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Hurley ET, Baker R, Danilkowicz RM, Levin JM, Klifto CS, Dickens JF, Taylor DC, Lau BC. Similar outcomes between biceps tenodesis and SLAP repair for SLAP tears in younger patients - A meta-analysis. J ISAKOS 2024; 9:79-83. [PMID: 37797939 DOI: 10.1016/j.jisako.2023.09.007] [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] [Received: 06/14/2023] [Revised: 09/12/2023] [Accepted: 09/22/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVES The purpose of this study is to systematically review the comparative studies in the literature to ascertain if biceps tenodesis or superior-labrum anterior to posterior (SLAP) repair results in superior clinical outcomes in the treatment of type II SLAP tears in patients under 40. METHODS A systematic search of articles in Pubmed, EMBASE and The Cochrane Library databases was carried out according to the PRISMA guidelines. Cohort studies comparing biceps tenodesis to repair in type II SLAP tears in patients under 40 were included. Clinical outcomes were extracted including return to play, reoperations, ASES, and VAS for pain. All statistical analysis was performed using Review Manager. A p-value of <0.05 was considered to be statistically significant. RESULTS Five studies were included. Biceps tenodesis resulted in comparable rates of return to play compared to SLAP repair (78.5% vs 67.7%, p = 0.33), and there was no significant difference in return to play in overhead athletes (83.6% vs 74%, p = 0.82). There was no significant difference in ASES score (87.2 vs 86.2, p = 0.27) or VAS score for pain (1.8 vs 2.1, p = 0.48). There was no significant difference in re-operation rates (2.9% vs 10.8%, p = 0.22). CONCLUSION This study found that biceps tenodesis has no significant difference in rates of return to play in athletes, as well as in functional outcome scores and rates of revision surgery in younger patients compared to SLAP repair. LEVEL OF EVIDENCE Level III, Systematic review of Level III studies.
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Affiliation(s)
- Eoghan T Hurley
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, 27705, USA.
| | - Rafeal Baker
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Richard M Danilkowicz
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Jay M Levin
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Christopher S Klifto
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Jonathan F Dickens
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Dean C Taylor
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Brian C Lau
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, 27705, USA
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Chau M, Limpisvasti O. Arthroscopic In Situ Biceps Tenodesis Using a Double Loop-and-Tack Knotless Suture Anchor. Arthrosc Tech 2023; 12:e1437-e1442. [PMID: 37654881 PMCID: PMC10466293 DOI: 10.1016/j.eats.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/13/2023] [Indexed: 09/02/2023] Open
Abstract
The long head biceps tendon is a common culprit of anterior shoulder pain and dysfunction that can be surgically treated with tenotomy or tenodesis. Many techniques exist for tenodesis. This article submits an arthroscopic technique using two loop-and-tack sutures and a knotless suture anchor to tenodese the long head biceps tendon in the proximal bicipital groove in situ. The advantage of this technique is that it maintains the biceps in its native position by performing tenodesis before tenotomy. Most other techniques attempt to restore native position of the biceps through approximation. The transverse humeral ligament is also released to decompress the bicipital groove. This technique can be used to treat isolated biceps pathology or combined with rotator cuff and labral procedures.
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Affiliation(s)
- Michael Chau
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, U.S.A
| | - Orr Limpisvasti
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, U.S.A
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Green CK, Scanaliato JP, Sandler AB, Czajkowski H, Rolf RH, Dunn JC, Parnes N. Midterm Outcomes Following Combined Biceps Tenodesis and Anterior Labral Repair in Active Duty Military Patients Younger than 35 Years. Am J Sports Med 2023:3635465231169238. [PMID: 37196664 DOI: 10.1177/03635465231169238] [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] [Indexed: 05/19/2023]
Abstract
BACKGROUND Superior labrum anterior-posterior (SLAP) lesions and anterior instability are common causes of shoulder pain and dysfunction among active-duty members of the United States military. However, little data have been published regarding the surgical management of type V SLAP lesions. PURPOSE To compare the outcomes of arthroscopic-assisted subpectoral biceps tenodesis and anterior labral repair with those of arthroscopic SLAP repair (defined as contiguous repair spanning from the superior labrum to the anteroinferior labrum) for type V SLAP tears in active-duty military patients younger than 35 years. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All consecutive patients from January 2010 to December 2015 who underwent arthroscopic SLAP repair or combined biceps tenodesis and anterior labral repair for a type V SLAP lesion with a minimum 5-year follow-up were identified. The decision to perform type V SLAP repair versus combined biceps tenodesis and anterior labral repair was based on the condition of the long head of the biceps tendon (LHBT). Labral repair was performed in patients who had a type V SLAP tear with an otherwise clinically and anatomically healthy LHBT. Combined tenodesis and repair was performed in patients with evidence of LHBT abnormalities. Outcomes including the visual analog scale (VAS) score, the Single Assessment Numeric Evaluation (SANE) score, the American Shoulder and Elbow Surgeons (ASES) shoulder score, the Rowe instability score, and range of motion were collected preoperatively and postoperatively, and scores were compared between the groups. RESULTS A total of 84 patients met the inclusion criteria for the study. All patients were active-duty service members at the time of surgery. A total of 44 patients underwent arthroscopic type V SLAP repair, and 40 patients underwent anterior labral repair with biceps tenodesis. The mean follow-up was 102.59 ± 20.98 months in the repair group and 94.50 ± 27.11 months in the tenodesis group (P = .1281). There were no significant differences in preoperative range of motion or outcome scores between the groups. Both groups experienced statistically significant improvements in outcome scores postoperatively (P < .0001 for all); however, compared with the repair group, the tenodesis group reported significantly better postoperative VAS (2.52 ± 2.36 vs 1.50 ± 1.91, respectively; P = .0328), SANE (86.82 ± 11.00 vs 93.43 ± 8.81, respectively; P = .0034), and ASES (83.32 ± 15.31 vs 89.90 ± 13.31, respectively; P = .0394) scores. There were no differences in the percentage of patients who achieved the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state for the SANE and ASES between the groups. Overall, 34 patients in each group returned to preinjury levels of work (77.3% vs 85.0%, respectively; P = .3677), and 32 patients (72.7%) in the repair group and 33 patients (82.5%) in the tenodesis group returned to preinjury levels of sporting activity (P = .2850). There were no significant differences in the number of failures, revision surgical procedures, or patients discharged from the military between the groups (P = .0923, P = .1602, and P = .2919, respectively). CONCLUSION Both arthroscopic-assisted subpectoral biceps tenodesis combined with anterior labral repair and arthroscopic SLAP repair led to statistically and clinically significant increases in outcome scores, marked improvements in pain, and high rates of return to unrestricted active duty in military patients with type V SLAP lesions. The results of this study suggest that biceps tenodesis combined with anterior labral repair produces comparable outcomes to arthroscopic type V SLAP repair in active-duty military patients younger than 35 years.
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Affiliation(s)
- Clare K Green
- The George Washington University, Washington, District of Columbia, USA
| | - John P Scanaliato
- William Beaumont Army Medical Center, Fort Bliss, Texas, USA
- Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Alexis B Sandler
- William Beaumont Army Medical Center, Fort Bliss, Texas, USA
- Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Hunter Czajkowski
- Carthage Area Hospital, Carthage, New York, USA
- Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
| | - Robert H Rolf
- Beacon Orthopaedics & Sports Medicine, Cincinnati, Ohio, USA
- TriHealth, Cincinnati, Ohio, USA
| | - John C Dunn
- William Beaumont Army Medical Center, Fort Bliss, Texas, USA
- Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Nata Parnes
- Carthage Area Hospital, Carthage, New York, USA
- Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
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Ulrich MN, Cvetanovich GL, Meeks BD, Jones GL. Return to Sport and Patient-Reported Outcomes After Subpectoral Biceps Tenodesis for SLAP Tear in Collegiate Gymnasts. Orthop J Sports Med 2023; 11:23259671231159354. [PMID: 37152551 PMCID: PMC10161309 DOI: 10.1177/23259671231159354] [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: 12/02/2022] [Accepted: 01/19/2023] [Indexed: 05/09/2023] Open
Abstract
Background The biceps superior labral complex is a known source of shoulder dysfunction in young, high-level athletes. Superior labral anterior-posterior (SLAP) repairs are often unsatisfactory for treating biceps-labral pathology in this demographic group, with high failure rates and poor return to sport (RTS). Minimal data have been published to demonstrate patient-reported outcomes (PROs) and RTS in gymnasts after treatment of SLAP pathologies. Hypothesis Gymnasts undergoing biceps tenodesis for SLAP pathologies would have satisfactory PROs and satisfactory RTS. Study Design Case series; Level of evidence, 4. Methods Gymnasts aged ≤25 years who underwent open subpectoral biceps tenodesis for SLAP tears with or without biceps tendon pathology between August 20, 2014, and August 20, 2019, and who had minimum 2-year follow-up data were included in this study. Tenodesis was performed using a subpectoral technique with bicortical button fixation. The following PROs were included: RTS, postoperative activity level, 10-point visual analog scale for pain (VAS-Pain), American Shoulder and Elbow Surgeons (ASES), and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results Of 16 shoulders in 14 gymnasts undergoing biceps tenodesis for SLAP tear during the study period, a follow-up was obtained for 13 of 16 shoulders (81%) at 4.3 ± 1.5 years. The mean age of patients at the time of surgery was 21.8 ± 2.2 years, with 12 (92%) male patients. Biceps tenodesis was performed as the primary procedure for the diagnosis of SLAP tear in 12 patients (92%) and for failed prior SLAP repair in 1 patient (8%). PROs were excellent at the follow-up, with VAS-Pain scores of 1.8 ± 1.7, ASES scores of 89.1 ± 9.1, and DASH scores of 2.4 ± 3.2. After surgery, 8 (62%) patients returned to their prior level of collegiate gymnastics. Three (60%) of 5 patients did not return to collegiate gymnastics because of the end of eligibility, and 2 (40%) patients did not return to collegiate gymnastics because of knee injuries. Significantly higher DASH scores were noted in the group that did not RTS (P = .04). No patients experienced postoperative complications or reoperation. Conclusion Biceps tenodesis was an effective primary operation for high-level gymnasts with SLAP tears, with a satisfactory rate of return to the same level of sport and excellent PROs.
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Affiliation(s)
- Marisa N. Ulrich
- The Ohio State University Sports Medicine Research Institute, Columbus, Ohio, USA
| | - Gregory L. Cvetanovich
- The Ohio State University Sports Medicine Research Institute, Columbus, Ohio, USA
- Gregory L. Cvetanovich, MD, Jameson-Crane Sports Medicine Institute, 2835 Fred Taylor Drive Columbus, OH 43202, USA ()
| | - Brett D. Meeks
- The Ohio State University Sports Medicine Research Institute, Columbus, Ohio, USA
- Northeast Georgia Physicians Group, Gainesville, Georgia, USA
| | - Grant L. Jones
- The Ohio State University Sports Medicine Research Institute, Columbus, Ohio, USA
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Surgical Treatment of Superior Labral/Biceps Pathology in the Overhead Thrower. J Am Acad Orthop Surg 2023; 31:e424-e434. [PMID: 36727732 DOI: 10.5435/jaaos-d-21-01199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 12/13/2022] [Indexed: 02/03/2023] Open
Abstract
Symptomatic superior labral anterior and posterior (SLAP) tears have become an increasingly common diagnosis, particularly within the competitive overhead athlete population. Type II SLAP tears are the most encountered variant in overhead throwing athletes. Given the high incidence of false positives on advanced imaging, corroborating the history and physical examination with imaging is paramount to accurately establish a SLAP lesion diagnosis. Previous studies have reported conflicting success rates with conservative management, but the number of pitching athletes able to return to prior level of performance with nonsurgical management strategies has been unsatisfactory. Although there has historically been a notable disconnect between the incidence of SLAP tears in the literature and the number of SLAP repairs in recent investigations, high-grade or unstable tears may be candidates for débridement, labral repair, biceps tenodesis, or less frequently, biceps tenotomy. Biceps tenodesis has been increasingly used for the management of these lesions, with recent studies reporting high rates of return to sport, high satisfaction, and good to excellent patient-reported outcomes in carefully selected athletes.
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Biceps Tenodesis in Patients Age 35 Years and Younger Yields Favorable Clinical Outcomes With Variable Rates of Return to Sport and Complications: A Systematic Review. Arthroscopy 2023; 39:830-837. [PMID: 36528216 DOI: 10.1016/j.arthro.2022.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/08/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To systematically evaluate reported clinical outcomes, return-to-sport (RTS) rates, and complications following biceps tenodesis in patients aged 35 years and younger and compare outcomes between overhead and nonoverhead athletes. METHODS A literature search was performed by querying Scopus, EMBASE, and PubMed computerized databases from database inception through August 2022 in accordance with the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Studies that evaluated clinical outcomes following biceps tenodesis in patients aged 35 years or younger were included. Study quality was assessed via the Methodological Index for Non-Randomized Studies criteria. Clinical outcomes, RTS rates, and complications were aggregated. RESULTS Nine studies from 2011 to 2022 comprising 161 patients (mean age, 25 years; range, 19.7-28.9 years) were included. At an average follow-up of 59 months, postoperative American Shoulder and Elbow Surgeons score ranged from 81.6 to 96 and the mean visual analog scale score ranged from 0 to 2.1. Mean overall RTS rate ranged from 35% to 100% for the entire patient cohort 35% to 86% among overhead athletes, and 46% to 100% among nonoverhead athletes. Among the overhead athletes, 24 were baseball pitchers. 17% to 100% able to return to sport at any level. Complications were reported in 0% to 19% of patients. 0 to 18% of patients underwent revision surgery. CONCLUSIONS Biceps tenodesis in patients 35 years of age and younger yields a wide variability in reported RTS rates, excellent clinical outcome scores, and low but variable reported rates of complications, reoperations, and failure. LEVEL OF EVIDENCE IV; Systematic Review of Level III and IV studies.
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Brand JC, Rossi MJ, Lubowitz JH. Arthroscopy Honors Award-Winning Articles and Authors: Our Annual Research Awards. Arthroscopy 2023; 39:1-6. [PMID: 36543414 DOI: 10.1016/j.arthro.2022.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022]
Abstract
With genuine gratitude to the AANA Education Foundation for their unstinting support, it is our honor to announce Arthroscopy's Annual Awards for the best Clinical Research, Basic Science Research, Resident/Fellow Research, and Systematic Reviews published in 2022, as well as the Most Downloaded and Most Cited papers published 5 years ago. And as is customary in January, our editors update their disclosures of potential conflicts of interest, as we require of authors, and we update our masthead to introduce new members of our Editorial Board and Social Media Board.
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Waterman BR, Newgren J, Richardson C, Romeo AA. High Rate of Return to Sporting Activity Among Overhead Athletes With Subpectoral Biceps Tenodesis for Type II SLAP Tear. Arthroscopy 2023; 39:11-16. [PMID: 35987458 DOI: 10.1016/j.arthro.2022.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/04/2022] [Accepted: 07/13/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the functional and athletic outcomes after primary subpectoral biceps tenodesis for type II SLAP tear in overhead athletes. METHODS All competitive elite athletes with type II SLAP tears undergoing biceps tenodesis by a single surgeon were isolated between 2007 and 2015. Exclusion criteria were applied to individuals not involved in overhead athletics, clinical follow-up <24 months, adjacent rotator cuff or labral repair, concomitant SLAP repair, and/or previous arthroscopic shoulder surgery. Patient-reported outcome measures included visual analog scale (VAS), Kerlan Jobe Orthopaedic Clinic shoulder score, and Single Assessment Numerical Assessment. Clinical and sporting outcomes were recorded using a sports-specific questionnaire. RESULTS Of 22 identified patients, 16 competitive overhead athletes (72.7%; 11 men, 5 women) with a mean age of 21.0 years were available at mean 4.5-year follow-up. Baseball or softball comprised the majority of patients (n = 9; 56.3%), followed by gymnastics (n = 2), swimming (n = 2), and other sports (n = 3). At mean 4.1 months postoperatively, 13 patients (81.3%) returned to previous level of athletic activity, whereas 2 patients (12.5%) failed to return to sporting activity and 1 (6.3%) returned at a lower level of competition. VAS pain significantly decreased from an average of 4.4 preoperatively to 1.7 postoperatively (P = .002), and mean Single Assessment Numerical Assessment scores also demonstrated significant improvement (55.4-76.7; P = .008). Final mean Kerlan Jobe Orthopaedic Clinic score was 74.0 (standard deviation 25.9), including 2 patients with suboptimal outcomes due to persistent pain. There were no significant differences in mean forward flexion or rotation in either the adducted or throwing position (P > .05), although small, significant decreases in postoperative active abduction were noted (165° vs 155°; P = .003). CONCLUSIONS In the current series of competitive overhead athletes, 81% of patients returned to previous level of play at an average of 4.1 months postoperatively after subpectoral biceps tenodesis for symptomatic SLAP tear. Athletes reliably experienced significant decreased activity-related pain with athletic function. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
| | - Jon Newgren
- Rush University Medical Center, Chicago, Illinois, USA
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Sandler AB, Childs BR, Scanaliato JP, Dunn JC, Parnes N. SLAP Repair Versus Biceps Tenodesis in Patients Younger Than 40 Years: A Cost-Effectiveness Analysis. Orthop J Sports Med 2022; 10:23259671221140364. [PMID: 36479458 PMCID: PMC9720817 DOI: 10.1177/23259671221140364] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/15/2022] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The surgical management of type II superior labrum anterior and posterior (SLAP) tears in patients younger than 40 years is controversial, but growing evidence suggests comparable outcomes between primary SLAP repair and primary biceps tenodesis, with lower rates of reoperations after primary biceps tenodesis. Given the relatively similar patient-reported outcomes, cost-effectiveness analyses of direct and indirect costs associated with the two procedures propound a valuable comparative technique. HYPOTHESIS In this value-based comparison of SLAP repair versus biceps tenodesis, we hypothesized that biceps tenodesis would be more cost-effective than SLAP repair in patients younger than 40 years. STUDY DESIGN Economic and decision analysis; Level of evidence, 4. METHODS A 1-month Markov cycle was simulated to reflect 10 years of health outcomes. Health states were selected based on outcomes that are especially important in assessing indirect costs for a younger, active patient population: return-to-sport rates, which demonstrate a return to baseline function, and reoperation rates. Transition state probabilities were obtained through an index systematic review and meta-analysis comparing labral repair and biceps tenodesis for the treatment of type II SLAP lesions in patients younger than 40 years. Health state utility and cost values were obtained from accepted values denoted in existing literature. RESULTS Both primary SLAP repair and primary biceps tenodesis yielded an average expected 8.1 quality-adjusted life years over the 10-year period. The average cost (in 2021 US$) was $16,619 for biceps tenodesis and $19,388 for SLAP repair. CONCLUSION In a younger patient population, SLAP repair and biceps tenodesis had comparable quality-adjusted life years and utility in the treatment of type II SLAP tears; however, SLAP repair cost $19,388, while biceps tenodesis cost $16,619, reflecting a 14% cost savings with biceps tenodesis. These findings can be extrapolated to further establish the role for these procedures in treating SLAP tears.
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Affiliation(s)
- Alexis B. Sandler
- Department of Orthopaedics, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Benjamin R. Childs
- Department of Orthopaedics, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - John P. Scanaliato
- Department of Orthopaedics, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - John C. Dunn
- Department of Orthopaedics, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Nata Parnes
- Department of Orthopedic Surgery, Carthage Area Hospital, Carthage, New York, USA
- Department of Orthopedics, Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
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10
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Recker AJ, Waters TL, Bullock G, Rosas S, Scholten DJ, Nicholson K, Waterman BR. Biceps Tenodesis Has Greater Expected Value Than Repair for Isolated Type II SLAP Tears: A Meta-analysis and Expected-Value Decision Analysis. Arthroscopy 2022; 38:2887-2896.e4. [PMID: 35662668 DOI: 10.1016/j.arthro.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/04/2022] [Accepted: 05/13/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To use an expected-value decision analysis to determine the optimal treatment decision between repair and biceps tenodesis (BT) for an isolated type II SLAP injury. METHODS An expected-value decision analysis with sensitivity analysis was performed to systematically quantify the clinical decision. To determine outcome probabilities, a decision tree was constructed (repair vs BT) and a meta-analysis was conducted. To determine outcome utilities, we evaluated 70 patients with a chief complaint of shoulder pain regarding age, sex, Shoulder Activity Level, and visual analog scale score in terms of potential outcome preferences. Statistical fold-back analysis was performed to determine the optimal treatment. One-way sensitivity analysis determined the effect of changing the reinjury rate on the expected value of BT. RESULTS The overall expected value was 8.66 for BT versus 7.19 for SLAP repair. One-way sensitivity analysis showed that BT was the superior choice if reinjury rates were expected to be lower than 28%. Meta-analysis of 23 studies and 908 patients revealed that the probability of a "well" outcome was significantly greater for BT (87.8%; 95% confidence interval [CI], 74.9%-94.6%; I2 = 0.0%) than for SLAP repair (62.9%; 95% CI, 55.9%-69.3%; I2 = 65.9%; P = .0023). The rate of reinjury was 1.5% for BT (95% CI, 0.05%-33.8%; I2 = 0.0%) and 6.4% for repair (95% CI, 4.2%-9.6%; I2 = 24%), which was not statistically significantly different (P = .411). A total of 50 participants (mean age, 25.4 years [standard deviation, 8.9 years]; 76% male patients; 50% overhead athletes) met the inclusion criteria. Forty-six percent of participants had a high Shoulder Activity Level score. CONCLUSIONS Decision analysis showed that BT is preferred over repair for an isolated type II SLAP tear based on greater expected value of BT versus repair. Meta-analysis showed more frequent favorable outcomes with BT. Surgeons can use this information to tailor discussions with patients. LEVEL OF EVIDENCE Level IV, meta-analysis of Level I-IV studies.
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Affiliation(s)
- Andrew J Recker
- Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Timothy L Waters
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Garrett Bullock
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A.; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, England
| | - Samuel Rosas
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Donald J Scholten
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Kristen Nicholson
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Brian R Waterman
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A..
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11
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Biceps Tenodesis Combined With Arthroscopic Posterior Labral Repair for Type VIII SLAP Lesions in Active-Duty Military Patients Yields Excellent Return to Military Duty. Arthroscopy 2022; 38:2620-2627. [PMID: 35367303 DOI: 10.1016/j.arthro.2022.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To report short-term outcomes following biceps tenodesis combined with arthroscopic posterior labral repair of type VIII SLAP lesions in active-duty military patients. METHODS All consecutive patients from January 2012 through December 2018 who underwent biceps tenodesis combined with arthroscopic posterior labral repair of type VIII SLAP tears performed by the senior surgeon with complete outcome scores and minimum 2.5 years follow-up were identified. Exclusion criteria included concomitant glenoid microfracture, rotator cuff repair, or other capsulolabral repair. Outcome measures were completed by patients within 7 days before surgery and at latest follow-up. Biceps tenodesis performed was a mini-open, through a subpectoral approach, using a double-loaded 2.9mm suture-anchor. RESULTS Thirty-two patients met the inclusion criteria for the study. All patients were active-duty military at time of surgery. Average follow-up was 73.53 ± 22.37 months. Thirty-one patients achieved the minimal clinically important difference, 30 of 32 reached the substantial clinical benefit, and 31 of 32 met the patient acceptable symptomatic state, as defined for the American Shoulder and Elbow Surgeons Shoulder Score. Similarly, 30 of 32 patients reached the minimal clinically important difference, 29 of 32 achieved the substantial clinical benefit, and 32 of 32 met the patient acceptable symptomatic state for the Single Assessment Numeric Evaluation. There were no significant changes in forward flexion, external rotation, or internal rotation between pre- and postoperative measurements. Three patients reported postoperative complications and 1 patient progressed to further surgery. Thirty (93.75%) patients remained on active-duty military service and were able to return to preinjury levels of activity. CONCLUSIONS Active-duty military patients with type VIII SLAP tears had statistically and clinically significant increases in outcome scores, marked improvement in pain, and high rates of return to unrestricted active-duty following mini-open subpectoral biceps tenodesis combined with posterior labral repair. LEVEL OF EVIDENCE IV, retrospective case series.
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12
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Akpinar B, Vasavada K, Colasanti CA, Alaia MJ, Strauss EJ, Jazrawi LM. Concomitant Cervical Spine Stenosis Negatively Affects Subpectoral Biceps Tenodesis Outcomes. Arthrosc Sports Med Rehabil 2022; 4:e1299-e1304. [PMID: 36033189 PMCID: PMC9402417 DOI: 10.1016/j.asmr.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/11/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose To determine whether an association exists between the presence of cervical spine pathology and postoperative patient-reported outcomes (PROs) in patients undergoing open subpectoral biceps tenodesis (BT). Methods A retrospective review of patients undergoing isolated BT from August 2011 to May 2019 was conducted. Cases were defined as patients with concomitant cervical spine disease (disc disease, disc herniations, neuroforaminal/central stenosis). Controls were patients without cervical spine disease. Postoperative PROs were collected from all patients with a minimum of 12-month follow-up. Cases and controls were matched 1:1 using age and body mass index. PROs were compared using the χ2 text, Fisher exact test, or analysis of variance. Results A total of 23 cases and 23 controls were identified. Cases and controls had similar distributions of age (42.4 ± 4.4 years, 40.4 ± 4.5, P = .15), sex (83% male, 87% male, P = .68), body mass index (28.0 ± 4.0, 27.6 ± 4.3, P = .78), and percentage of athletes (65% athlete, 61% athlete. P = .76). All cases had evidence of neuroforaminal stenosis and multilevel degenerative disc disease, whereas 19 of 23 (83%) had evidence of central canal stenosis. Cases had a greater visual analog scale (VAS) score during Sport score (3.6 ± 0.7 vs 1.2 ± 0.6, P = .013) and lower Subjective Shoulder Value (69.5 ± 5.8 vs 84.1 ± 5.4, P = .070) and Shoulder Instability-Return to Sport after Injury score (60.4 ± 5.8 vs 77.4 ± 6.0, P = .046). There were no significant differences between groups’ ASES, baseline VAS, overall satisfaction scores, and willingness to undergo the same operation again. No significant differences were found in postoperative rate of return to sport, time to return, and return to preoperative competitiveness. Conclusions Patients with SLAP tears undergoing isolated BT in the presence of cervical spinal stenosis may have inferior Subjective Shoulder Value, Shoulder Instability-Return to Sport after Injury, and VAS during sport scores as compared with controls, although many PROs were similar at follow-up. Athletes undergoing BT, particularly with concomitant cervical spine pathology, should be counseled appropriately before surgery. Level of Evidence Level III, case–control study.
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Sandler AB, Scanaliato JP, Baird MD, Dunn JC, Parnes N. Lower Reoperation and Higher Return-to-Sport Rates After Biceps Tenodesis Versus SLAP Repair in Young Patients: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e1887-e1895. [PMID: 36312714 PMCID: PMC9596896 DOI: 10.1016/j.asmr.2022.07.004] [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] [Received: 03/27/2022] [Accepted: 07/11/2022] [Indexed: 01/02/2023] Open
Abstract
Purpose To evaluate patient-reported outcomes, return to sport, and adverse events after SLAP repair versus biceps tenodesis (BT) in a young patient population undergoing treatment of SLAP tears. Methods We performed a systematic review and meta-analysis of the PubMed (MEDLINE), Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Web of Science databases for comparative studies discussing outcomes after SLAP repair and BT in patients younger than 40 years with at least 1 year of follow-up. Results Four studies were included, comprising a total of 274 patients who underwent treatment of SLAP tears with SLAP repair (169 patients) or BT (105 patients). Most patients were male patients (79.8%) and athletes (74.5%). Preoperative and postoperative pain visual analog scale scores decreased similarly in both groups (range, 6.6-6.7 preoperatively to 0.8-2.6 postoperatively in SLAP repair group vs 5.6-7.3 preoperatively to 0.7-1.9 postoperatively in BT group). Similar and substantial American Shoulder and Elbow Surgeons Standardized Shoulder Assessment score increases were observed after both procedures (range, 40.6-45.8 preoperatively to 75.4-92.0 postoperatively in SLAP repair vs 41.9-55.0 preoperatively to 85.7-91.2 postoperatively in BT group). Patient satisfaction rates were similar but showed slightly higher ranges after BT (8.5-8.8 vs 8.0-8.2). Rates of return to sport were higher after BT (63%-85% vs 50%-76%), with higher odds of returning to sport after BT reported by all studies. Surgical complications were rare after SLAP repair and BT. Rates of reoperation were substantially higher after SLAP repair (3%-15% vs 0%-6%), with 3 of 4 studies reporting no reoperations after BT. BT comprised 78% to 100% of reoperation procedures after SLAP repair. Conclusions Postoperative pain, function, and patient satisfaction were similar after SLAP repair and BT in patients younger than 40 years. There are higher rates of reoperation and lower rates of return to sport after SLAP repair than after BT. Level of Evidence Level III, systematic review of Level III studies.
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Affiliation(s)
- Alexis B. Sandler
- George Washington University School of Medicine and Health Sciences, Washington, DC, U.S.A
- Address correspondence to Alexis B. Sandler, M.D., William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, 18511 Highlander Medics Dr, El Paso, TX 79934, U.S.A.
| | - John P. Scanaliato
- Department of Orthopaedics, William Beaumont Army Medical Center, El Paso, Texas, U.S.A
| | - Michael D. Baird
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - John C. Dunn
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York, U.S.A
- Department of Orthopaedic Surgery, Claxton-Hepburn Medical Center, Ogdensburg, New York, U.S.A
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Hurley ET, Mojica ES, Markus DH, Lorentz NA, Colasanti CA, Campbell KA, Alaia MJ, Jazrawi LM. High Rate of Satisfaction and Return to Play at 5-Year Follow-Up After Arthroscopic Superior-Labrum Anterior-Posterior Repairs. Arthroscopy 2022; 38:2178-2182. [PMID: 35124221 DOI: 10.1016/j.arthro.2022.01.039] [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: 08/01/2021] [Revised: 12/07/2021] [Accepted: 01/27/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the outcomes of patients 5 years postoperatively following arthroscopic SLAP repair, and to evaluate factors associated with satisfaction. METHODS A retrospective review of patients who underwent SLAP repair with a minimum of 5-year follow-up was performed. Recurrence, visual analog scale (VAS) score, Subjective Shoulder Value (SSV), American Shoulder & Elbow Surgeons (ASES) score, satisfaction, whether they would undergo the same surgery again, and the rate, level and timing of return to play (RTP) were evaluated. Multilinear regression models were used to evaluate factors affecting postoperative satisfaction. RESULTS Overall, 122 patients who underwent SLAP repair were included, with a mean age of 33.4 years. 81% were males, and 58.2% were participating in sport preoperatively. The mean follow-up was 86.4 ± 14.4 months. At final follow up, the mean satisfaction was 87.7%, and the mean SSV was 82.9. Overall, the rate of RTP was 85.9%, with 64.8% returning at the same level at a mean of 10.5 ± 8 months. Ultimately, 13 (10.7%) patients had a further surgery, including 10 (8.2%) patients that had a biceps tenodesis. VAS during sport (P = .025), SSV (P < .001), and time to RTP (P = .0056), were associated with higher satisfaction. CONCLUSION There was a high rate of satisfaction at 5-year follow-up, with excellent patient-reported outcomes but with one-tenth of patients requiring revision surgeries. Additionally, while there was an overall high rate of RTP, there was only a modest rate of RTP at their preinjury level, and overhead athletes took longer to RTP. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Eoghan T Hurley
- New York University Langone Health, Orthopaedic Surgery Department, Sports Medicine Division, New York, New York, U.S.A..
| | - Edward S Mojica
- New York University Langone Health, Orthopaedic Surgery Department, Sports Medicine Division, New York, New York, U.S.A
| | - Danielle H Markus
- New York University Langone Health, Orthopaedic Surgery Department, Sports Medicine Division, New York, New York, U.S.A
| | - Nathan A Lorentz
- New York University Langone Health, Orthopaedic Surgery Department, Sports Medicine Division, New York, New York, U.S.A
| | - Christopher A Colasanti
- New York University Langone Health, Orthopaedic Surgery Department, Sports Medicine Division, New York, New York, U.S.A
| | - Kirk A Campbell
- New York University Langone Health, Orthopaedic Surgery Department, Sports Medicine Division, New York, New York, U.S.A
| | - Michael J Alaia
- New York University Langone Health, Orthopaedic Surgery Department, Sports Medicine Division, New York, New York, U.S.A
| | - Laith M Jazrawi
- New York University Langone Health, Orthopaedic Surgery Department, Sports Medicine Division, New York, New York, U.S.A
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Evaluation of factors associated with successful 5-year outcomes following arthroscopic Bankart repair in athletes. Knee Surg Sports Traumatol Arthrosc 2022; 30:2092-2098. [PMID: 34811577 DOI: 10.1007/s00167-021-06803-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the outcomes of athletes 5-years post-operatively following arthroscopic Bankart repair, and to evaluate factors associated with satisfaction and shoulder function, as defined by subjective shoulder value. METHODS A retrospective review of athletes who underwent arthroscopic Bankart repair, with a minimum of 5-year follow-up was performed. Recurrence, Visual Analogue Scale (VAS) score, Subjective Shoulder Value (SSV), satisfaction, and whether they would undergo the same surgery again, and rate, level and timing of return to play, and Shoulder Instability-Return to Sport after Injury (SIRSI) score were evaluated. Multi-linear regression models were used to evaluate factors affecting postoperative Satisfaction, and SSV level. RESULTS Overall, 144 athletes who underwent arthroscopic Bankart repair were included, with a mean age of 26.9 years (SD: 8.1), 132 (91.7%) were males, and mean follow-up of 75.7 months. At final follow up, 82.6% were satisfied/very satisfied, and the mean SSV was 85.8 (SD: 14.4). Overall, the rate of return to play was 80.5%, with 63.9% returning at the same level at a mean of 6.2 months (SD: 2.7). Overall, there was 18 (12.5%) had recurrent instability, and a further procedure was performed in 15 (10.4%) patients. Linear regression revealed that the SIRSI score (p < 0.0001), SSV (p < 0.0001), VAS (p < 0.0031), no sleep trouble (p = 0.0129) was associated with satisfaction. Logistic regression revealed whether a patient required revision surgery (p = 0.0029), or had re-dislocation (p = 0.0031) was also associated with satisfaction. Linear regression revealed that the SIRSI score (p < 0.0001), VAS score (p < 0.0001), and no sleep trouble (p < 0.0001), were associated with SSV score. CONCLUSION There was a high rate of satisfaction at 5-year follow-up, with excellent patient-reported outcomes and a high rate of return to play among athletes. However, there was a moderate rate of recurrent instability and further revision surgery. This study identified that the SIRSI score, VAS score, no sleep trouble and ability to return to play at the same level were associated with both satisfaction and SSV score. LEVEL OF EVIDENCE III.
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Primary Double-Pulley SLAP Repair in an Active-Duty Military Population With Type II SLAP Lesions Results in Improved Outcomes and Low Failure Rates at Minimum Six Years of Follow-up. Arthrosc Sports Med Rehabil 2022; 4:e1141-e1149. [PMID: 35747638 PMCID: PMC9210478 DOI: 10.1016/j.asmr.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/12/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To report mid-term outcomes of active-duty patients younger than the age of 35 years with shoulder type II SLAP lesions following our technique for double-pulley SLAP repair (DPSR). Methods All consecutive patients aged 18 to 35 years from January 2014 through December 2015 who underwent primary DPSR by the senior surgeon with complete outcome scores were identified. The clinical significance measures (patient acceptable symptomatic state [PASS], substantial clinical benefit [SCB], minimal clinically important difference [MCID]) have not yet been fully defined for type II SLAP repair procedures, so the values for biceps tenodesis were used as a stand-in. Patients were excluded if they were lost to follow-up of if they underwent a concomitant rotator cuff repair. Outcome measures were completed by patients within 1 week before surgery and at latest follow-up. Results Overall, 22 of 41 (53.7%) patients met the inclusion criteria for the study, and all were active-duty military at time of surgery. In total, 21 of 22 (95.5%) patients met the PASS, whereas 20 of 22 (90.9%) achieved SCB and 22 of 22 (100.0%) exceeded the MCID for their operative shoulder as determined by the American Shoulder and Elbow Surgeons score. In total, 19 of 22 (86.4%) patients met the PASS, whereas 22 of 22 (100.0%) achieved SCB and exceeded the MCID for their operative shoulder as determined by the Single Assessment Numeric Evaluation. In addition, 21 of 22 (95.5%) met the PASS, whereas 22 of 22 (100%) achieved SCB and exceeded the MCID for their operative shoulder as determined by the pain visual analog scale. Pre- and postoperative range of motion did not vary significantly. In total, 18 of 22 (81.8%) of patients remained on active duty and were able to return to preinjury work and recreation activity levels. In 2 patients (9.09%), the repair did not heal. Conclusions Mid-term outcomes in this population of young, active-duty patients undergoing DPSR for type II SLAP tears demonstrate a statistically and clinically significant improvement in patient-reported outcomes and an overall return to active-duty rate of 81.8%. Level of Evidence Level IV, therapeutic case series.
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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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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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Rehabilitation and Return to Play of the Athlete after an Upper Extremity Injury. Arthrosc Sports Med Rehabil 2022; 4:e163-e173. [PMID: 35141548 PMCID: PMC8811509 DOI: 10.1016/j.asmr.2021.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/29/2021] [Indexed: 11/22/2022] Open
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