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Abourisha E, Sakr M, Srinivasan A, Singh HP. Surgical management of SLAP lesions: Which technique has better surgical outcomes? J Orthop 2024; 50:29-35. [PMID: 38162261 PMCID: PMC10755497 DOI: 10.1016/j.jor.2023.11.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 11/19/2023] [Indexed: 01/03/2024] Open
Abstract
Background The gold-standard surgical management for superior labral anterior to posterior (SLAP) lesions is unclear. This meta-analysis compares the outcomes of different surgical SLAP lesion management techniques including labral repair, long head of biceps (LHB) tenodesis and LHB tenotomy with consideration to clinical scores, return to sports, re-operation, range-of-motion and patient satisfaction. Methods PRISMA guidelines were adhered. Web of Science, PubMed, Cochrane Central, Science direct and EMBASE were searched using relevant keywords. Eligible studies were screened, data extracted and synthesised using Review Manager (Version 5.4.1). Bayesian network meta-analysis (NMA) was conducted. Randomised control and clinical trials regarding SLAP lesion management in patients over 18 years old were included. Studies were excluded if patients had concomitant massive tears of the rotator cuff, Bankart lesions or instability of the shoulder. Results Patient satisfaction with LHB tenodesis was superior to superior labral repair. No difference was demonstrated with respect to ASES score, pain VAS score, return to sports and pre-injury activities, reoperation rate or range-of-motion. LHB tenodesis and LHB tenotomy show no difference in ASES score or post operative deformity in management of SLAP lesions. Discussion High-quality, standardised randomised control studies between the different surgical techniques is warranted.
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Affiliation(s)
- Eslam Abourisha
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | | | - Ananth Srinivasan
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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Nam J, Koh YG, Chung S, Kim PS, Jang J, Park JH, Kang KT. The Application of Virtual Reality in Shoulder Surgery Rehabilitation. Cureus 2024; 16:e58280. [PMID: 38752078 PMCID: PMC11094526 DOI: 10.7759/cureus.58280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/18/2024] Open
Abstract
To achieve a positive functional prognosis in orthopedic surgery, particularly in shoulder surgeries, effective rehabilitation is essential. Recently, there has been growing interest in the use of virtual reality (VR) in the field of orthopedics, particularly for preoperative education and training, as well as clinical and home-based rehabilitation. This report describes the process of developing an application utilizing Meta Quest 2 VR technology (Meta, CA, USA) for rehabilitation after shoulder surgery. This application assists patients in performing postoperative exercises at home by wearing VR equipment tailored to their postoperative weeks. The advantages of VR rehabilitation lie in overcoming the limitations of traditional rehabilitation methods and providing patients with a better rehabilitation experience. Moreover, automating the rehabilitation process and reducing patients' visits to clinics can lead to cost savings. This report raises expectations for the potential and scalability of VR utilization, extending beyond orthopedics to other fields. In addition, it anticipates that with better feedback and motivation, the rehabilitation effects for patients can be further enhanced.
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Affiliation(s)
- Jihun Nam
- Mechanical Engineering, Yonsei University, Seoul, KOR
| | - Yong-Gon Koh
- Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, KOR
| | | | - Paul S Kim
- Orthopaedic Surgery, The Bone Hospital, Seoul, KOR
| | - Jihoon Jang
- Orthopaedics, Yonsei Siwon Orthopaedic Clinic, Seoul, KOR
| | - Joon-Hee Park
- Anesthesiology & Pain Medicine, Hallym University College of Medicine and Kangdong Sacred Heart Hospital, Seoul, KOR
| | - Kyoung-Tak Kang
- Skyve R&D Lab, Skyve Co. LTD., Seoul, KOR
- Mechanical Engineering, Yonsei University, Seoul, KOR
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Della Rotonda G, Guastafierro A, Viglione S, Cozzolino A, Russo F, Polito R, Daniele A, Nigro E, Ciccarelli M, Russo R. Long-term results of arthroscopic repair of type II SLAP lesions in sports: assessment of return to pre-injury playing level and critical risk factors for complication. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:433-440. [PMID: 37573541 PMCID: PMC10771416 DOI: 10.1007/s00590-023-03677-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE The management of isolated SLAP lesions is still debated especially in athletes. Aims of the study were: 1. to analyse our algorithm to treat SLAP lesions starting from the selection of patients for surgery and 2. to correlate the familiarity for diabetes and hypothyroid disorders with post-operative results. METHODS Seventy-eight patients with isolated SLAP lesion were arthroscopically treated using knotless anchors and microfractures. All patients had a pre-operative and post-operative clinical examination according to Walch-Duplay, Constant, Rowe and Dash scores and interviewed for familiarity to diabetes and hypothyroid disorders. RESULTS About 68.8% of patients solved pain with rehabilitation. About 29% of patients returned to the sports activities. About 32% of patients were no responder to physiotherapy and were arthroscopically treated. About 53.9% of patients responded excellent, 34.7% good, 3.8% medium and 7.6% poor results according to Walch-Duplay score. The Constant score increased from 64 to 95, the Rowe score from 48 to 96. The outcomes were significantly worse in patients with familiarity for diabetes. CONCLUSIONS Microfractures and knotless anchor give long-term good results for the treatment of SLAP lesions in athletes. The familiarity for diabetes is an important risk factor that can lead to decreased outcomes.
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Affiliation(s)
- G Della Rotonda
- Orthopaedic Department, Pineta Grande Hospital Castel Volturno, Caserta, Italy
| | - A Guastafierro
- Orthopaedic Department, Pineta Grande Hospital Castel Volturno, Caserta, Italy
| | - S Viglione
- Orthopaedic Department, Pineta Grande Hospital Castel Volturno, Caserta, Italy
| | - A Cozzolino
- Orthopaedic Department, Pineta Grande Hospital Castel Volturno, Caserta, Italy
| | - F Russo
- Orthopaedic Department, Pineta Grande Hospital Castel Volturno, Caserta, Italy
| | - R Polito
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università Degli Studi Della Campania, "Luigi Vanvitelli", Naples, Italy
- CEINGE-Biotecnologie Avanzate Scarl, Naples, Italy
| | - A Daniele
- Dipartimento di Scienze e Tecnologie Ambientali Biologiche Farmaceutiche, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Gaetano Salvatore, 486, 80145, Naples, Italy
- CEINGE-Biotecnologie Avanzate Scarl, Naples, Italy
| | - E Nigro
- Dipartimento di Scienze e Tecnologie Ambientali Biologiche Farmaceutiche, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Gaetano Salvatore, 486, 80145, Naples, Italy.
- CEINGE-Biotecnologie Avanzate Scarl, Naples, Italy.
| | - M Ciccarelli
- Orthopaedic Department, Pineta Grande Hospital Castel Volturno, Caserta, Italy
| | - R Russo
- Orthopaedic Department, Pineta Grande Hospital Castel Volturno, Caserta, Italy
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Althoff AD, Brunette C, Brockmeier S. Postoperative Rehabilitation After Superior Labrum Anterior Posterior Repair. Phys Med Rehabil Clin N Am 2023; 34:377-392. [PMID: 37003659 DOI: 10.1016/j.pmr.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
The 4-phase rehabilitation protocol outlined in this article provides a comprehensive 26-week program to return patients with superior labrum anterior posterior repairs to their preinjury states. It is guided by the principle of gradual return to preinjury function while preserving the integrity of the surgical repair. Objective criteria are present at the conclusion of each phase to ensure patients are progressing appropriately. The goal is to allow patients to return to their previous functional ability in their sport-specific or occupational-specific training.
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Affiliation(s)
- Alyssa D Althoff
- Department of Orthopaedic Surgery, University of Virginia, 2280 Ivy Road, Charlottesville, VA, USA.
| | - Colby Brunette
- Department of Orthopaedic Surgery, University of Virginia, 2280 Ivy Road, Charlottesville, VA, USA
| | - Stephen Brockmeier
- Department of Orthopaedic Surgery, University of Virginia, 2280 Ivy Road, Charlottesville, VA, USA
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Shi Q, Ma Y, Zhang X, Jiao P, Zhang K, Barchi LC, Bedetti B, Wu J, Wei B, Ng CSH, Toker A, Shen J, Fruscio R, Gilbert S, Petersen RH, Hochwald S, Štupnik T, Elkhayat H, Scarci M, Levi Sandri GB, Abu Akar F, Waseda R, Sihoe ADL, Fiorelli A, Gonzalez M, Davoli F, Li GS, Tang X, Qiu B, Wang SD, Chen Y, Gao S. Reporting guidelines for surgical technique could be improved: a scoping review and a call for action. J Clin Epidemiol 2023; 155:1-12. [PMID: 36574532 DOI: 10.1016/j.jclinepi.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 11/11/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify reporting guidelines related to surgical technique and propose recommendations for areas that require improvement. STUDY DESIGN AND SETTING A protocol-guided scoping review was conducted. A literature search of MEDLINE, the EQUATOR Network Library, Google Scholar, and Networked Digital Library of Theses and Dissertations was conducted to identify surgical technique reporting guidelines published up to December 31, 2021. RESULTS We finally included 55 surgical technique reporting guidelines, vascular surgery (n = 18, 32.7%) was the most common among the clinical specialties covered. The included guidelines generally showed a low degree of international and multidisciplinary cooperation. Few guidelines provided a detailed development process (n = 14, 25.5%), conducted a systematic literature review (n = 13, 23.6%), used the Delphi method (n = 4, 7.3%), or described post-publication strategy (n = 6, 10.9%). The vast majority guidelines focused on the reporting of intraoperative period (n = 50, 90.9%). However, of the guidelines requiring detailed descriptions of surgical technique methodology (n = 43, 78.2%), most failed to provide guidance on what constitutes an adequate description. CONCLUSION Our study demonstrates significant deficiencies in the development methodology and practicality of reporting guidelines for surgical technique. A standardized reporting guideline that is developed rigorously and focuses on details of surgical technique may serve as a necessary impetus for change.
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Affiliation(s)
- Qianling Shi
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Lanzhou University Institute of Health Data Science, Lanzhou, China
| | - Yanfang Ma
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
| | - Xianzhuo Zhang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Panpan Jiao
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Kaiping Zhang
- Editorial Office, AME Publishing Company, Hong Kong, China
| | - Leandro Cardoso Barchi
- Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | - Benedetta Bedetti
- Department of Thoracic Surgery, Helios Clinic Bonn/Rhein Sieg, Bonn, Germany
| | - Jinlin Wu
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Benjamin Wei
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama Birmingham, Birmingham, USA
| | - Calvin S H Ng
- The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Alper Toker
- Department of Cardiovascular and Thoracic Surgery, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Jianfei Shen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Sebastien Gilbert
- Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Rene Horsleben Petersen
- Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Steven Hochwald
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Tomaž Štupnik
- Department of Thoracic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Hussein Elkhayat
- Cardiothoracic Surgery, Assiut University, Faculty of Medicine, Assiut, Egypt
| | - Marco Scarci
- Department of Thoracic Surgery, S. Gerardo Hospital, Monza, Italy
| | | | - Firas Abu Akar
- Department of Cardiothoracic Surgery, Makassed Charitable Society Hospital, East Jerusalem, Palestine
| | - Ryuichi Waseda
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University, Fukuoka, Japan
| | | | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Michel Gonzalez
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Fabio Davoli
- Department of Thoracic Surgery, AUSL Romagna, S. Maria delle Croci Teaching Hospital, Ravenna, Italy
| | - Grace S Li
- Editorial Office, AME Publishing Company, Hong Kong, China
| | - Xueqin Tang
- Editorial Office, AME Publishing Company, Hong Kong, China
| | - Bin Qiu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Stephen D Wang
- Editorial Office, AME Publishing Company, Hong Kong, China
| | - Yaolong Chen
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; World Health Organization (WHO) Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China.
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Kibler WB, Sciascia A, Tokish JT, Kelly JD, Thomas S, Bradley JP, Reinold M, Ciccotti M. Disabled Throwing Shoulder: 2021 Update: Part 2-Pathomechanics and Treatment. Arthroscopy 2022; 38:1727-1748. [PMID: 35307239 DOI: 10.1016/j.arthro.2022.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/15/2021] [Accepted: 02/03/2022] [Indexed: 02/02/2023]
Abstract
The purpose of this paper is to provide updated information for sports healthcare specialists regarding the disabled throwing shoulder (DTS). A panel of experts, recognized for their experience and expertise in this field, was assembled to address and provide updated information on several topics that have been identified as key areas in creating the DTS spectrum. Each panel member submitted a concise presentation on one of the topics within these areas, each of which were then edited and sent back to the group for their comments and consensus agreement in each area. Part two presents the following consensus conclusions and summary findings regarding pathomechanics and treatment, including (1) internal impingement results from a combination of scapular protraction and humeral head translation; (2) the clinically significant labral injury that represents pathoanatomy can occur at any position around the glenoid, with posterior injuries most common; (3) meticulous history and physical examination, with a thorough kinetic chain assessment, is necessary to comprehensively identify all the factors in the DTS and clinically significant labral injury; (4) surgical treatment should be carefully performed, with specific indications and techniques incorporating low profile implants posterior to the biceps that avoid capsular constraint; (5) rehabilitation should correct all kinetic chain deficits while also developing high-functioning, throwing-specific motor patterns and proper distribution of loads and forces across all joints during throwing; and (6) injury risk modification must focus on individualized athlete workload to avoid overuse. LEVEL OF EVIDENCE: V, expert opinion.
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Affiliation(s)
- W Ben Kibler
- Shoulder Center of Kentucky, Lexington Clinic, Lexington, Kentucky, U.S.A
| | - Aaron Sciascia
- Department of Exercise and Sport Science, Eastern Kentucky University, Richmond, Kentucky, U.S.A..
| | - J T Tokish
- Orthopedic Sports Medicine Fellowship, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - John D Kelly
- Shoulder Sports Medicine, Penn Perleman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Stephen Thomas
- Department of Exercise Science, Jefferson College of Rehabilitation Science, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - James P Bradley
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Michael Reinold
- Champion PT and Performance, Boston, Massachusetts, U.S.A.; Chicago White Sox, Chicago, Illinois, U.S.A
| | - Michael Ciccotti
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
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7
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Kibler WB, Grantham WJ, Pike JSM, Sciascia AD. Glenoid Labral Injuries Are More Common Posteriorly Than Superiorly and Are Combined Across Multiple Areas of the Glenoid. Arthrosc Sports Med Rehabil 2022; 4:e535-e544. [PMID: 35494307 PMCID: PMC9042739 DOI: 10.1016/j.asmr.2021.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose To categorize arthroscopically observed labral injuries to include location on the glenoid and frequency of the injuries in each location. Methods Patients undergoing arthroscopic labral surgery between January 2018 and June 2020 were reviewed. Inclusion criteria for labral injury were consistently applied and included history, clinical examination and imaging findings, and failure of rehabilitation. Exclusion criteria included arthritis, adhesive capsulitis, and previous surgery. Injury locations were categorized into superior, anterior, and/or posterior areas on the glenoid and as isolated in one area or combined in more than one area. Injury patterns also were evaluated. Interrater and intrarater agreement was assessed between 2 raters for injury location and tear pattern for 22 randomly assigned cases. Results In total, 167 cases met the inclusion criteria. Injuries were found in all areas. Combined injuries were found almost twice as often as isolated injuries (63.5% vs 37.5%). Isolated posterior injuries had the greatest frequency of all specific injury types (26.3%). Isolated superior injuries (SLAP 2-4) had a frequency of 7.2%. Tear patterns included peel back, separation/split, insubstance injury, peripheral rim flattening, and extension into the posterior inferior glenohumeral ligament. Interrater was excellent for all tear locations (intraclass correlation coefficient ≥0.85) whereas intrarater agreement was good to excellent (intraclass correlation coefficient ≥0.63). Conclusions Labral injuries that are associated with clinical symptoms can occur as isolated or combined types in the superior, anterior, and posterior glenoid areas and can display multiple injury patterns. Combined types of injuries are almost twice as common as those that are isolated in one area. Posterior injuries, isolated or combined, are frequent but superior injuries are less common Level of Evidence Level IV, therapeutic case series.
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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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Single-Portal Proximal Biceps Tenodesis Using an All-Suture Anchor. Arthrosc Tech 2022; 11:e497-e503. [PMID: 35493056 PMCID: PMC9051634 DOI: 10.1016/j.eats.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/22/2021] [Indexed: 02/03/2023] Open
Abstract
The long head of the biceps is an important pain generator of the shoulder joint. Pathologies of the long head of the biceps involve superior labrum anterior to posterior lesions, pulley lesions, partial tears of the biceps tendon, biceps tendonitis, and medial biceps subluxation caused by full-thickness subscapularis tendon tears. Treatment of an inflamed or injured long head of the biceps by either tenotomy or tenodesis is often mandatory during shoulder arthroscopy to avoid persisting pain and possible revision procedures. In comparison with a tenotomy of the biceps tendon, a biceps tenodesis preserves the tension, anatomy, and cosmesis of the biceps muscle. The presented technique demonstrates a single portal technique for a proximal biceps tenodesis in the bicipital groove using an all-suture anchor.
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Waterman BR. Editorial Commentary: Subpectoral Biceps Tenodesis Is a Safe Alternative to Arthroscopic Repair for Unstable SLAP Tear in the Young Athlete: Should We Do the Last Operation First? Arthroscopy 2022; 38:313-314. [PMID: 35123711 DOI: 10.1016/j.arthro.2021.10.019] [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: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 02/02/2023]
Abstract
The clinical significance of structural pathology affecting the biceps-superior labrum complex may be highly variable. Among younger, physically active patients with symptomatic superior labrum anterior-posterior (SLAP) tears that have failed to respond to nonoperative treatment, we continue to lack clear high-level evidence to guide surgical decision making, including a decision between arthroscopic SLAP repair or primary biceps tenodesis for more unstable, type II lesions. Rates of patient satisfaction, return to play, return to prior level of activity, and secondary revision rate are widely reported, and we lack consensus for surgical best practice treatment. With the high rate of postoperative stiffness and revision reoperation and inconsistent functional outcomes after modern arthroscopic shoulder SLAP repair with knotless anchor technology, subpectoral biceps tenodesis may emerge as a primary alternative for treating the young athlete with unstable SLAP tears.
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Hermanns CA, Coda RG, Cheema S, Vopat ML, Tarakemeh A, Veazey K, Schroeppel JP, Mullen S, Vopat BG. Variability in Rehabilitation Protocols after Superior Labrum Anterior Posterior Surgical Repair. Kans J Med 2021; 14:243-248. [PMID: 34671439 PMCID: PMC8523106 DOI: 10.17161/kjm.vol14.15286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/04/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Rehabilitation after a superior labral anterior posterior (SLAP) repair is an important aspect of patient outcomes; however, no standardized rehabilitation protocol has been defined. The purpose of this paper is to assess the variability of rehabilitation after a SLAP repair to understand the need for standardization to improve patient outcomes. Methods Protocols for SLAP repairs were collected through a search for Academic Orthopedic Programs and a general Google search using the terms “[Program Name (if applicable)] SLAP Repair Rehab Protocol”. Protocols were compared by sling, range of motion (ROM), physical therapy, return to sport (RTS), return to throwing, and biceps engagement and tenodesis recommendations. Protocols for non-operative or generalized shoulders were excluded. Results Sixty protocols were included. A total of 61.7% (37/60) recommended a sling for four to six weeks and 90% (54/60) included a full ROM recommendation, but time was variable. There were different exercises recommended, but pendulum swings were recommended by 53% (32/60), submaximal isometrics by 55% (33/60), and scapular strengthening by 65% (39/60). Of the sixty protocols, 33% (20/60) recommended return to sports in 24 weeks and 38.3% (23/60) recommended allowing throwing in 16 weeks. Conclusions There was variability in protocols for SLAP repair, especially time until full ROM, RTS, and biceps strengthening. Time in sling and scapular strengthening were the least variable. A lack of specificity within protocols in what return to throwing meant for functional ability made it difficult to compare protocols. Considering the large number of orthopedic programs, a relatively small number had published protocols. Further studies are needed to evaluate a standardized post-operative rehabilitation for SLAP repairs to improve outcomes.
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Affiliation(s)
- Christina A Hermanns
- Department of Orthopaedics, University of Kansas School of Medicine, Kansas City, KS
| | - Reed G Coda
- Department of Orthopaedics, University of Kansas School of Medicine, Kansas City, KS
| | - Sana Cheema
- Department of Orthopaedics, University of Kansas School of Medicine, Kansas City, KS
| | - Matthew L Vopat
- Department of Orthopaedics, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Armin Tarakemeh
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Kyle Veazey
- Department of Physical Therapy, University of Kansas Medical Center, Kansas City, KS
| | - John P Schroeppel
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Scott Mullen
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Bryan G Vopat
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
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DeFazio MW, Özkan S, Wagner ER, Warner JJP, Chen NC. Isolated type II SLAP tears undergo reoperation more frequently. Knee Surg Sports Traumatol Arthrosc 2021; 29:2570-2578. [PMID: 33388941 DOI: 10.1007/s00167-020-06397-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 11/24/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE There is discrepancy in the reported reoperation rate and factors associated with reoperation after type II SLAP repair. The aim was to determine the incidence and factors associated with unplanned reoperation and repair failure after type II SLAP repair. METHODS Five-hundred and thiry-nine patients with SLAP repairs were identified from 2005 to 2016. Patient characteristics were recorded and subgroup analyses performed. Multivariable logistic regression was used to identify factors independently associated with unplanned reoperation and SLAP repair failure. RESULTS Sixty-six of 539 patients (12%) had unplanned reoperation after SLAP repair. Additional procedures during SLAP repair were associated with fewer unplanned reoperations (OR 0.57; P = 0.046). Age < 40 was associated with unplanned reoperation (55% vs 40%; P = 0.032), but this was not an independent association. Forty-five of 539 patients (8.3%) had SLAP repair failure (defined by repeat SLAP repair or biceps tenodesis/tenotomy). Smoking (OR 3.1; P = 0.004) and knotless suture anchors (OR 3.4; P = 0.007) were associated with SLAP repair failure. Isolated SLAP repair was associated with SLAP repair failure (64% vs 46%; P = 0.020), but this was not an independent association. In those who did not have an isolated SLAP repair, knotless suture anchors (19% vs 3.4%; P = 0.024) were associated with repair failure. CONCLUSION After type II SLAP repair, roughly 1 in 10 patients may undergo reoperation. Isolated SLAP repair is independently associated with unplanned reoperation. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Matthew W DeFazio
- Hand and Arm Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. .,Boston University School of Medicine, Boston, MA, USA.
| | - Sezai Özkan
- Hand and Arm Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Trauma Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Eric R Wagner
- Harvard Shoulder Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jon J P Warner
- Harvard Shoulder Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Neal C Chen
- Hand and Arm Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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The majority of patients return to athletic activity following biceps tenodesis. Knee Surg Sports Traumatol Arthrosc 2021; 29:216-222. [PMID: 32185452 DOI: 10.1007/s00167-020-05930-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Biceps tenodesis is widely used as a primary treatment for long head of the biceps brachii pathology and superior labral anterior and posterior (SLAP) lesions. However, rates and timing of full return to sports (RTSs)/duty have not been systematically analysed. This systematic review examines the literature to ascertain the rate and timing of return to athletic activity, and the availability of specific criteria for safe return to atheletic activity following the biceps tenodesis. METHODS Based on PRISMA guidelines, this systematic review utilised the EMBASE, MEDLINE, and The Cochrane Library Databases. Eligible for inclusion were clinical studies reporting on return to athletic activity following biceps tenodesis. Statistical analysis was performed using SPSS. RESULTS This review identified 17 studies including 374 cases meeting the inclusion criteria. The majority of patients were men 260 (69.7%), with an median age of 42.2 years (range 16-88) and a mean follow-up of 37.4 months. The overall rate of RTS was 217/269 (80.7%), with 43/59 (72.9%) returning to the same level. In overhead athletes, the overall rate of return to play was 39/49 (79.6%). Among military personnel, the overall rate of return to duty was 61/74 (82.4%). The average time to RTS was 5.4 (range 3-11) months. 10 (58.8%) Studies reported a recommended time window within which patients were allowed to return to full activity. Specific criteria for return to play were not reported in any of the identified studies. CONCLUSION While overall rate of return to athletic activity was reportedly high following biceps tenodesis, one in four patients were not able to resume athletic activity at the same level. At present, there is no objective assessment of when patients can return to full activity reported in the literature. LEVEL OF EVIDENCE IV.
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Knapik DM, Kolaczko JG, Gillespie RJ, Salata MJ, Voos JE. Complications and Return to Activity After Arthroscopic Repair of Isolated Type II SLAP Lesions: A Systematic Review Comparing Knotted Versus Knotless Suture Anchors. Orthop J Sports Med 2020; 8:2325967120911361. [PMID: 32341926 PMCID: PMC7171991 DOI: 10.1177/2325967120911361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 10/04/2019] [Indexed: 01/02/2023] Open
Abstract
Background: Superior labral anterior to posterior (SLAP) tears are one of the most common injuries to the shoulder, with the type II variant representing the most frequently encountered subtype. Purpose: To systematically review the literature to better understand outcomes after arthroscopic repair of isolated type II SLAP lesions using knotted versus knotless anchors based on implant number, implant location, patient position, and portal position. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review investigating all studies in the literature between January 2000 and June 2019 reporting on patients undergoing arthroscopic repair for isolated type II SLAP lesions using knotted versus knotless suture anchors was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the PubMed, BIOSIS Previews, SPORTDiscus, PEDro, and Embase databases. Results: A total of 234 patients undergoing isolated arthroscopic repair of type II SLAP lesions using suture anchors were identified, with 76% (179/234) treated using knotted anchors versus 24% (55/234) treated using knotless anchors. Complications were reported in 12% of patients treated using knotted anchors versus no patients treated using knotless anchors (P = .008). The incidence of complications for knotted anchor repair was not significantly affected by patient position (P = .22) or portal position (P = .19). Using multiple regression analysis, we found no significant association with the incidence of complications when analyzing for anchor design (R2 = 0.02; P = .06) or anchor position (R2 = 0.02; P = .92). No significant difference in return-to-activity timing was appreciated based on anchor type (P = .28), patient position (P = .98), or portal position (P = .97) in patients treated using knotted anchors. Conclusion: Patients treated using knotted anchors were significantly more likely to experience a postoperative complication compared with patients treated using knotless anchors after arthroscopic repair of isolated type II SLAP lesions. Despite the increased incidence of a postoperative complication after knotted anchor fixation compared with knotless anchor fixation, multiple regression analysis showed that anchor design and anchor position were not significantly predictive of the incidence of complications. Given the increasing popularity of knotless anchor fixation, further study on the long-term outcomes after knotless repair for isolated type II SLAP lesions is warranted.
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Affiliation(s)
- Derrick M Knapik
- Sports Medicine Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jensen G Kolaczko
- Sports Medicine Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Robert J Gillespie
- Sports Medicine Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Michael J Salata
- Sports Medicine Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Cleveland Browns, Cleveland, Ohio, USA
| | - James E Voos
- Sports Medicine Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Cleveland Browns, Cleveland, Ohio, USA
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Itoigawa Y, Hooke AW, Sperling JW, Steinmann SP, Zhao KD, Itoi E, An KN. Bankart repair alone in combined Bankart and superior labral anterior-posterior lesions preserves range of motion without compromising joint stability. JSES Int 2020; 4:63-67. [PMID: 32195465 PMCID: PMC7075760 DOI: 10.1016/j.jseint.2019.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Hypothesis The purpose was to investigate joint stability and range of motion after a Bankart repair without superior labral anterior-posterior (SLAP) repair (termed “Bankart repair”) and after combined Bankart and SLAP repairs (termed “combined repair”). Methods Eight fresh-frozen shoulders were used. Combined Bankart and SLAP lesions were created (10- to 6-o'clock positions). The labrum and capsule were repaired at the 2-o'clock, 3:30 clock-face, and 5-o'clock positions in the Bankart repair group and at the 11-o'clock, 1-o'clock, 2-o'clock, 3:30 clock-face, and 5-o'clock positions in the combined repair group. The internal- and external-rotation ranges of motion were determined with the arm positioned at 0° and 60° of glenohumeral abduction. The rotation angle was defined when a constant torque of 200 N-mm was applied. Joint stability was measured with a custom stability-testing device. The peak translational force in the anterior-posterior direction was measured with the arm at the end range of external rotation. Results External rotation angles were greater at 0° and 60° of abduction in the Bankart repair group than in the combined repair group (0° of abduction, P < .01; 60° of abduction, P < .05). The internal rotation angle was greater at 60° of abduction in the Bankart repair group than in the combined repair group (P < .01). The stability between the 2 groups was not significantly different (P = .60). Conclusion In patients with combined Bankart and SLAP lesions and the need for a wide range of motion, a Bankart repair alone may provide a greater range of motion without compromising the joint stability at the end range compared with a combined repair.
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Affiliation(s)
- Yoshiaki Itoigawa
- Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA.,Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | | | - John W Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Kristin D Zhao
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kai-Nan An
- Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA
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Molecular Pattern and Density of Axons in the Long Head of the Biceps Tendon and the Superior Labrum. J Clin Med 2019; 8:jcm8122129. [PMID: 31816921 PMCID: PMC6947398 DOI: 10.3390/jcm8122129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 11/24/2019] [Accepted: 11/26/2019] [Indexed: 01/02/2023] Open
Abstract
The type II superior labrum anterior to posterior (SLAP) repair is a viable option in young and demanding patients, although a prolonged period of pain after surgery is described in the literature. The reason for this fact remains unknown. Thus, the purpose of this study was to investigate the molecular pattern of the biceps tendon anchor, where the sutures for repair are placed. The long head of the biceps tendon (LHBT), including the superior labrum, was dissected in the setting of reverse total shoulder arthroplasty. Immunohistochemical staining was performed using neurofilament (NF) and protein gene product (PGP) 9.5 as general markers for axons and calcitonin gene-related peptide (CGRP) and substance P for nociceptive transmission. A quantitative assessment was performed according to the two regions of interest (ROIs), i.e., the anterosuperior (ROI I) and the posterosuperior labrum (ROI II). Eleven LHBTs with a mean age of 73 years (range: 66–87 years) were harvested intraoperatively. Six LHBTs were gained in osteoarthrosis and five in fractures. We found an inhomogeneous distribution of axons in the anterosuperior and posterosuperior parts of the labrum in all the specimens irrespective of the age, gender, and baseline situation. There was a significantly higher number (p < 0.01) as well as density (p < 0.001) of NF-positive axons in ROI I compared to ROI II. Nociceptive fibers were always found along the NF-positive axons. Thus, our results indicate that the biceps tendon anchor itself is a highly innervated region comprising different nerve qualities. The anterosuperior labrum contains a higher absolute number and density of axons compared to the posterosuperior parts. Furthermore, we were able to prove the presence of nociceptive fibers in the superior labrum. The results obtained in this study could contribute to the variability of pain after SLAP repair.
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17
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Not All SLAPs Are Created Equal: A Comparison of Patients with Planned and Incidental SLAP Repair Procedures. Adv Orthop 2019; 2019:9013935. [PMID: 31781400 PMCID: PMC6875328 DOI: 10.1155/2019/9013935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 07/21/2019] [Indexed: 11/21/2022] Open
Abstract
Background Epidemiological studies have shown a progressive increase in the rate of superior labrum anterior-posterior (SLAP) repair surgery after the year 2000. However, it is not clear whether this is due to increased recognition of isolated SLAP tears or increased SLAP repair performed secondarily during arthroscopy for other purposes. Hypothesis/Purpose We hypothesized that both isolated SLAP repair and secondary SLAP repair increased with time and that patient age influenced the pathway to SLAP diagnosis and surgery—such that younger patients were more likely to have isolated SLAP repair surgery after being diagnosed in clinic. Study Design Descriptive epidemiology study. Methods Data were obtained from the MarketScan database from 2003 to 2013. CPT and ICD-9 codes were used to identify SLAP surgery patients and concomitant procedures. The timing of SLAP diagnosis relative to surgery was used to determine whether the injury was recognized preoperatively. Results 64,497 SLAP surgery patients were included. Preoperative SLAP diagnosis increased from 17.1% in 2003 to 44.6% in 2013. Patients diagnosed preoperatively were younger and had fewer concomitant procedures. Increasing age and concomitant rotator cuff tear (RCT) repair corresponded to lower odds of preoperative SLAP diagnosis. Discussion Younger patients were more likely to have their SLAP tear diagnosed prior to surgery. Those diagnosed before surgery had fewer simultaneous procedures during their operations, suggesting that SLAP repair was more likely the primary operation. From 2003 to 2013, SLAP tears were increasingly recognized in the preoperative setting.
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18
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Sullivan S, Hutchinson ID, Curry EJ, Marinko L, Li X. Surgical management of type II superior labrum anterior posterior (SLAP) lesions: a review of outcomes and prognostic indicators. PHYSICIAN SPORTSMED 2019; 47:375-386. [PMID: 30977691 DOI: 10.1080/00913847.2019.1607601] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A Type II SLAP (superior labrum anterior posterior) lesion is a tear of the superior glenoid labrum with involvement of the long head of the biceps tendon insertion. In patients that do not improve with conservative treatment, there is a great deal of variability in the surgical management of these injuries that includes arthroscopic SLAP repair, arthroscopic SLAP repair with biceps tenodesis, biceps tenodesis alone and biceps tenotomy. Each surgical technique has specific effects on a patient's postoperative course and functional recovery. Rehabilitation strategies may be best formulated on an individual basis with an open line of communication between the operating surgeon and the physical therapist. Despite an increased incidence in treatment, there is currently no consensus on the optimal surgical procedure or treatment algorithm for Type II SLAP injuries. However, in middle-aged or older patients (>35) with Type II SLAP tears, either arthroscopic suprapectoral or mini-open subpectoral biceps tenodesis is recommended due to the higher failure rates observed with arthroscopic SLAP repair in this patient group. Although more patients present with a 'Popeye' sign after biceps tenotomy, long-term functional outcome is similar between biceps tenodesis compared to tenotomy. However, more patients will experience biceps fatigue or cramping after the tenotomy procedure. Biceps tenodesis is preferred in younger, more active patients, while tenotomy is preferred in the middle-aged or older and lower demand patients. The aim of this paper is to provide a brief description of the different surgical techniques employed to address Type II SLAP lesions (arthroscopic repair, biceps tenodesis, and biceps tenotomy) and provide a review of available literature regarding outcomes and prognostic factors associated with each technique.
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Affiliation(s)
- Sean Sullivan
- Department of Physical Therapy & Athletic Training, Boston University College of Health & Rehabilitation Sciences: Sargent College, Boston, MA, USA
| | - Ian D Hutchinson
- Department of Orthopaedic Surgery, Albany Medical Medical Center, Albany, NY, USA
| | - Emily J Curry
- School of Public Health, Boston University, Boston, MA, USA
| | - Lee Marinko
- Department of Physical Therapy & Athletic Training, Boston University College of Health & Rehabilitation Sciences: Sargent College, Boston, MA, USA
| | - Xinning Li
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, USA
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Vishwanathan K. Simple, Cost-Effective Technique to Create a Double-Loaded Suture Anchor from a Non-loaded Suture Anchor. J Orthop Case Rep 2019; 9:80-83. [PMID: 31534942 PMCID: PMC6727456 DOI: 10.13107/jocr.2250-0685.1382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Suture anchors are used in the repair of rotator cuff repair, bankart’s repair, SLAP repair, tendoachilles avulsion type injury, bony avulsion of medial collateral ligament of the knee, etc. The cost of preloaded suture anchors varies from INR 4500 to 10,000. Double-loaded suture anchors are better than single-loaded suture anchors in terms of having more hold in the soft tissues and having multiple anchoring points. Non-loaded screw type suture anchors are available with their inserter devices through which one suture stranded can be passed to create single-loaded suture anchor. However, passing two sutures through the eyelet of the suture anchor and subsequently passing two sutures through the long tubular cannulated suture anchor inserter device can be fiddly, time-consuming and difficult to pass because the sutures can get entangled within this device and not pass inside the inserter device. Hence, a technique was devised to simultaneously pass both sutures through the eyelet of the suture anchor and subsequently through the suture anchor inserter device. This method of loading suture anchors has not been described previously in literature. Technique: A single number 1–0 Ethilon is used to shuttle two sutures of number 2 Ethibond through the suture anchor insertion device after passing the two Ethibond sutures through the eyelet of a 5mm non-loaded suture anchor. This technique saves considerable time during the surgical procedure and can be easily taught to scrub nurses. The greatest cost benefit is seen in cases where more than two suture anchors have to be inserted. The above technique has been used in patients with rotator cuff repair, biceps tenodesis, tendoachilles avulsion repair with great degree of success and no case of failure of suture or suture anchor seen in any of the cases. Conclusion: The cost of a double-loaded suture anchor using our method is INR 1950 which is much cheaper compared to the available preloaded suture anchors. This is a novel, time saving, simple, cheap, and easy and easily replicable method to create an effective twin-loaded suture anchor from a non-loaded suture anchor.
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Affiliation(s)
- Karthik Vishwanathan
- Department of Orthopaedics, Pramukhswami Medical College, Karamsad, Gujarat, India
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20
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Patriota GSQA, Belangero PS, Figueiredo EA, Lara PHS, Roncetti Junior R, Ejnisman B. SLAP IV IN OVERHEAD SPORTS PRACTICE. ACTA ORTOPEDICA BRASILEIRA 2019; 27:169-172. [PMID: 31452615 PMCID: PMC6699401 DOI: 10.1590/1413-785220192703191478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Superior labral tear from anterior to posterior (SLAP) is the most common disease in overhead sports practice.
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21
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Superior labral anterior to posterior (SLAP) injury in the workplace. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2019.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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22
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Navío-Fernández F, Miranda I, Sánchez-Alepuz E, Shahin M, Pastor-Fernández E, Carratalá V, Lucas FJ. Superior labral anterior to posterior (SLAP) injury in the workplace. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:261-267. [PMID: 31109817 DOI: 10.1016/j.recot.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/07/2019] [Accepted: 03/10/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Superior labral anterior to posterior (SLAP) injuries are widely recognised as a cause of pain and dysfunction in the shoulders of active patients. The aims of the present study were to analyze SLAP injuries in the workplace, and to evaluate the reliability of physical examination and imaging techniques for the diagnosis of work-related SLAP injuries. MATERIAL AND METHODS Retrospective chart review of 58 SLAP injuries treated in our occupational health centre from 2005 to 2015 in 815 patients undergoing shoulder arthroscopy. Data were collected on mechanism of injury, clinical proceedings, complementary tests (contrasting the initial magnetic resonance imaging report with that of a radiologist specializing in musculoskeletal pathology), arthroscopy findings and treatments performed. RESULTS The most common mechanism of injury was acute injury while handling weight, in the majority of cases, above the head. SLAP injury was suspected in 41% of cases through anamnesis and physical exam, in 29% through the initial magnetic resonance imaging report, and in 52% through the specialised radiologist's report. In 78%, associated injuries were present, the most common being rotator cuff injuries. CONCLUSIONS SLAP injuries in the workplace are rare and are often a diagnostic finding during surgical intervention performed for a different associated injury. Arthro-magnetic resonance imaging and magnetic resonance imaging have lower reliability than physical exams in the diagnosis of work-related SLAP injuries. A radiologist specializing in musculoskeletal pathology could probably improve the reliability of imaging test interpretation in work-related SLAP injuries.
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Affiliation(s)
- F Navío-Fernández
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, España; Rotatorio de Formación en Unión de Mutuas, Valencia, España
| | - I Miranda
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, España; Servicio de Cirugía Ortopédica y Traumatología de Unión de Mutuas, Valencia, España.
| | - E Sánchez-Alepuz
- Servicio de Cirugía Ortopédica y Traumatología de Unión de Mutuas, Valencia, España; Servicio de Cirugía Ortopédica y Traumatología, Hospital IMED Valencia, Burjassot, Valencia, España
| | - M Shahin
- ERESA (Unión de Mutuas), Valencia, España
| | - E Pastor-Fernández
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, España; Rotatorio de Formación en Unión de Mutuas, Valencia, España
| | - V Carratalá
- Servicio de Cirugía Ortopédica y Traumatología de Unión de Mutuas, Valencia, España
| | - F J Lucas
- Servicio de Cirugía Ortopédica y Traumatología de Unión de Mutuas, Valencia, España
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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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Charles MD, Christian DR, Cole BJ. An Age and Activity Algorithm for Treatment of Type II SLAP Tears. Open Orthop J 2018; 12:271-281. [PMID: 30197708 PMCID: PMC6110066 DOI: 10.2174/1874325001812010271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/24/2018] [Accepted: 05/24/2018] [Indexed: 12/26/2022] Open
Abstract
Background Type II SLAP tears predominantly occur in males between their third and fifth decades of life. The mechanism of injury is often repeated overheard activity but can also occur due to direct compression loads and traction injuries. The treatment options have changed over the years and include non-operative therapy, direct labral-biceps complex repair, and labral debridement with biceps tenodesis or tenotomy. Objective To review the existing literature on the management of Type II SLAP tears and provide clinical recommendations based on patient age and activity level. Methods A review of the existing literature through October 2017 investigating the management of Type II SLAP tears was performed. Emphasis was placed on distinguishing the outcomes based on age and activity level to provide an appropriate treatment algorithm. Results Patients with Type II SLAP tears should first be trialed with non-operative management and many patients will have a successful result with ability to return to their respective sports or activities. Surgical management should be considered if non-operative management does not provide symptomatic relief. Young, athletic, or high-demand patients should be treated with a SLAP repair while biceps tenodesis should be considered for older or worker's compensation patients. Patients undergoing revision surgery for a failed SLAP repair should be managed with biceps tenodesis. Conclusion Type II SLAP tears remain a difficult pathology to manage clinically, but the treatment indications are narrowing. The age and activity algorithm described in this review provides an effective method of managing this complex clinical condition.
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Affiliation(s)
- Michael D Charles
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - David R Christian
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
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25
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Stathellis A, Brilakis E, Georgoulis JD, Antonogiannakis E, Georgoulis A. Treatment of SLAP Lesions. Open Orthop J 2018; 12:288-294. [PMID: 30197710 PMCID: PMC6110059 DOI: 10.2174/1874325001812010288] [Citation(s) in RCA: 8] [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: 03/05/2018] [Revised: 04/20/2018] [Accepted: 05/24/2018] [Indexed: 12/13/2022] Open
Abstract
Background: The surgical treatment of a Superior Labrum Anterior and Posterior (SLAP) lesion becomes more and more frequent as the surgical techniques, the implants and the postoperative rehabilitation of the patient are improved and provide in most cases an excellent outcome. Objective: However, a standard therapy of SLAP lesions in the shoulder surgery has not been established yet. An algorithm on how to treat SLAP lesions according to their type and data on the factors that influence the surgical outcome is essential for the everyday clinical practice. Method: In this article, a retrospective evaluation of patients with SLAP lesion, treated surgically in our orthopaedic clinic was conducted. Results: According to the clinical outcome and our experience with the surgical therapy of SLAP lesions we demonstrate an algorithm on the proper therapeutic approach. Conclusion: SLAP I lesions are treated with debridement. Most controversies concern patients with SLAP II lesions, whose therapy is either fixation of the superior labrum or tenotomy/tenodesis of the long head of the biceps tendon. For patients with SLAP III or IV lesions the most commonly accepted approach is tenotomy or tenodesis of the long head of biceps tendon.
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26
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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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27
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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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Rose MB, Noonan T. Glenohumeral internal rotation deficit in throwing athletes: current perspectives. Open Access J Sports Med 2018; 9:69-78. [PMID: 29593438 PMCID: PMC5865552 DOI: 10.2147/oajsm.s138975] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Glenohumeral internal rotation deficit (GIRD) is an adaptive process in which the throwing shoulder experiences a loss of internal rotation (IR). GIRD has most commonly been defined by a loss of >20° of IR compared to the contralateral shoulder. Total rotational motion of the shoulder is the sum of internal and external rotation and may be more important than the absolute value of IR loss. Pathologic GIRD has been defined as a loss of IR combined with a loss of total rotational motion. The leading pathologic process in GIRD is posterior capsular and rotator-cuff tightness, due to the repetitive cocking that occurs with the overhead throwing motion. GIRD has been associated with numerous pathologic conditions, including posterior superior labral tears, partial articular-sided rotator-cuff tears, and superior labral anterior-to-posterior tears. The mainstay of treatment for patients with GIRD is posterior capsular stretching and strengthening to improve scapular mechanics. In patients who fail nonoperative therapy, shoulder arthroscopy can be performed. Arthroscopic surgery in the high-level throwing athlete should be to restore them to their functional baseline with the minimum amount of intervention possible.
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Affiliation(s)
- Michael B Rose
- Steadman Hawkins Clinic, University of Colorado School of Medicine, Denver, CO, USA
| | - Thomas Noonan
- Steadman Hawkins Clinic, University of Colorado School of Medicine, Denver, CO, USA
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Altintas B, Pitta R, Fritz EM, Higgins B, Millett PJ. Technique for Type IV SLAP Lesion Repair. Arthrosc Tech 2018; 7:e337-e342. [PMID: 29868401 PMCID: PMC5981853 DOI: 10.1016/j.eats.2017.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 10/07/2017] [Indexed: 02/03/2023] Open
Abstract
Type IV SLAP tears involve bucket-handle tears of the superior labrum with the tears extending into the biceps tendon. Surgical treatment options involve either primary repair or biceps tenodesis. Recent literature has shown good clinical outcomes after subpectoral biceps tenodesis for the treatment of type II and IV SLAP lesions. The purpose of this article is to present our technique for arthroscopic superior labrum repair with suture anchors and open subpectoral biceps tenodesis with an interference screw.
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Affiliation(s)
- Burak Altintas
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Rafael Pitta
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Erik M. Fritz
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Brendan Higgins
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,The Steadman Clinic, Vail, Colorado, U.S.A
| | - Peter J. Millett
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,The Steadman Clinic, Vail, Colorado, U.S.A.,Address correspondence to Peter J. Millett, M.D., M.Sc., The Steadman Clinic, 181 W Meadow Dr, Ste 400, Vail, CO 81657, U.S.A.
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Schmerzhafte Bizepssehne im Verlauf des Lebensalters. ARTHROSKOPIE 2017. [DOI: 10.1007/s00142-017-0150-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Banga K, Memon M, Baisi LP, de SA D, Bedi A, Ayeni OR. Outcomes in surgical and conservative treatment of symptomatic non-traumatic shoulder labrum tears in the paediatric population: a systematic review. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rossi MJ, Lubowitz JH, Brand JC, Provencher MT. Making the Right Treatment Decision Requires Consideration of Utility and Reconsideration of Value. Arthroscopy 2017; 33:239-241. [PMID: 28160927 DOI: 10.1016/j.arthro.2016.11.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 11/30/2016] [Indexed: 02/02/2023]
Abstract
To achieve a good clinical outcome, arthroscopic and related surgeons must choose the proper treatment, and the basis of this choice is accurate diagnosis. Generally, our clinical focus is on outcome, but outcome is achieved after the fact. While this seems obvious, arthroscopic and related surgeons-and our patients who participate in shared decision making-evaluate the utility, or usefulness, of potential treatments based on desired and expected benefits versus potential risks. Today, cost is frequently considered as a determinant of value in medicine and may be applied to the decision analysis, but if an individual patient perceives health to be priceless, cost becomes irrelevant. In the end, an individual patient's satisfaction is determined on a case-by-case basis. Proper choice of treatment cannot be formulaic.
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Arthroscopic and Related Surgeons and Scientists Are Devoted in Their Service. Arthroscopy 2016; 32:1943-1944. [PMID: 27697175 DOI: 10.1016/j.arthro.2016.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/10/2016] [Indexed: 02/02/2023]
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Harris JD. Editorial Commentary: On Kibler & Sciascia: What Did the Five Fingers Say to the Face? SLAP. A Systematic Review Wake-Up Call to Improve SLAP Repair Guidelines. Arthroscopy 2016; 32:684-5. [PMID: 27039686 DOI: 10.1016/j.arthro.2016.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 01/19/2016] [Indexed: 02/02/2023]
Abstract
Both the quality and quantity of reporting in the SLAP repair literature, especially the surgical indications and technical intraoperative characteristics, leaves significant room for improvement. In their systematic review, Kibler and Sciascia identify this considerable underlying imprecision. Based on the current literature, no consensus exists for establishing any criteria for a successful SLAP repair--surgical indications, characteristics (type, location, number of anchors), completeness of repair, or rehabilitation.
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