the Korean Health Insurance Review and Assessment Service from 2008 to 2017. We investigated the trends in SLAP repair by time, sex, age, and the type of health care institution. RESULTS From 2008 to 2017, 27,850 isolated SLAP repairs were identified. Age-adjusted incidence rate of isolated SLAP repair increased by 692% from 1.07/100,000 in 2008 to 8.48/100,000 in 2012 (P = 0.005). However, the incidence rate declined significantly after 2012 (P = 0.032) and was 5.28/100,000 in 2017. Sex-specific incidence rate of isolated SLAP repair was 2.3 times higher in men than in women. The decline since 2012 was most evident in patients aged ≥ 40 years (P = 0.01); however, the incidence rates of isolated SLAP repair during the study period were similar between patients aged ≥ 40 years and those aged < 40 years. Moreover, hospitals with 30-100 beds had the greatest change in the number of isolated SLAP repair cases. CONCLUSION In Korea, the incidence of isolated SLAP repair increased dramatically until 2012; since then, it has declined. Although the decrease in isolated SLAP repair later in the study was evident in those aged ≥ 40 years, the incidence rate was still relatively high in patients aged ≥ 40 years.
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Affiliation(s)
- Young Hoon Jo
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, Korea
| | - Hyun Keun Oh
- Department of Orthopedic Surgery, Base Orthopedic Clinic, Seoul, Korea
| | - Soo Young Jeong
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Bong Gun Lee
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea.
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Lim S, Kim SK, Kim YS. Comparison between SLAP Repair and Biceps Tenodesis with Concomitant Rotator Cuff Repair in Patients Older than 45 Years: Minimum 2-Year Clinical and Imaging Outcomes. Clin Orthop Surg 2020; 12:364-370. [PMID: 32904029 PMCID: PMC7449846 DOI: 10.4055/cios19157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/26/2019] [Indexed: 01/02/2023] Open
Abstract
Backgroud There is controversy over how to surgically treat symptomatic superior labrum anterior to posterior (SLAP) tears in middle-aged patients with concomitant rotator cuff tears. The aim of the study was to compare the clinical and imaging outcomes of SLAP repair versus biceps tenodesis (BT) each combined with arthroscopic rotator cuff repair (ARCR). Methods We retrospectively reviewed 35 patients older than 45 years who underwent arthroscopic surgery to manage concomitant SLAP tears and rotator cuff tears. In addition to ARCR, 17 patients underwent SLAP repair, whereas 18 patients underwent BT. Shoulder range of motion (ROM), visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, Constant score, and University of California at Los Angeles (UCLA) score were used for clinical assessment. The integrity of rotator cuff repair and change of superior labrum-biceps complex were evaluated by postoperative magnetic resonance imaging (MRI). Results There was significant improvement in the pain VAS and all functional scores in both groups (p < 0.001) at a mean followup of 29.4 ± 11.4 months (range, 24–84 months) postoperatively. Shoulder ROM showed significant improvement postoperatively (p < 0.05). No significant difference in outcomes could be found between the 2 groups after surgery. The retear rate of rotator cuff repair on MRI was 11.8% in the SLAP repair group and 11.1% in the BT group. Conclusions In middle-aged patients with combined SLAP lesions and rotator cuff tears, both SLAP repair and BT can be safe adjuncts to ARCR.
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Affiliation(s)
- Sungjoon Lim
- Department of Orthopaedic Surgery, Incheon Medical Center, Incheon, Korea
| | - Sang Ki Kim
- Yonsei Hangmac Surgical Clinic, Goyang, Korea
| | - Yang-Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Wall A, McGonigle O, Gill TJ. Arthroscopic Circumferential Labral Repair for Patients With Multidirectional Instability: A Comparative Outcome Study. Orthop J Sports Med 2019; 7:2325967119890103. [PMID: 31909054 PMCID: PMC6935876 DOI: 10.1177/2325967119890103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Circumferential tears of the glenohumeral labrum are an uncommon injury, comprising 2.4% of all labral lesions. Currently, the clinical outcomes of arthroscopic circumferential labral repair for patients with instability and combined anterior, posterior, and superior labral tears are not well-known. Hypothesis: Patients treated with arthroscopic circumferential shoulder labral repairs will have inferior clinical outcomes and higher failure rates compared with patients who have isolated arthroscopic anterior labral repairs. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study was performed to identify patients aged 18 years and older who underwent circumferential arthroscopic stabilization for recurrent instability as compared with an age-matched control group of arthroscopic primary anterior labral repairs. Age at surgery, American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form score, Simple Shoulder Test (SST) score, 12-Item Short Form Health Survey (SF-12) score (mental and physical), and overall patient satisfaction with surgery were assessed for each group. Results: A total of 35 consecutive patients (36 shoulders) who underwent an arthroscopic 360° circumferential labral repair were compared with a matched group of 31 patients who underwent an isolated arthroscopic anterior labral repair. The mean follow-up period was 34.3 and 56.8 months, respectively. No significant difference was found between the 2 groups for overall satisfaction with the surgery or recurrent instability. At the time of the follow-up survey, 22% of the patients experienced pain and 25% of the patients experienced instability in the circumferential repair group, whereas 15% of the patients experienced some level of pain and 30% of patients experienced a subjective sense of subtle instability in the isolated repair group. The ASES scores were 87.3 in the combined labral repair group and 93.3 in the isolated anterior group (P = .35), SST scores were 10.7 and 11.3 (P = .70), SF-12 mental scores were 54.6 and 56.8 (P = .80), SF-12 physical scores were 53.2 and 54.2 (P = .98), and age at time of the surgery was 26.7 and 24.6 years (P = .33), respectively. There was no difference between the 2 groups in pre- and postoperative range of motion (P > .05). Conclusion: There was no difference in shoulder stability and function in patients after 360° combined labral repairs versus anterior labral repair alone. With proper patient selection, patients can expect similar outcomes despite the more extensive surgical procedure and complex postoperative rehabilitation protocol for circumferential repairs.
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Affiliation(s)
- Andrew Wall
- University of Albany Medical School, Albany, New York, USA
| | - Owen McGonigle
- McNeil Orthopedics Inc, Steward Healthcare Network, Brockton, Massachusetts, USA
| | - Thomas J Gill
- Department of Orthopedic Surgery, Tufts University School of Medicine, Boston, Massachusetts, USA
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Thayaparan A, Yu J, Horner NS, Leroux T, Alolabi B, Khan M. Return to Sport After Arthroscopic Superior Labral Anterior-Posterior Repair: A Systematic Review. Sports Health 2019; 11:520-527. [PMID: 31584340 DOI: 10.1177/1941738119873892] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
CONTEXT Superior labral anterior-posterior (SLAP) lesions often result in significant sporting limitations for athletes. Return to sport is a significant outcome that often needs to be considered by athletes undergoing the procedure. OBJECTIVE To evaluate return to sport among individuals undergoing arthroscopic SLAP repair. DATA SOURCES Four databases (MEDLINE, EMBASE, PubMed, and Cochrane) were searched from database inception through January 29, 2018. STUDY SELECTION English-language articles reporting on return-to-activity rates after arthroscopic SLAP repairs were included. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Data including patient demographics, surgical procedure, and return to activity were extracted. The methodological quality of included studies was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) tool. RESULTS Of 1938 screened abstracts, 22 articles involving a total of 944 patients undergoing arthroscopic SLAP repair met inclusion criteria. Of the total included patients, 270 were identified as overhead athletes, with 146 pitchers. Across all patients, 69.6% (657/944 patients) of individuals undergoing arthroscopic SLAP repair returned to sport. There was a 69.0% (562/815 patients) return to previous level of play, with a mean time to return to sport of 8.9 ± 2.4 months (range, 6.0-11.7 months). The return-to-sport rate for pitchers compared with the return-to-activity rate for nonpitchers, encompassing return to work and return to sport, was 57.5% (84/146 patients) and 87.1% (572/657 patients), respectively, after arthroscopic SLAP repair. CONCLUSION Arthroscopic SLAP repair is associated with a fair return to sport, with 69.6% of individuals undergoing arthroscopic SLAP repair returning to sport. SLAP repair in pitchers has significantly decreased return to sport in comparison with nonpitching athletes. Athletes on average return to sport within 9 months postoperatively.
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Affiliation(s)
- Aarabi Thayaparan
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - James Yu
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nolan S Horner
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Timothy Leroux
- Division of Orthopedic Surgery, University of Toronto, Ontario, Canada
| | - Bashar Alolabi
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Abstract
Knowledge of the pertinent anatomy, pathogenesis, clinical presentation and treatment of the spectrum of injuries involving the superior glenoid labrum and biceps origin is required in treating the patient with a superior labrum anterior and posterior (SLAP) tear.Despite the plethora of literature regarding SLAP lesions, their clinical diagnosis remains challenging for a number of reasons.First, the diagnostic value of many of the available physical examination tests is inconsistent and ambiguous.Second, SLAP lesions most commonly occur concomitantly with other shoulder injuries.Third, SLAP lesions have no specific associated pain pattern.Outcomes following surgical treatment of SLAP tears vary depending on the method of treatment, associated pathology and patient characteristics.Biceps tenodesis has been receiving increasing attention as a possible treatment for SLAP tears. Cite this article: EFORT Open Rev 2019;4:25-32. DOI: 10.1302/2058-5241.4.180033.
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Affiliation(s)
- Filippo Familiari
- Department of Orthopaedic and Traumatology, Villa del Sole Clinic, Catanzaro, Italy
| | - Gazi Huri
- Department of Orthopaedic and Traumatology, Hacettepe University, Ankara, Turkey
| | | | - Edward G McFarland
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
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Michener LA, Abrams JS, Bliven KCH, Falsone S, Laudner KG, McFarland EG, Tibone JE, Thigpen CA, Uhl TL. National Athletic Trainers' Association Position Statement: Evaluation, Management, and Outcomes of and Return-to- Play Criteria for Overhead Athletes With Superior Labral Anterior-Posterior Injuries. J Athl Train 2018; 53:209-229. [PMID: 29624450 DOI: 10.4085/1062-6050-59-16] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To present recommendations for the diagnosis, management, outcomes, and return to play of athletes with superior labral anterior-posterior (SLAP) injuries. BACKGROUND In overhead athletes, SLAP tears are common as either acute or chronic injuries. The clinical guidelines presented here were developed based on a systematic review of the current evidence and the consensus of the writing panel. Clinicians can use these guidelines to inform decision making regarding the diagnosis, acute and long-term conservative and surgical treatment, and expected outcomes of and return-to-play guidelines for athletes with SLAP injuries. RECOMMENDATIONS Physical examination tests may aid diagnosis; 6 tests are recommended for confirming and 1 test is recommended for ruling out a SLAP lesion. Combinations of tests may be helpful to diagnose SLAP lesions. Clinical trials directly comparing outcomes between surgical and nonoperative management are absent; however, in cohort trials, the reports of function and return-to-sport outcomes are similar for each management approach. Nonoperative management that includes rehabilitation, nonsteroidal anti-inflammatory drugs, and corticosteroid injections is recommended as the first line of treatment. Rehabilitation should address deficits in shoulder internal rotation, total arc of motion, and horizontal-adduction motion, as well as periscapular and glenohumeral muscle strength, endurance, and neuromuscular control. Most researchers have examined the outcomes of surgical management and found high levels of satisfaction and return of shoulder function, but the ability to return to sport varied widely, with 20% to 94% of patients returning to their sport after surgical or nonoperative management. On average, 55% of athletes returned to full participation in prior sports, but overhead athletes had a lower average return of 45%. Additional work is needed to define the criteria for diagnosing and guiding clinical decision making to optimize outcomes and return to play.
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Hester WA, O'Brien MJ, Heard WMR, Savoie FH. Current Concepts in the Evaluation and Management of Type II Superior Labral Lesions of the Shoulder. Open Orthop J 2018; 12:331-341. [PMID: 30197715 PMCID: PMC6110065 DOI: 10.2174/1874325001812010331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/26/2018] [Accepted: 05/24/2018] [Indexed: 01/02/2023] Open
Abstract
Background: Superior labrum tears extending from anterior to posterior (SLAP lesion) are a cause of significant shoulder pain and disability. Management for these lesions is not standardized. There are no clear guidelines for surgical versus non-surgical treatment, and if surgery is pursued there are controversies regarding SLAP repair versus biceps tenotomy/tenodesis. Objective: This paper aims to briefly review the anatomy, classification, mechanisms of injury, and diagnosis of SLAP lesions. Additionally, we will describe our treatment protocol for Type II SLAP lesions based on three groups of patients: throwing athletes, non-throwing athletes, and all other Type II SLAP lesions. Conclusion: The management of SLAP lesions can be divided into 4 broad categories: (1) nonoperative management that includes scapular exercise, restoration of balanced musculature, and that would be expected to provide symptom relief in 2/3 of all patients; (2) patients with a clear traumatic episode and symptoms of instability that should undergo SLAP repair without (age < 40) or with (age > 40) biceps tenotomy or tenodesis; (3) patients with etiology of overuse without instability symptoms should be managed by biceps tenotomy or tenodesis; and (4) throwing athletes that should be in their own category and preferentially managed with rigorous physical therapy centered on hip, core, and scapular exercise in addition to restoration of shoulder motion and rotator cuff balance. Peel-back SLAP repair, Posterior Inferior Glenohumeral Ligament (PIGHL) release, and treatment of the partial infraspinatus tear with debridement, PRP, or (rarely) repair should be reserved for those who fail this rehabilitation program.
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Affiliation(s)
| | | | - Wendell M R Heard
- Tulane University School of Medicine, Department of Orthpaedic Surgery, New Orleans, LA 70112, USA
| | - Felix H Savoie
- Tulane University School of Medicine, Department of Orthpaedic Surgery, New Orleans, LA 70112, USA
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Cagle PJ, Olujimi V, Parsons BO. Arthroscopic Treatment of Labral Tears: A Critical Analysis Review. JBJS Rev 2018; 6:e4. [PMID: 29634588 DOI: 10.2106/jbjs.rvw.17.00081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Paul J Cagle
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY
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Shin SJ, Lee J, Jeon YS, Ko YW, Kim RG. Clinical outcomes of non-operative treatment for patients presenting SLAP lesions in diagnostic provocative tests and MR arthrography. Knee Surg Sports Traumatol Arthrosc 2017; 25:3296-3302. [PMID: 27342986 DOI: 10.1007/s00167-016-4226-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 06/17/2016] [Indexed: 01/02/2023]
Abstract
PURPOSE In the present prospective study, the functional outcomes of non-operative treatment were evaluated in patients aged between 30 and 45 years presenting SLAP lesion in diagnostic provocative tests and magnetic resonance (MR) arthrography. METHODS Forty-six patients with a symptomatic SLAP lesion who participated in recreational level of sports were prospectively enroled. SLAP lesion was diagnosed using combinations of several clinical tests and MR arthrography findings. All patients were treated with intra-articular corticosteroid injections, followed by rotator cuff and periscapular muscle-strengthening exercises. Patients with persistent discomfort after second injection underwent arthroscopic SLAP repair. Functional outcomes were evaluated using ASES and Constant scores, and pain and satisfaction for visual analogue scale (VAS). RESULTS Pain had significantly improved from 5.2 ± 2.2 to 1.0 ± 1.1 (p < 0.001) in all patients after the first corticosteroid injection. SLAP symptoms relapsed in 12 patients at an average of 2.4 months after the first injection. Symptoms were relieved in 5 of 12 patients after the second injection and strengthening exercises. The remaining seven patients underwent arthroscopic SLAP repair. Thirty-nine patients (85 %) who were treated non-operatively showed improved VAS, Constant, and ASES scores at final follow-up (p < 0.001). CONCLUSIONS Non-operative treatment with an appropriate regimen provided satisfactory clinical outcomes in middle-aged patients with symptomatic SLAP lesions and should be considered before recommending operative treatment. CLINICAL RELEVANCE Non-operative management using combined intra-articular corticosteroid injection with rotator cuff and periscapular strengthening exercises could be applied as primary treatment for patients with symptomatic SLAP lesion who participate in recreational level of sports. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sang-Jin Shin
- Ewha Shoulder Disease Center, Department of Orthopaedic Surgery, School of Medicine, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Korea.
| | - Juyeob Lee
- Ewha Shoulder Disease Center, Department of Orthopaedic Surgery, School of Medicine, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Korea
| | - Yoon-Sang Jeon
- Ewha Shoulder Disease Center, Department of Orthopaedic Surgery, School of Medicine, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Korea
| | - Young-Won Ko
- Ewha Shoulder Disease Center, Department of Orthopaedic Surgery, School of Medicine, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Korea
| | - Rag-Gyu Kim
- Ewha Shoulder Disease Center, Department of Orthopaedic Surgery, School of Medicine, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Korea
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Zughaib M, Robbins CB, Miller BS, Gagnier JJ. Outcomes in patients with glenoid labral lesions: a cohort study. BMJ Open Sport Exerc Med 2017; 2:e000209. [PMID: 28879037 PMCID: PMC5569263 DOI: 10.1136/bmjsem-2016-000209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND/AIM For patients presenting with glenoid labral pathologies, there is little information on how operative interventions affect long-term outcomes and health-related quality of life (HRQoL). This study evaluated outcomes in operative and non-operative patients presenting with labral tears versus labral degenerations. METHODS Participants completed a pain Visual Analogue Scale (VAS), the Veterans RAND 12-item Health Survey, Western Ontario Rotator Cuff Index, American Shoulder and Elbow Surgeons instrument, Scapular Assistance Test (SAT), Shoulder Activity Level, and Single Assessment Numeric Evaluation at baseline and at 6-month, 12-month and 2-year follow-ups. χ2and Student's t-test were used to test the differences between categorical and continuous variables. Analysis of variance investigated the differences between groups, and linear regression analyses explored the relationship of baseline characteristics with outcome scores. RESULTS After 2 years, the operative cohort (n=68) significantly improved in all measures. The non-operative cohort (n=55) showed significant improvements in all scores except the mental component summary (MCS) and pain VAS. Labral tear patients (n=52) within the operative group (n=28) significantly improved in all measures except MCS. Non-operative labral tear patients (n=24) indicated significant improvements in all measures except MCS, VAS and SAT. Labral degeneration patients (n=71) within the operative group (n=27) significantly improved in all measures except MCS and SAT. Non-operative labral degeneration patients (n=44) indicated significant improvements in all measures except the physical component summary, MCS, VAS and SAT. CONCLUSION Patients who were surgically treated for labral tears or degenerations had significantly improved outcomes and HRQoL scores after 2 years compared with the non-operative cohort.
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Affiliation(s)
- Marc Zughaib
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Bruce S Miller
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Joel J Gagnier
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Park JG, Cho NS, Kim JY, Song JH, Hong SJ, Rhee YG. Arthroscopic Knot Removal for Failed Superior Labrum Anterior-Posterior Repair Secondary to Knot-Induced Pain. Am J Sports Med 2017; 45:2563-2568. [PMID: 28696789 DOI: 10.1177/0363546517713662] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Studies on failed superior labrum anterior-posterior (SLAP) repair are increasing. However, the number of reports on treatment options for failed SLAP repair remains quite low, and the clinical results vary between different study groups. PURPOSE To describe the clinical presentation of failed SLAP repair due to knot-induced pain and evaluate the efficacy of arthroscopic knot removal. STUDY DESIGN Case series; Level of evidence, 4. METHODS The authors retrospectively reviewed records of 11 patients (mean age, 24.6 ± 8.6 years; range, 17-43 years) with stable, healed SLAP lesions with knot-induced pain after arthroscopic fixation of unstable type II SLAP lesions. All patients demonstrated a positive compression-rotation test before knot removal. The mean follow-up duration after knot removal was 48.0 ± 37.4 months (range, 24-156 months). The mean duration between primary fixation and knot removal was 21.2 ± 14.7 months (range, 8-56 months). RESULTS Sharp pain (100%) and clicking (64%) were the most common symptoms. The knot was positioned on the glenoid side in 5 patients and the labral side in 6 patients. The knots on the glenoid side had associated humeral head cartilage damage. The mean University of California at Los Angeles score significantly improved from 15.2 points to 31.7 points after knot removal ( P = .003) Additionally, the mean Constant score greatly improved from a mean of 56.5 points to 89.8 points ( P = .003). At a mean of 3 weeks after surgery, we observed dramatic pain relief. Six weeks after surgery, the compression-rotation test was negative in all patients. CONCLUSION The most common symptom of knot-induced pain after SLAP repair was persistent sharp pain followed by clicking. The knot appears to be a cause of pain in failed SLAP repairs, and arthroscopic knot removal can provide dramatic pain relief and significant improvement of clinical outcomes.
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Affiliation(s)
- Jung Gwan Park
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Nam Su Cho
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jung Youn Kim
- Department of Orthopaedic Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jong Hoon Song
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Se Jung Hong
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Zughaib M, Gagnier JJ. Modelling the Functional Comorbidity Index as a predictor of health-related quality of life in patients with glenoid labrum disorders. BMJ Open Sport Exerc Med 2017; 2:bmjsem-2016-000167. [PMID: 29616143 PMCID: PMC5875632 DOI: 10.1136/bmjsem-2016-000167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2016] [Indexed: 01/02/2023] Open
Abstract
Background/aim Health-related quality of life (HRQoL) is increasingly assessed within orthopaedic research. For those patients presenting with glenoid labral pathologies, there is little information on how baseline comorbidities affect long-term outcomes and HRQoL. This study aimed to investigate a model, including baseline comorbidities and demographics, to predict change in 2-year HRQoL scores in adult patients with glenoid labral tears or degenerations. Methods Participants provided Functional Comorbidity Index (FCI) scores and self-completed the Western Ontario Rotator Cuff (WORC) index at 6, 12 and 24 months. Univariable and multivariable linear regressions were performed to assess predictive quality of baseline comorbidities and demographics on the primary outcome measure of interest (change in WORC score). Results Multivariate regression with a continuous scaled FCI (β=617.8, p=0.042), age (by decade) (β=297, p<0.01), surgical group (β=−476.69, p<0.01) and an interaction term between FCI and age (β=−103.65, p=0.03) were significant predictors of change in WORC scores at 2-year follow-up (r2=0.293858). Multivariate regression with FCI scaled categorically reported only patients with three comorbidities (β=−454.06, p=0.057) and age (by decade) (β=156.87, p=0.04) as the only significant predictors of change in WORC scores at 2-year follow-up (r2=0.1279). Conclusion The continuous FCI model is better suited to predict future WORC and HRQoL scores among this patient population. Patients reporting with higher numbers of baseline comorbidities improved significantly more than patients with fewer comorbidities. This information on expected change in HRQoL scores among patients with a wide range of FCI scores at baseline may help guide treatment decisions based on these criteria.
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Affiliation(s)
- Marc Zughaib
- Department of Orthopaedic Surgery, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Joel J Gagnier
- Department of Orthopaedic Surgery, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Trofa DP, Ahmad CS. The Management of Superior Labrum Anterior-Posterior Tears in the Thrower’s Shoulder. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2016.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Kibler WB, Sciascia A. Current Practice for the Surgical Treatment of SLAP Lesions: A Systematic Review. Arthroscopy 2016; 32:669-83. [PMID: 26553961 DOI: 10.1016/j.arthro.2015.08.041] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 08/07/2015] [Accepted: 08/28/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze current literature reporting surgical treatment of SLAP lesions to examine the consistency of reported surgical details (surgical indications, surgical technique, and postoperative rehabilitation) that are deemed important for best treatment outcomes and to try to establish a consensus regarding treatment. METHODS A systematic review of papers reporting surgical treatment of a SLAP lesion was performed. Each paper was analyzed for the description of (1) the arthroscopic indications for surgery; (2) surgical aspects including type, location, and number of anchors and sutures; (3) description of criteria for determination of completeness of the repair; and (4) postoperative rehabilitation details. These findings were also analyzed to determine whether a consensus could be developed regarding surgical treatment. RESULTS Twenty-six papers were included, with 12 focused on isolated SLAP repair and 14 focused on combined SLAP repair with other lesions; 54% did not report indications for surgery. Reporting of the anchor/suture details was not consistent, with 35% reporting some variation of 12:00 placement but 31% not reporting the position of placement; 89% of papers did not report the criteria for determining completeness of the repair; 85% reported general postoperative rehabilitation guidelines, but only 4% reported in-depth details. CONCLUSIONS This review demonstrated a wide variability in the reported surgical aspects and that a relatively high percentage of papers did not report many of the details. This lack of precision and consistency makes analysis of individual papers and comparison between papers and their outcomes difficult and does not allow a consensus regarding current practice to be developed. These findings may be some of the factors responsible for the variability in treatment outcomes and suggest that efforts could be directed toward consistency in documenting and reporting surgical indications, surgical techniques, surgical endpoints, and efficacious rehabilitation programs. LEVEL OF EVIDENCE Level IV, systematic review of level III-IV studies.
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Affiliation(s)
- W Ben Kibler
- Shoulder Center of Kentucky, Lexington, Kentucky, U.S.A
| | - Aaron Sciascia
- Shoulder Center of Kentucky, Lexington, Kentucky, U.S.A..
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Jang SH, Seo JG, Jang HS, Jung JE, Kim JG. Predictive factors associated with failure of nonoperative treatment of superior labrum anterior-posterior tears. J Shoulder Elbow Surg 2016; 25:428-34. [PMID: 26671775 DOI: 10.1016/j.jse.2015.09.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 09/06/2015] [Accepted: 09/15/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Uncertainty remains in the natural course of superior labrum anterior-posterior (SLAP) tears treated conservatively with rehabilitation and activity modification. Our purpose was to evaluate clinical outcomes after nonoperative treatment of type II SLAP tear in young active patients and to identify factors related to negative outcomes. METHODS We retrospectively reviewed 63 patients who initially underwent nonoperative treatment for isolated type II SLAP tear. Assessments were made at baseline and at 6 months, and telephone survey was used to evaluate the final outcome. All included patients underwent a consistent nonoperative treatment protocol, and patient-specific data on the outcome were assessed. Failure was defined as abandonment of nonoperative management for surgery at any time points, <20-point improvement in American Shoulder and Elbow Surgeons score at final follow-up, or inability to return to activities. RESULTS At the average follow-up of 21 months, pain relief and function improved significantly (American Shoulder and Elbow Surgeons score, 54.2-86.4; Visual Analog Scale score, 4.6-1.7; P < .05) in 45 patients (71.4%) with successful nonoperative treatment. Eighteen patients (28.5%) were either dissatisfied with treatment or had arthroscopic surgery and were considered a failure group. Multivariate analysis showed that failure of nonoperative treatment is strongly linked with history of trauma, positive compression-rotation test result, and participation in overhead activities (P < .05). CONCLUSIONS An initial trial of nonoperative management may be considered in young active patients with isolated SLAP tear. Patients with history of trauma, mechanical symptoms, and demand for overhead activities are less likely to succeed.
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Affiliation(s)
- Suk-Hwan Jang
- Department of Orthopedic Surgery, Inje University, Seoul Paik Hospital, Seoul, Republic of Korea.
| | - Jeong-Gook Seo
- Department of Orthopedic Surgery, Inje University, Seoul Paik Hospital, Seoul, Republic of Korea
| | - Ho-Su Jang
- Department of Orthopedic Surgery, Inje University, Seoul Paik Hospital, Seoul, Republic of Korea
| | - Jae-Eun Jung
- Sports Medical Center, Inje University, Seoul Paik Hospital, Seoul, Republic of Korea
| | - Jin-Goo Kim
- Department of Orthopedic Surgery, Konkuk University Hospital, Seoul, Republic of Korea
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Sergi S, Guillem C, Lluis P, Lluis L, Miguel C. Slap Lesions in Middle-aged Patients: Biceps Repair or Tenodesis? What Should We Perform for Long Biceps Tendon? JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2015. [DOI: 10.1016/j.jotr.2014.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Background/Purpose Superior labrum anterior and posterior (SLAP) lesion repair poses a significant discussion due to its high failure rate. The purpose of this study was to determine in which indications it is better to perform a tenodesis than a straight anatomical repair. The hypothesis was that in middle-aged patients and in those who did not suffer from a traumatic lesion, it is better to perform a long biceps tendon (LBT) tenodesis than a straight anatomical repair. Methods A total of 22 patients between the ages of 19 years and 55 years who underwent SLAP lesion repair between 2007 and 2011 were reviewed. The cases were divided into the following two groups: those with an isolated SLAP lesion (15 patients) and those with both a SLAP and a Bankart lesion (7 patients). This was a level IV longitudinal and retrospective study. Results Eight patients had persistent postoperative pain, which required to be revised from an anatomical repair to an LBT tenodesis. All of these patients were in the isolated SLAP lesion group. The average time between primary surgery and revision was 21.6 months. Patients over the age of 45 years had significantly poorer results after the repair. Conclusion Biceps tenodesis is a feasible therapeutic alternative to anatomical repair for the treatment of SLAP lesions in middle-aged patients; the reinsertion failure rates for this type of lesion are rather discouraging due to the high percentage of revision surgeries that must be carried out after the primary intervention.
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Affiliation(s)
- Sastre Sergi
- Orthopedic Surgery Service, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Claret Guillem
- Orthopedic Surgery Service, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Peidro Lluis
- Orthopedic Surgery Service, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Lozano Lluis
- Orthopedic Surgery Service, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Caballero Miguel
- Orthopedic Surgery Service, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Kibler WB, Sciascia A. Current Practice for the Diagnosis of a SLAP Lesion: Systematic Review and Physician Survey. Arthroscopy 2015; 31:2456-69. [PMID: 26321113 DOI: 10.1016/j.arthro.2015.06.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 06/09/2015] [Accepted: 06/18/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate current practice reported in the literature for making a SLAP lesion diagnosis and compare the findings with a survey sent to experienced shoulder surgeons assessing how they make a SLAP diagnosis. METHODS We performed a systematic review of articles reporting surgical repair of SLAP lesions, documenting the use of 4 diagnostic areas of evaluation: history, clinical examination, imaging, and diagnostic arthroscopy. A survey was distributed electronically to 175 surgeons with expertise in shoulder surgery. The survey listed common components within the 4 diagnostic areas and asked surgeons to indicate components they used in establishing the diagnosis. The 4 diagnostic areas were ranked from 1 to 4 (most to least important). RESULTS Of the articles, 23% reported using all 4 diagnostic areas, 58% used 3 areas, and 19% used 2 areas or fewer. Thirty-five percent did not report history components, 31% did not report clinical examination elements, 27% did not report imaging findings, and 4% did not report arthroscopic findings. Eight percent reported using a comprehensive history and examination but without describing specific symptoms or tests. The most common components reported in the literature were pain (42%), the active compression test (65%), magnetic resonance imaging/arthrography (65%), and tear/unstable biceps-labral complex (27%). A total of 70 surgeons (40%) responded to the survey. More specific history components, examination maneuvers, and imaging/arthroscopy variants were reported on the survey compared with the literature. Diagnostic arthroscopy and history ranked as the most important for a SLAP diagnosis. CONCLUSIONS The current literature and practice for making the SLAP diagnosis are variable and inconsistent. The SLAP diagnosis appears to be a clinical impression; however, the criteria described within the literature vary among the evaluation areas and differ from the results of the survey. These types of variability may have a significant influence on consistency and accuracy in making the diagnosis of the SLAP injury, developing the subsequent treatment, and maximizing outcomes. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies with cross-sectional survey.
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Affiliation(s)
- W Ben Kibler
- Shoulder Center of Kentucky, Lexington, Kentucky, U.S.A
| | - Aaron Sciascia
- Shoulder Center of Kentucky, Lexington, Kentucky, U.S.A..
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Abstract
Sports injuries of the upper limbs are very common in physical activities and therefore, they need to be studied in detail, taking into consideration specific aspects of the types of sports practiced. Special attention should be paid to the dynamics of the shoulder girdle and the entire scapular belt, since the most appropriate treatment for athletes can only be provided in this manner. This can also help to prevent recurrences, which can occur in some cases because athletes always seek to return to their pre-injury level of sports activity. This article will focus primarily on the management of upper-limb tendon injuries, from the physiopathology through to the new methods of injury treatment that are more prevalent in sports practice in Brazil.
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Affiliation(s)
- Rogerio Teixeira da Silva
- Correspondence: Rua Botucatu, 591, 18° andar, Vila Clementino, 04023-062 São Paulo, SP - Web: www.neo.org.brCorrespondence: Rua BotucatuVila ClementinoSão PauloSP04023-062
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Trantalis JN, Sohmer S, More KD, Nelson AA, Wong B, Dyke CH, Thornton GM, Boorman RS, Lo IKY. Arthroscopic repair of type II SLAP lesions: Clinical and anatomic follow-up. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2015; 9:74-80. [PMID: 26288536 PMCID: PMC4528287 DOI: 10.4103/0973-6042.161434] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Aims: The aim was to evaluate the clinical and anatomic outcome of arthroscopic repair of type II SLAP lesions. Materials and Methods: The senior author performed isolated repairs of 25 type II SLAP lesions in 25 patients with a mean age of 40.0 ± 12 years. All tears were repaired using standard arthroscopic suture anchor repair to bone. All patients were reviewed using a standardized clinical examination by a blinded, independent observer, and using several shoulder outcome measures. Patients were evaluated by magnetic resonance imaging arthrogram at a minimum of 1-year postoperatively. Statistical Analysis Used: Two-tailed paired t-test were used to determine significant differences in preoperative and postoperative clinical outcomes scores. In addition, a Fisher's exact test was used. Results: At a mean follow-up of 54-month, the mean American Shoulder and Elbow Surgeons Shoulder Index (ASES) scores improved from 52.1 preoperatively to 86.1 postoperatively (P < 0.0001) and the Simple Shoulder Test (SST) scores from 7.7 to 10.6 (P < 0.0002). Twenty-two out of the 25 patients (88%) stated that they would have surgery again. Of the 21 patients who had postoperative magnetic resonance imaging arthrographys (MRAs), 9 patients (43%) demonstrated dye tracking between the labrum bone interface suggestive of a recurrent tear and 12 patients (57%) had a completely intact repair. There was no significant difference in ASES, SST, and patient satisfaction scores in patients with recurrent or intact repairs. Conclusions: Arthroscopic repair of type II SLAP lesions demonstrated improvements in clinical outcomes. However, MRA imaging demonstrated 43% of patients with recurrent tears. MRA results do not necessarily correlate with clinical outcome.
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Affiliation(s)
- John N Trantalis
- Department of Orthopaedics, Concord Public Hospital, Concord, NSW 2137, Australia
| | - Stephen Sohmer
- Department of Surgery, Campbell River Hospital, 375 2nd Avenue, Campbell River, BC V9W 3V1, Canada
| | - Kristie D More
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute of Bone and Joint Health, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 1N4, Canada
| | - Atiba A Nelson
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute of Bone and Joint Health, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 1N4, Canada
| | - Ben Wong
- Department of Radiology, Foothills Medical Centre, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Corinne H Dyke
- Department of Radiology, Foothills Medical Centre, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Gail M Thornton
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute of Bone and Joint Health, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 1N4, Canada
| | - Richard S Boorman
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute of Bone and Joint Health, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 1N4, Canada
| | - Ian K Y Lo
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute of Bone and Joint Health, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 1N4, Canada
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Erickson J, Lavery K, Monica J, Gatt C, Dhawan A. Surgical treatment of symptomatic superior labrum anterior-posterior tears in patients older than 40 years: a systematic review. Am J Sports Med 2015; 43:1274-82. [PMID: 24961444 DOI: 10.1177/0363546514536874] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Successful arthroscopic repair of symptomatic superior labral tears in young athletes has been well documented. Superior labral repair in patients older than 40 years is controversial, with concerns for residual postoperative pain, stiffness, and higher rates of revision surgery. PURPOSE To analyze the published data on the surgical treatment of superior labral injuries in patients aged ≥40 years, including those with concomitant injuries to the rotator cuff. STUDY DESIGN Systematic review. METHODS A systematic review of the literature was performed using the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The MEDLINE database via PubMed and the Cochrane Database of Systematic Reviews were searched for articles related to superior labrum anterior-posterior (SLAP) tears. Studies were included if they met the following criteria: the study contained at least 1 group of patients who had undergone arthroscopic repair of a type II or IV SLAP lesion with a minimum 2-year follow-up, objective and/or functional scoring systems were used to evaluate postoperative outcomes, and the mean patient age was ≥40 years for at least 1 treatment arm or subgroup analysis. Studies were excluded if the article was a review or if the article included data for SLAP type I, III, or V to X tears or Bankart lesions. RESULTS While several authors reported equivalent outcomes of SLAP repair in patients both older than 40 years and younger than 40 years, others demonstrated significantly higher failure rates in the older cohort. Decreased patient satisfaction and increasing complications, including postoperative stiffness and reoperations, occur at higher rates as the patient age increases. The literature demonstrates that biceps tenotomy and tenodesis are reliable alternatives to SLAP repair and that biceps tenotomy is a viable revision procedure for failed SLAP repair. With concomitant rotator cuff tears, the evidence favors debridement or biceps tenotomy over SLAP repair. CONCLUSION While studies show that good outcomes can be obtained with SLAP repair in an older cohort of patients, age older than 40 years and workers' compensation status are independent risk factors for increased surgical complications. The cumulative evidence supports labral debridement or biceps tenotomy over labral repair when an associated rotator cuff injury is present.
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Affiliation(s)
- John Erickson
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Kyle Lavery
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - James Monica
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Charles Gatt
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Aman Dhawan
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
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Gottschalk MB, Karas SG, Ghattas TN, Burdette R. Subpectoral biceps tenodesis for the treatment of type II and IV superior labral anterior and posterior lesions. Am J Sports Med 2014; 42:2128-35. [PMID: 25053696 DOI: 10.1177/0363546514540273] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical repair remains the gold standard for most type II and type IV superior labral anterior and posterior (SLAP) lesions that fail nonoperative management. However, most recently, there have been data demonstrating unacceptably high failure rates with primary repair of type II SLAP lesions. Biceps tenodesis may offer an acceptable, if not better, alternative to primary repair of SLAP lesions. HYPOTHESIS Subpectoral biceps tenodesis provides satisfactory, reproducible outcomes for the treatment of type II and type IV SLAP lesions. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients who underwent subpectoral biceps tenodesis and labral debridement for type II and type IV SLAP lesions by a single board-certified shoulder surgeon from 2006 to 2012 were evaluated. Exclusion criteria included those patients who underwent biceps tenodesis with an associated rotator cuff repair, anterior labral repair, or posterior labral repair. Outcome measures included the visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, and demographic data. RESULTS Between 2006 and 2012, a total of 36 subpectoral biceps tenodesis procedures were performed in 33 patients for type II or IV SLAP lesions. Twenty-six patients with 29 shoulder surgeries were available for follow-up. The average age was 46.7 years, with 16 male and 10 female patients participating in the study. The average follow-up was 40.17 months. There was a significant improvement in ASES and VAS scores: 48.1 and 6.4 preoperatively compared with 87.5 and 1.5 postoperatively, respectively (P < .001). There was no significant difference based on SLAP lesion type, patient age, or patient sex. Of 29 shoulders, 26 (89.66%) were able to return to the previous level of activity. CONCLUSION This study adds to the evolving literature supporting biceps tenodesis as a viable treatment for type II and IV SLAP lesions. Patient age had no effect on the outcomes. Based on these results, biceps tenodesis is a safe, effective, and technically straightforward alternative to primary SLAP repair in patients with type II and IV SLAP tears.
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Affiliation(s)
- Michael B Gottschalk
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Spero G Karas
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA Atlanta Falcons, Atlanta, Georgia, USA
| | - Timothy N Ghattas
- OrthoAtlanta Sports Medicine, Southern Orthopaedic Specialists LLC, Atlanta, Georgia, USA
| | - Rachel Burdette
- Department of Sports Medicine, Ochsner Health Systems, New Orleans, Louisiana, USA
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Vogel LA, Moen TC, Macaulay AA, Arons RR, Cadet ER, Ahmad CS, Levine WN. Superior labrum anterior-to-posterior repair incidence: a longitudinal investigation of community and academic databases. J Shoulder Elbow Surg 2014; 23:e119-26. [PMID: 24496049 DOI: 10.1016/j.jse.2013.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 10/11/2013] [Accepted: 11/06/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Superior labrum anterior-to-posterior (SLAP) lesion repair is controversial regarding indications and potential complications. METHODS Databases were used to determine the SLAP repair incidence compared with all orthopaedic procedures over a period of 10 years. In part A, the New York Statewide Planning and Research Cooperative System ambulatory surgery database was investigated from 2002 to 2009. In part B, the California Office of Statewide Health Planning and Development ambulatory surgery database was investigated from 2005 to 2009. In part C, the American Board of Orthopaedic Surgery (ABOS) database was investigated from 2003 to 2010. RESULTS In part A, from 2002 to 2009, there was a 238% increase in SLAP repair volume compared with a 125% increase in all orthopaedic procedures. In part B, from 2005 to 2009, there was a 20.17% increase in SLAP repair volume compared with a decrease of 13.64% in all orthopaedic procedures. In part C, among candidates performing at least 1 SLAP repair, there was no statistically significant difference in likelihood of performing a SLAP repair (95% confidence interval, 0.973-1.003) in 2010 as compared with 2003 (P > .10). CONCLUSIONS There has been a significant increase in the incidence of SLAP repairs in the past 10 years in statewide databases. This pattern was not seen in the ABOS database, in which the annual volume of SLAP repairs remained stable over the same period. This suggests that SLAP lesions have been over-treated with surgical repair but that part II ABOS candidates are becoming more aware of the need to narrow indications. LEVEL OF EVIDENCE Epidemiology study, database analysis.
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Affiliation(s)
- Laura A Vogel
- Department of Orthopaedic Surgery, New York Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Todd C Moen
- W.B. Carrell Memorial Clinic, Dallas, TX, USA
| | - Alec A Macaulay
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Raymond R Arons
- Department of Orthopaedic Surgery, New York Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Edwin R Cadet
- Department of Orthopaedic Surgery, New York Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Christopher S Ahmad
- Department of Orthopaedic Surgery, New York Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - William N Levine
- Department of Orthopaedic Surgery, New York Presbyterian/Columbia University Medical Center, New York, NY, USA.
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Hanchard NCA, Lenza M, Handoll HHG, Takwoingi Y. Physical tests for shoulder impingements and local lesions of bursa, tendon or labrum that may accompany impingement. Cochrane Database Syst Rev 2013; 2013:CD007427. [PMID: 23633343 PMCID: PMC6464770 DOI: 10.1002/14651858.cd007427.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Impingement is a common cause of shoulder pain. Impingement mechanisms may occur subacromially (under the coraco-acromial arch) or internally (within the shoulder joint), and a number of secondary pathologies may be associated. These include subacromial-subdeltoid bursitis (inflammation of the subacromial portion of the bursa, the subdeltoid portion, or both), tendinopathy or tears affecting the rotator cuff or the long head of biceps tendon, and glenoid labral damage. Accurate diagnosis based on physical tests would facilitate early optimisation of the clinical management approach. Most people with shoulder pain are diagnosed and managed in the primary care setting. OBJECTIVES To evaluate the diagnostic accuracy of physical tests for shoulder impingements (subacromial or internal) or local lesions of bursa, rotator cuff or labrum that may accompany impingement, in people whose symptoms and/or history suggest any of these disorders. SEARCH METHODS We searched electronic databases for primary studies in two stages. In the first stage, we searched MEDLINE, EMBASE, CINAHL, AMED and DARE (all from inception to November 2005). In the second stage, we searched MEDLINE, EMBASE and AMED (2005 to 15 February 2010). Searches were delimited to articles written in English. SELECTION CRITERIA We considered for inclusion diagnostic test accuracy studies that directly compared the accuracy of one or more physical index tests for shoulder impingement against a reference test in any clinical setting. We considered diagnostic test accuracy studies with cross-sectional or cohort designs (retrospective or prospective), case-control studies and randomised controlled trials. DATA COLLECTION AND ANALYSIS Two pairs of review authors independently performed study selection, assessed the study quality using QUADAS, and extracted data onto a purpose-designed form, noting patient characteristics (including care setting), study design, index tests and reference standard, and the diagnostic 2 x 2 table. We presented information on sensitivities and specificities with 95% confidence intervals (95% CI) for the index tests. Meta-analysis was not performed. MAIN RESULTS We included 33 studies involving 4002 shoulders in 3852 patients. Although 28 studies were prospective, study quality was still generally poor. Mainly reflecting the use of surgery as a reference test in most studies, all but two studies were judged as not meeting the criteria for having a representative spectrum of patients. However, even these two studies only partly recruited from primary care.The target conditions assessed in the 33 studies were grouped under five main categories: subacromial or internal impingement, rotator cuff tendinopathy or tears, long head of biceps tendinopathy or tears, glenoid labral lesions and multiple undifferentiated target conditions. The majority of studies used arthroscopic surgery as the reference standard. Eight studies utilised reference standards which were potentially applicable to primary care (local anaesthesia, one study; ultrasound, three studies) or the hospital outpatient setting (magnetic resonance imaging, four studies). One study used a variety of reference standards, some applicable to primary care or the hospital outpatient setting. In two of these studies the reference standard used was acceptable for identifying the target condition, but in six it was only partially so. The studies evaluated numerous standard, modified, or combination index tests and 14 novel index tests. There were 170 target condition/index test combinations, but only six instances of any index test being performed and interpreted similarly in two studies. Only two studies of a modified empty can test for full thickness tear of the rotator cuff, and two studies of a modified anterior slide test for type II superior labrum anterior to posterior (SLAP) lesions, were clinically homogenous. Due to the limited number of studies, meta-analyses were considered inappropriate. Sensitivity and specificity estimates from each study are presented on forest plots for the 170 target condition/index test combinations grouped according to target condition. AUTHORS' CONCLUSIONS There is insufficient evidence upon which to base selection of physical tests for shoulder impingements, and local lesions of bursa, tendon or labrum that may accompany impingement, in primary care. The large body of literature revealed extreme diversity in the performance and interpretation of tests, which hinders synthesis of the evidence and/or clinical applicability.
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Affiliation(s)
- Nigel C A Hanchard
- Health and Social Care Institute, Teesside University, Middlesbrough, UK.
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McCulloch PC, Andrews WJ, Alexander J, Brekke A, Duwani S, Noble P. The effect on external rotation of an anchor placed anterior to the biceps in type 2 SLAP repairs in a cadaveric throwing model. Arthroscopy 2013. [PMID: 23177591 DOI: 10.1016/j.arthro.2012.06.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE This study examined whether there is a difference in external rotation (ER) between type 2 SLAP repairs consisting of anchors placed only posterior to the biceps insertion compared with repairs with an additional anchor placed anterior to the biceps. METHODS Seven cadaveric shoulders from donors with a mean age of 39.4 years were tested. Type 2 SLAP lesions were created, followed by a 3-anchor repair: a standard repair with 2 anchors posterior to the biceps plus an additional anchor anterior to the biceps. The specimens were placed on a material testing system machine and rotation was measured under a constant torque. The sutures were then removed sequentially from anterior to posterior during testing. RESULTS The average ER of the intact shoulder was 115.7° ± 2.6°. After SLAP tear creation and cyclic loading, the ER was 118.5° ± 2.6°, which decreased to 116.5° ± 2.6° after repair. This corresponds to a reduction of 2.0° of ER (P < .0001) with the repair. After release of the anterior anchor, the ER increased to 117.9° ± 2.6°, which corresponds to an increase in shoulder motion of 1.4° of ER (P = .0011). Additional release of the middle anchor, leaving only the posterior anchor intact, resulted in 118.0° ± 2.7° of ER, which corresponds to an increase of only 0.1° of ER (P = .7667). CONCLUSIONS Following type 2 SLAP repair in the cadaveric shoulder, removing the effect of the anchor anterior to the biceps resulted in a small but statistically significant increase in ER. The anterior anchor had the greatest effect on ER. The presence of 1 or 2 anchors posterior to the biceps did not have a significant effect on rotation. CLINICAL RELEVANCE When performing SLAP repairs on those in whom even a small loss of ER would be detrimental, such as baseball pitchers, avoidance of the use of an anchor anterior to the biceps should be considered.
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Affiliation(s)
- Patrick C McCulloch
- Methodist Center for Sports Medicine, The Methodist Hospital, Houston, Texas, USA.
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Kibler WB, Kuhn JE, Wilk K, Sciascia A, Moore S, Laudner K, Ellenbecker T, Thigpen C, Uhl T. The disabled throwing shoulder: spectrum of pathology-10-year update. Arthroscopy 2013; 29:141-161.e26. [PMID: 23276418 DOI: 10.1016/j.arthro.2012.10.009] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 08/31/2012] [Accepted: 10/03/2012] [Indexed: 02/02/2023]
Abstract
In the 10 years since the current concept series entitled "The Disabled Throwing Shoulder: Spectrum of Pathology" was conceived and written, many studies have been reported that add much more information to the understanding of the disabled throwing shoulder (DTS). The editors of Arthroscopy and the authors of the original series believed that an update to the original series would be beneficial to provide an organized overview of current knowledge that could update the thought process regarding this problem, provide better assessment and treatment guidelines, and guide further research. A dedicated meeting, including current published researchers and experienced clinicians in this subject, was organized by the Shoulder Center of Kentucky. The meeting was organized around 5 areas of the DTS that were highlighted in the original series and appear to be key in creating the DTS spectrum and to understanding and treating the DTS: (1) the role of the kinetic chain; (2) the role and clinical evaluation of the scapula; (3) the role of deficits in glenohumeral rotation, glenohumeral internal rotation deficit, and total range-of-motion deficit in the causation of labral injury and DTS; (4) the role of superior labral (SLAP) injuries and rotator cuff injuries; and (5) the composition and progression of rehabilitation protocols for functional restoration of the DTS. The meeting consisted of presentations within each area, followed by discussions, and resulted in summaries regarding what is known in each area, what is not known but thought to be important, and strategies to implement and enlarge the knowledge base.
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Affiliation(s)
- W Ben Kibler
- Shoulder Center of Kentucky, Lexington, 40504, USA
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Schrøder CP, Skare O, Gjengedal E, Uppheim G, Reikerås O, Brox JI. Long-term results after SLAP repair: a 5-year follow-up study of 107 patients with comparison of patients aged over and under 40 years. Arthroscopy 2012; 28:1601-7. [PMID: 22608888 DOI: 10.1016/j.arthro.2012.02.025] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 02/23/2012] [Accepted: 02/28/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The aims of this prospective cohort study were to assess the long-term results after isolated superior labral repair and to determine whether the results were associated with age. METHODS One hundred seven patients underwent repair of isolated SLAP tears. There were 36 women and 71 men with a mean age of 43.8 years (range, 20 to 68 years). Mean follow-up was 5.3 years (range, 4 to 8 years). Of the patients, 62 (57.9%) were aged 40 years or older. Follow-up examinations were performed by an independent examiner; 102 patients (95.3%) had a 5-year follow-up. RESULTS The Rowe score improved from 62.8 (SD, 11.4) preoperatively to 92.1 (SD, 13.5) at follow-up (P < .001). Satisfaction was rated excellent/good for 90 patients (88%) at 5 years. There was no significant difference in the results for patients aged 40 years or older and those aged under 40 years. Difficulty with postoperative stiffness and pain was reported by 14 patients (13.1%). CONCLUSIONS Our results suggest that long-term outcomes after isolated labral repair for SLAP lesions are good and independent of age. Postoperative stiffness was registered in 13.1% of the patients. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Stephenson DR, Hurt JH, Mair SD. Rotator cuff injury as a complication of portal placement for superior labrum anterior-posterior repair. J Shoulder Elbow Surg 2012; 21:1316-21. [PMID: 22056325 DOI: 10.1016/j.jse.2011.08.054] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 08/01/2011] [Accepted: 08/06/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND An accessory trans-rotator cuff portal is commonly used in shoulder arthroscopy, primarily in the repair of SLAP (superior labrum anterior-posterior) lesions. Improper placement of the trans-rotator cuff portal can result in damage to the rotator cuff near its attachment site. METHODS Six patients were studied, having been referred to our clinic after previous shoulder arthroscopy with SLAP repair. Review of operative notes showed that the rotator cuff had been described as normal in 5 patients and having a mild partial-thickness tear of the supraspinatus in 1 patient at the time of the first surgery. All patients underwent repeat shoulder arthroscopy within 10 to 22 months. RESULTS All 6 patients were found to have full-thickness rotator cuff tears at the time of the second surgery. The rotator cuff injuries appeared to be associated with portal placement from the previous SLAP repair. All patients underwent rotator cuff repair, and 3 had concomitant revision SLAP repair. All patients had clinical improvement, with a mean preoperative American Shoulder and Elbow Surgeons score of 45.3 and mean postoperative score of 90.5. Mean follow-up was 58.3 months. CONCLUSIONS Proper placement of a trans-rotator cuff portal should be performed cautiously, traversing the rotator cuff medial to the muscle-tendon junction. This report highlights the potential for injury to the rotator cuff tendons with improper placement of this portal. In patients with persistent pain after previous SLAP repair with a trans-rotator cuff portal technique, rotator cuff injury may be the source of symptoms. Revision surgery with rotator cuff repair can provide improvement.
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Short-term clinical results after arthroscopic type II SLAP repair. Wien Klin Wochenschr 2012; 124:370-6. [PMID: 22688135 DOI: 10.1007/s00508-012-0184-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 05/16/2012] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this study was to retrospectively review the clinical results of arthroscopic repair of type II SLAP lesions with respect to daily living activities and return to preinjury sports level. PATIENTS AND METHODS Twenty-one patients with an average age of 28 (range 18-44 years, respectively) underwent arthroscopic repair of isolated type II SLAP lesions. Surgery was performed by two of the senior authors with specialty training in arthroscopic shoulder surgery. Mean follow-up was 30.3 months (range 12-71 months, respectively). The clinical results were objectively measured using the individual relative Constant score (CS(indiv)). RESULTS At follow-up the mean CS(indiv) was 92 % (range 78-100 %). Restrictions to active motion were seen in six patients (28.6 %), four (19 %) in internal rotation and two (9.5 %) in external rotation but not all of these were restricted in their activities of daily living. Five patients (23.8 %) had an affected sleep, three patients (14.3 %) were limited in sports and one patient (4.7 %) was restricted at work. After surgery, 18 of 21 patients (85.7 %) regained preinjury sports level. CONCLUSIONS Although the rehabilitation process may be affected by a protracted period of pain, a long-term limitation of the range of motion (ROM) after surgery is very unlikely. The results in this study are encouraging and the authors recommend anatomic restoration and repair of type II SLAP lesions.
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Milewski MD, Diduch DR, Hart JM, Tompkins M, Ma SY, Gaskin CM. Bone replacement of fast-absorbing biocomposite anchors in arthroscopic shoulder labral repairs. Am J Sports Med 2012; 40:1392-401. [PMID: 22523371 DOI: 10.1177/0363546512441589] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Newer generation biocomposite anchors are hypothesized to resorb more reliably and faster, while allowing for bone ingrowth and replacement. PURPOSE The purposes of this study were to (1) assess anchor resorption and bone ingrowth over time, (2) identify tunnel widening or potential reactions to the implants, (3) compare imaging findings for different sites of labral repair, and (4) determine patient subjective outcomes with the use of biocomposite anchors in glenoid labral repair. STUDY DESIGN Case series; Level of evidence, 4. METHODS We enrolled 22 patients to participate in a 24-month outcomes study that included subjective and objective outcome assessments after glenoid labrum repair surgery. Magnetic resonance imaging (MRI) was performed at 6 and 12 months to identify any potential reactions to implants. Computed tomography (CT) scans were performed at 12 and 24 months to determine anchor resorption and bone ingrowth. Sixteen patients and 47 anchors were available for follow-up at 24 months. An independent, fellowship-trained musculoskeletal radiologist read the scans. Subjective outcome scores measured at 24 months postoperatively included Simple Shoulder Test, Tegner activity scale, American Shoulder and Elbow Surgeons (ASES), and University of California, Los Angeles (UCLA) shoulder scores. RESULTS No adverse events were reported with the use of biocomposite anchors at the end of the study period. At 12 and 24 months, respectively, CT scans demonstrated that an estimated 68% and 98% of combined anchor material had been absorbed, 56% and 78% of the anchor material had been replaced by soft tissue of variable density, and 9% and 20% of total anchor volume was replaced by bone. No obvious mechanical failure of the labral repairs was detected on nonarthrogram MRI. Three of the 47 anchors showed bone cyst formation. Tunnel widening (expansion beyond tunnel diameter of 3 mm; 2.9-mm drill hole utilized) was seen in 55% of the anchors but decreased between 12 and 24 months, consistent with bone replacement. Tunnel widening was seen more in anteroinferior and posterior glenoid anchor locations (84% and 57%, respectively) than in superior labral anchors (13%). Subjective outcome scores at 24 months for ASES and UCLA shoulder scores averaged 88 and 30, respectively. All but one patient were satisfied with their outcome at 24 months. CONCLUSION Our imaging evaluation indicates resorption of newer generation biocomposite anchors with progressive bone replacement at 12 and 24 months while maintaining acceptable subjective outcomes.
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Superior Labrum Anterior and Posterior Lesions and Microinstability. Magn Reson Imaging Clin N Am 2012; 20:277-94, x-xi. [DOI: 10.1016/j.mric.2012.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Park S, Glousman RE. Outcomes of revision arthroscopic type II superior labral anterior posterior repairs. Am J Sports Med 2011; 39:1290-4. [PMID: 21441419 DOI: 10.1177/0363546511398648] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Outcomes of arthroscopic type II superior labral anterior posterior (SLAP) repairs have been reported with success. However, published data regarding outcomes of revision arthroscopic type II SLAP repairs are lacking. HYPOTHESIS Outcomes of revision arthroscopic type II SLAP repairs are inferior to those of primary repairs. STUDY DESIGN Case series; Level of evidence, 4. METHODS A retrospective chart review was performed to identify patients who had undergone revision arthroscopic type II SLAP repairs at our institution. Patients who underwent concomitant rotator cuff repairs or labral repairs for instability were excluded. Twelve patients were contacted, and the following outcome data were prospectively gathered: American Shoulder and Elbow Surgeons (ASES) score, patient satisfaction level, return to work, return to sports, and physical examination. Demographics and intraoperative report data were also collected from the charts. RESULTS The mean age at the time of revision arthroscopic type II SLAP repairs was 32.6 years (range, 19-67 years) with a mean follow-up of 50.5 months (range, 8-81 months). There were 5 workers' compensation patients and 6 overhead athletes. Pain was the chief complaint at the time of initial and revision SLAP repairs. The mean ASES score was 72.5, patient satisfaction level was 6.4 (scale of 0-10), mean return to work was at 57.8% of the previous level, and mean return to sports was at 42.2% of the previous level. In overhead athletes, mean return to sports was at 41.3% of the previous level, and none of the 4 baseball players returned to preinjury level. The mean values for all outcome data and range of motion values were lower in workers' compensation patients. There were no reported complications, but 2 patients required additional arthroscopic surgeries. CONCLUSION Arthroscopic revision type II SLAP repairs yield worse results than primary repairs as reported in the literature, with workers' compensation patients and overhead athletes doing especially worse. A larger prospective study of this relatively rare procedure is needed to better determine which patients may benefit from this procedure.
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Affiliation(s)
- SangDo Park
- SangDo Park, Metrocrest Orthopaedics and Sports Medicine, Carrollton, TX 75010, USA.
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Superior labral tears: repair versus biceps tenodesis. J Shoulder Elbow Surg 2011; 20:S2-8. [PMID: 21281918 DOI: 10.1016/j.jse.2010.11.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 11/18/2010] [Accepted: 11/20/2010] [Indexed: 02/01/2023]
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Byram IR, Dunn WR, Kuhn JE. Humeral head abrasion: an association with failed superior labrum anterior posterior repairs. J Shoulder Elbow Surg 2011; 20:92-7. [PMID: 20863719 DOI: 10.1016/j.jse.2010.05.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Revised: 05/09/2010] [Accepted: 05/25/2010] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS An abrasion on the humeral head under the articulating portion of the biceps tendon has been observed in patients with pain and stiffness after superior labrum anterior posterior (SLAP) repair. This study examined this humeral head abrasion (HHA) and its association with various diagnoses involving pathology of the biceps-labral complex. We hypothesized that it would be more common in failed SLAP repairs than other diagnoses. MATERIALS AND METHODS A retrospective chart review was performed of 253 patients who underwent shoulder arthroscopy by a single surgeon during a 5-year period. Postoperative diagnoses were used to confirm one of the following diagnoses: failed SLAP repair, biceps tendonitis, SLAP lesion with biceps tendonitis, and isolated SLAP lesion. Operative reports and surgical images were analyzed to identify the presence or absence of HHA. Demographic data, including age, sex, handedness, and onset of injury, were also collected. The frequency of this lesion among the different diagnoses and patient characteristics was compared by χ² analysis. RESULTS HHA was observed in 13 of 18 patients (72.2%) with failed SLAP repairs, in 8 of 18 (44.4%) with biceps tendonitis, in 11 of 20 (55%) with SLAP lesion and biceps tendonitis, and in 1 of 71 (1.4%) with isolated SLAP lesions, significantly differing in frequency by diagnosis (P < .001). Patients with HHA were an older median age than those without (48 vs 40; P = .004). DISCUSSION HHA is common in patients with a pathologic biceps-labral complex, especially those with failed SLAP repair. We speculate that this lesion is due to inflammation of the biceps tendon resulting in increased biceps-humeral head contact pressure.
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Affiliation(s)
- Ian R Byram
- Vanderbilt Sports Medicine, Nashville, TN, USA.
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43
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Neri BR, ElAttrache NS, Owsley KC, Mohr K, Yocum LA. Outcome of type II superior labral anterior posterior repairs in elite overhead athletes: Effect of concomitant partial-thickness rotator cuff tears. Am J Sports Med 2011; 39:114-20. [PMID: 20940452 DOI: 10.1177/0363546510379971] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are conflicting reports in the literature regarding the outcome of superior labral anterior posterior (SLAP) repairs in overhead athletes and a paucity of data demonstrating ability to return to prior level of competition. HYPOTHESIS Kerlan-Jobe Orthopaedic Clinic shoulder and elbow score provides more accurate assessment of shoulder function and ability to return to previous level of athletic competition after SLAP lesion repair than does the conventional American Shoulder and Elbow Surgeons scoring system. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Twenty-three elite (collegiate or professional) overhead athletes who were more than 1-year status postarthroscopic repair of type II SLAP lesions were evaluated using both the Kerlan-Jobe Orthopaedic Clinic shoulder and elbow score and American Shoulder and Elbow Surgeons score. P values were computed using the analysis of variance model. Postoperative American Shoulder and Elbow Surgeons and Kerlan-Jobe Orthopaedic Clinic scores from subjects were compared with control values obtained from a healthy athletic cohort; the relationship between the scores was investigated using the linear regression model and assessed using Pearson correlations. RESULTS At a mean 38-month follow-up, 13 athletes were playing pain free at the time of the questionnaire administration, 6 were playing with pain, and 4 were not playing because of pain. Regarding American Shoulder and Elbow Surgeons scores, 22 athletes (96%) had good-excellent scores, whereas 1 (4%) had a fair score. The Kerlan-Jobe Orthopaedic Clinic scores revealed 9 excellent (39%), 3 good (13%), 4 fair (17%), and 7 poor (30%) results for the same study group. Of the 23 patients, 13 (57%) had returned to their pain-free preinjury levels of competition at final follow-up. The inability to return to this level of competition correlated with the presence of a partial-thickness rotator cuff tear (P = .0059). The Kerlan-Jobe Orthopaedic Clinic demonstrated better overall accuracy (85%) than did the American Shoulder and Elbow Surgeons (70%) in evaluating return to pain-free preinjury levels. CONCLUSION Return to preinjury level of competition for elite overhead athletes after type II SLAP lesion repairs was 57%, despite high American Shoulder and Elbow Surgeons scores. Return to play status correlated with the presence of a partial-thickness rotator cuff tear. The Kerlan-Jobe Orthopaedic Clinic score, designed specifically for the evaluation of the overhead athlete, was a more accurate assessment tool than was the American Shoulder and Elbow Surgeons in this population of elite overhead athletes with SLAP tears.
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Affiliation(s)
- Brian R Neri
- ProHEALTH Care Associates, Lake Success, NY 11042, USA.
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Miyazaki AN, Fregoneze M, Santos PD, da Silva LA, do Val Sella G, Soares AL, Junior AFM, Checchia SL. EVALUATION OF RESULTS AND COMPLICATIONS FROM ARTHROSCOPIC SUTURE OF SLAP LESIONS. Rev Bras Ortop 2011; 46:51-6. [PMID: 27026986 PMCID: PMC4799152 DOI: 10.1016/s2255-4971(15)30176-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 06/14/2010] [Indexed: 01/02/2023] Open
Abstract
Objective: To evaluate the results and complications from arthroscopic suturing of SLAP lesions. Methods: Seventy-one patients who underwent arthroscopic suturing of SLAP lesions between July 1995 and May 2008 were evaluated. The procedures were performed by the Shoulder and Elbow Surgery Group of the Department of Orthopedics and Traumatology, Fernandinho Simonsen Wing, Santa Casa de São Paulo, Brazil. Associated lesions were seen in 68 of the 71 patients evaluated (96%), and the other three (4%) had SLAP lesions alone. Results: The associated lesions most frequently found in the patients under 40 years of age were labral lesions (69%), while in patients aged 40 years or over, impact syndrome with or without rotator cuff injury was the most commonly associated condition (71.4%). According to the UCLA method, 79% of our results (56 cases) were good or excellent. Postoperative complications occurred in 15 cases (21%); among these, the most common was the presence of residual pain (46.6%), followed by adhesive capsulitis (33.3%). Conclusions: There was a great association between SLAP lesions and other shoulder lesions, which varied according to the patients' age groups. Arthroscopic suturing of the SLAP lesions provided excellent results in the majority of the cases, but complications occurred in 21%.
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Affiliation(s)
- Alberto Naoki Miyazaki
- Assistant Professor and Head of the Shoulder and Elbow Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
| | - Marcelo Fregoneze
- Assistant Professor and Attending Physician in the Shoulder and Elbow Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
| | - Pedro Doneux Santos
- Attending Physician in the Shoulder and Elbow Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
| | - Luciana Andrade da Silva
- Attending Physician in the Shoulder and Elbow Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
| | - Guilherme do Val Sella
- Attending Physician in the Shoulder and Elbow Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
| | - André Lopes Soares
- Trainee in the Shoulder and Elbow Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
| | - Adriano Fernando Mendes Junior
- Trainee in the Shoulder and Elbow Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
| | - Sérgio Luiz Checchia
- Adjunct Professor, Academic Consultant and Member of the Shoulder and Elbow Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, Brazil
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Oh JH, Kim SH, Kwak SH, Oh CH, Gong HS. Results of concomitant rotator cuff and SLAP repair are not affected by unhealed SLAP lesion. J Shoulder Elbow Surg 2011; 20:138-45. [PMID: 20634099 DOI: 10.1016/j.jse.2010.04.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Revised: 04/10/2010] [Accepted: 04/12/2010] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS To verify the anatomic results of combined repair of a full-thickness rotator cuff tear and superior labral anterior and posterior (SLAP) lesion. In addition, we compared the anatomic and functional outcomes according to the status of the repaired SLAP lesion. METHODS We enrolled 61 patients who underwent cuff repair with concomitant SLAP repair and were available for both functional and radiologic outcome evaluation at least 1 year after the operation. There were 40 male and 21 female patients with a mean age of 57.4 years (range, 39-70 years). We measured various clinical outcomes and evaluated the structural outcomes of the rotator cuff and the superior labrum and rotator cuff using computed tomography arthrography at the final follow-up visit. We also evaluated the functional outcome according to anatomic healing of the superior labrum. RESULTS Labral healing to the bony glenoid was achieved in 49 patients (80.3%), and anatomic healing of the rotator cuff was observed in 44 patients (72.1%). The retear rate of the rotator cuff was not statistically different with respect to labral healing status. All functional outcomes improved significantly (P < .001), and there were no statistical differences in functional outcome with respect to postoperative healing of the superior labrum. CONCLUSIONS An unhealed SLAP lesion did not preclude the successful outcome of concomitant rotator cuff repair. Therefore, repair of a concomitant SLAP lesion may not be an essential procedure for a successful outcome of a rotator cuff repair.
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Affiliation(s)
- Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Kyeonggi-do, South Korea
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Galano GJ, Ahmad CS, Bigliani L, Levine W. Percutaneous SLAP lesion repair technique is an effective alternative to portal of Wilmington. Orthopedics 2010; 33:803. [PMID: 21053881 DOI: 10.3928/01477447-20100924-15] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Athletes with superior labral tear from anterior to posterior (SLAP) lesions place large demands on their rotator cuff and often have partial articular-sided rotator cuff tears as part of an internal impingement process. A percutaneous technique that facilitates SLAP repair may decrease the rotator cuff morbidity associated with establishment of the standard Wilmington portal. The current study reports the clinical outcome of patients with SLAP lesions treated with a percutaneous repair technique. Twenty-two patients with SLAP lesions underwent percutaneous repair. Mean patient age was 26.9 years. Standard posterior viewing and anterior working portals were used. Anchor placement and suture passing were performed with a 3-mm percutaneous and transtendinous approach to the superior labrum. Knot tying was performed via the standard anterior working portal. Clinical outcomes were assessed with validated shoulder evaluation instruments. Mean follow-up was 31.1 months (±6.6 months). Improvement of shoulder evaluation scores from pre- to postoperative were as follows: American Shoulder and Elbow Surgeons score improved from 49.5 to 83.6, visual analog scale improved from 5.4 to 1.5, and Simple Shoulder Score improved from 6.4 to 11.0. All were significant improvements (P<.05). There was no significant difference in functional scores between Type II lesions versus combined lesions, or between patients with or without a concurrent low-grade rotator cuff tear. Ninety percent of athletes were able to return to sport at pre-injury level of function. Percutaneously-assisted arthroscopic SLAP lesion repair may minimize surgical morbidity to the rotator cuff and provides excellent results.
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Affiliation(s)
- Gregory J Galano
- Department of Orthopedic Surgery, Columbia University, New York, New York, USA
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47
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Alpert JM, Wuerz TH, O'Donnell TFX, Carroll KM, Brucker NN, Gill TJ. The effect of age on the outcomes of arthroscopic repair of type II superior labral anterior and posterior lesions. Am J Sports Med 2010; 38:2299-303. [PMID: 20739578 DOI: 10.1177/0363546510377741] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The majority of clinical outcome studies of type II superior labral anterior and posterior (SLAP) repair assess patients younger than age 40. Biceps tenotomy or tenodesis is often recommended for patients older than age 40 with superior labrum-biceps complex injury. HYPOTHESIS There is no difference in patient clinical outcomes comparing arthroscopic type II SLAP repair in patients younger or older than age 40. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Fifty-two patients stratified to groups younger than age 40 (21 patients; average age, 32.9 years) and older than age 40 (31 patients; average age, 55.1 years) were identified at a minimum 2-year follow-up (average, 28 months) after type II SLAP repair by a single surgeon using suture anchors. Outcome scores included American Shoulder and Elbow Society scores (ASES), Short Form-12 scores, Simple Shoulder Test scores, and visual analog pain scale. RESULTS At follow-up, there was no statistical difference in visual analog pain scale (P = .16), ASES scores (P = .07), Simple Shoulder Test scores (P =.41), Short Form-12 testing, or range of motion testing. Patients older than age 40 noted their shoulder to be 87% of normal; 26 of 31 (84%) were satisfied to completely satisfied, and 28 of 31 (90%) would have the surgery again. Patients younger than 40 noted their shoulder to be approximately 89% of normal; 20 of 21 (95%) were satisfied to completely satisfied, and 18 of 21 (86%) would have the same procedure performed again. CONCLUSION Our findings support that arthroscopic treatment of isolated type II SLAP repair using suture anchors can yield good to excellent results in patients older and younger than age 40. We found no statistically significant difference in patient outcome scores, satisfaction levels, or willingness to have the same procedure again when comparing arthroscopic SLAP repair in patients younger or older than age 40.
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Affiliation(s)
- Joshua M Alpert
- Midwest Bone and Joint Institute, 420 W. Northwest Highway, Barrington, IL 60010, USA.
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Friel NA, Karas V, Slabaugh MA, Cole BJ. Outcomes of type II superior labrum, anterior to posterior (SLAP) repair: prospective evaluation at a minimum two-year follow-up. J Shoulder Elbow Surg 2010; 19:859-67. [PMID: 20554453 PMCID: PMC3869567 DOI: 10.1016/j.jse.2010.03.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 02/28/2010] [Accepted: 03/01/2010] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Patients with type II superior labrum, anterior to posterior (SLAP) lesions will have improved function and decreased pain at a minimum of 2 years after arthroscopic SLAP repair using bioabsorbable suture anchor fixation. MATERIALS AND METHODS The study population consisted of 48 patients who underwent arthroscopic SLAP repair. Subjective shoulder scores, range of motion, and strength (postoperative only) were assessed preoperatively and at a minimum of 2 years postoperatively. RESULTS At an average of 3.4 years after surgery, statistically significant improvement was seen in American Shoulder and Elbow Surgeons score, University of California, Los Angeles score, Simple Shoulder Test scores, Constant activities of daily living, visual analog scale for pain, and Short Form-12 Health Survey physical outcome scores. Improvements were made in forward flexion, abduction, external rotation, and internal rotation. Subgroup analysis of nonathletes, nonoverhead athletes, recreational overhead athletes, and collegiate overhead athletes showed preoperative to postoperative improvements in subjective outcomes scores. Overhead laborers and nonlaborers also showed preoperative to postoperative improvements in subjective shoulder scores. DISCUSSION No differences were seen between the outcomes of nonathletes, nonoverhead athletes, recreational overhead athletes, and collegiate overhead athletes, suggesting that SLAP type II repair is successful independent of the patient's vocation or sport. CONCLUSION These results show that arthroscopic SLAP repair of type II lesions with bioabsorbable suture anchors provides a significant improvement in functional capacity and pain relief.
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Affiliation(s)
- Nicole A Friel
- Department of Orthopaedics, Rush University Medical Center, Chicago, IL 60612, USA
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Edwards SL, Lee JA, Bell JE, Packer JD, Ahmad CS, Levine WN, Bigliani LU, Blaine TA. Nonoperative treatment of superior labrum anterior posterior tears: improvements in pain, function, and quality of life. Am J Sports Med 2010; 38:1456-61. [PMID: 20522835 DOI: 10.1177/0363546510370937] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although there are multiple reports documenting successful outcomes with operative treatment of superior labrum anterior posterior (SLAP) tears, there are few reports on the results of nonoperative treatment. HYPOTHESIS Nonoperative treatment of SLAP tears will result in improved outcomes over pretreatment values using validated, patient-derived outcome instruments. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 371 patients with a diagnosis of labral tear at our institution were mailed a questionnaire that included the following validated, patient-derived outcome assessment instruments: Short Form 36 (SF-36), European Quality of Life measure (EuroQol), visual analog pain scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, and simple shoulder test (SST). Sixty-six surveys did not reach the patients because of incorrect addresses, and 50 surveys were returned, for a 16.4% (50 of 305) response rate. Of the patients with a clinically documented SLAP lesion (positive O'Brien test, pain at the bicipital groove, and positive magnetic resonance imaging) and sufficient follow-up data (minimum 1 year), 39 patients who met the criteria returned the survey and 19 had nonoperative treatment. Twenty patients (51%) from the overall surveyed group were considered nonoperative treatment failures and had arthroscopic surgical reconstruction. Nonoperative treatment consisted of nonsteroidal anti-inflammatory drugs and a physical therapy protocol focused on scapular stabilization exercises and posterior capsular stretching. Statistical analysis was performed using the paired t test; values of P < .05 were considered significant. RESULTS At an average follow-up of 3.1 years, function improved significantly (ASES function 30.8 to 45.0 [P < .001]; ASES total 58.5 to 84.7 [P = .001], SST 8.3 to 11.0 [P = .02]) in those patients with successful nonoperative treatment. Quality of life also improved after treatment (EuroQol 0.76 to 0.89, P = .009). Pain relief was significant, as VAS pain scores decreased from 4.5 to 2.1 (P = .043). All patients with successful nonoperative treatment returned to sports. Seventy-one percent of all athletes were able to return to preparticipation levels, but only 66% of overhead athletes returned to their sport at the same or higher level. CONCLUSION Using validated, patient-derived outcome instruments, the present study shows that successful nonoperative treatment of superior labral tears results in improved pain relief and functional outcomes compared with pretreatment assessments. Although 20 patients (51%) in this group elected surgery and may be considered nonoperative treatment failures, those patients with successful nonoperative treatment had significant improvements in pain, function, and quality of life. Return to sports was comparable with patients with successful surgical treatment, although return to overhead sports at the same level was difficult to achieve (66%). Based on these findings, a trial of nonoperative treatment may be considered in patients with the diagnosis of isolated superior labral tear. In overhead athletes and in those patients where pain relief and functional improvement is not achieved, surgical treatment should be considered.
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Levy HJ, Schachter AK, Hurd JL, Lassen B, Panagopoulos G. The effect of rotator cuff tears on surgical outcomes after type II superior labrum anterior posterior tears in patients younger than 50 years. Am J Sports Med 2010; 38:318-22. [PMID: 19966095 DOI: 10.1177/0363546509347364] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rotator cuff injury in the setting of type II superior labrum anterior posterior lesions is a common finding. Although predictable surgical outcomes can be expected after type II superior labrum anterior posterior repair, the effect of rotator cuff tears on surgical outcome is unknown. HYPOTHESIS Rotator cuff tears will not negatively affect surgical outcome of type II superior labrum anterior posterior repairs. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The study group included 93 patients younger than 50 years who underwent arthroscopic type II superior labrum anterior posterior repair and were available for review at a minimum of 2 years after surgery. Group 1 patients were identified as having normal rotator cuffs at the time of repair. Group 2 patients were identified as having rotator cuff injury at the time of repair (either partial-thickness or full-thickness tears). Statistical analysis was performed comparing the postoperative University of California, Los Angeles shoulder scores and overall improvement in University of California, Los Angeles score using the Student t test for significance. RESULTS Mean follow-up was 2.54 years; 52.7% of patients had evidence of rotator cuff tears at the time of surgery. The mean postoperative University of California, Los Angeles score for group 1 was 32.9 (improvement of 11.0), and the mean postoperative University of California, Los Angeles score for group 2 was 33.3 (improvement of 12.2). There was not a significant difference in any of the outcome measures between groups. CONCLUSION Predictable short-term surgical results and return to activity can be expected after repair of type II superior labrum anterior posterior lesions in patients younger than 50 years who have coexistent rotator cuff tear. Although cuff lesions did not have a negative effect on the short-term outcome in patients with type II superior labrum anterior posterior lesions, longer-term follow-up is needed to determine natural history of this pathologic condition.
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Affiliation(s)
- Howard J Levy
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York, USA.
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