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Nair AV, Jangale A, Kumar MP, Reddy P, kuntwad V, Goud N, Murthy R. Trans-cuff portals heal by 6 weeks: an ultrasonography-based study. JSES Int 2021; 5:1072-1076. [PMID: 34766087 PMCID: PMC8568988 DOI: 10.1016/j.jseint.2021.07.012] [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] [Indexed: 11/20/2022] Open
Abstract
Background Various arthroscopic portals have been described for repair of superior labrum anterior-posterior (SLAP) lesions. The difficulty in doing repair through the rotator interval and the problems in direction and placement of anchors still persist. Functional outcomes of the patients after treating them using trans-cuff portal are well established in literature, but the actual healing of the portal is not clear. We made a sincere effort to identify healing of the trans-cuff portal with ultrasound guidance and functional outcome using American Shoulder and Elbow Surgeons Shoulder Score (ASES score), Constant Shoulder Score, and Oxford Shoulder Score. Material and methods Twenty-two patients with SLAP or labral tears and normal contralateral shoulders were included. Surgery was performed using the trans-cuff portal as a viewing or working portal for biceps repair and labral repair. Rehabilitation was initiated from day 1 and followed up on 6 weeks, 3 months and, 6 months with a maximum follow-up duration of 2 years. Ultrasound was used to measure the depth of healing and graded at 6 weeks of follow-up postoperatively. Functional outcomes were measured using ASES score, Constant Shoulder Score, and Oxford Shoulder Score measured at 6 months. Results Seventeen patients were of grade 1 (complete healing); 1 patient was of grade 2 (more than 50% healing); 1 of grade 3 (less than 50% healing), and 3 were lost to follow-up. Fourteen patients out of 19 had excellent ASES scores, 4 patients had good scores, and 1 patient was considered as poor with an average ASES score of 84.51 (range 93-48) and standard deviation of 10.37. The ASES score indicated that healing of the rotator cuff portal is directly related to the functional outcome of the shoulder. The Constant Shoulder Score and Oxford Shoulder Score on the contrary were statistically not significant indicating no relation of the Oxford and Constant scores with healing of the rotator cuff portals. Conclusion Trans-cuff portal is safe, gives proper angle for insertion of anchors, and can be used for repair of SLAP lesions with ease. Ultrasonography helps in confirming the healing of portal.
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Affiliation(s)
| | - Ajit Jangale
- Corresponding author: Dr Ajit Jangale, MS, MRCS, Banglore Shoulder Institute, No. 1372/A, Ground Floor, 31 st B Cross 4 Block Jayanagar, Bangalore, 560041, Karnataka, India.
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Weick JW, Workman WB, Bush CJ, McCollum KA, Sugaya H, Freehill MT. Reported Technical Aspects of Type II SLAP Lesion Repairs in Athletes. Arthrosc Sports Med Rehabil 2021; 3:e289-e296. [PMID: 34027434 PMCID: PMC8128993 DOI: 10.1016/j.asmr.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 09/01/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose To systematically review the available literature to further describe and report the available data on SLAP repair techniques and the association with outcomes. Methods A systematic review of literature was performed on manuscripts describing type II SLAP repairs in athletes. Selection criteria included studies reporting exclusively type II SLAP tears without concomitant pathology, minimum 2-year postoperative follow-up, use of anchor fixation, and return to previous level of play data available. We extracted patient outcome as well as surgical construct details from each article. Average outcomes and return to play rates were calculated and substratified further by athlete type. Return to play rates were compared by repair constructs with the Student t test. Results Initial search resulted in 107 articles. After exclusion criteria were applied, 17 articles were included in the final analysis. Overall, 84% of patients had good-to-excellent results. Of all athletes, 66% returned to previous level of play. There was significant variation in reported technique in terms of anchor number, location, material, suture type, and knotless versus knotted constructs. No significant difference was reported in outcomes in comparison of suture type (P-value .96) or knotted versus knotless constructs (P-value .91). Given the significant variability in reporting, no statistical analysis was felt able to be performed on anchor location and number. Conclusions Repair of type II SLAP tears in athletes is a difficult problem to treat with overall low return to play despite a high rate of “good” outcomes when assessed by outcome measures. Significant variability exists in surgical technique, as well as reporting of surgical technique, potentially limiting the ability to define the best or most effective technique for SLAP repair. Level of Evidence IV, systematic review of level III and level IV studies.
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Affiliation(s)
- Jack W Weick
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Will B Workman
- Walnut Creek Orthopedics & Sports Medicine, Team Orthopedic Surgeon, Oakland Athletics, Walnut Creek, California
| | - Christopher J Bush
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Katherine A McCollum
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | | | - Michael T Freehill
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, U.S.A
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Fanning E, Maher N, Cools A, Falvey EC. Outcome Measures After Shoulder Stabilization in the Athletic Population: A Systematic Review of Clinical and Patient-Reported Metrics. Orthop J Sports Med 2020; 8:2325967120950040. [PMID: 32984424 PMCID: PMC7498977 DOI: 10.1177/2325967120950040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/07/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Athletic endeavor can require the “athletic shoulder” to tolerate significant
load through supraphysiological range and often under considerable
repetition. Outcome measures are valuable when determining an athlete’s safe
return to sport. Few data are available to guide a clinician’s choice from
the variety of measures available. Purpose: To describe the use of quantifiable objective outcome measures and
patient-reported outcome tools after glenohumeral joint stabilization,
specifically in an athletic population. The secondary aim of our study was
to assess whether the method of measurement used was clearly described and
standardized to aid clinical interpretation. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of MEDLINE, Scopus, SPORTDiscus, and Web of Science
databases was performed in December 2018 based on the PRISMA (Preferred
Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. After
the application of selection criteria, a full review of identified papers,
and screening of reference lists, a total of 62 studies were included in the
review. All studies were independently appraised for quality, predefined
data fields were populated and cross-checked for accuracy, and results were
then summarized from these data fields. Results: Of the 62 included studies, 94% used a quantifiable objective clinical
outcome. A majority (85%) of the studies measured range of motion, 21%
recorded muscle strength, 5% measured electromyographic activity, 5%
examined shoulder kinematics, and 3% assessed joint proprioception after
surgery. However, only 18% of the studies clearly described a standardized
method of measuring the outcome. Nearly all (95%) of the studies used at
least 1 patient-reported outcome measure. The Rowe score was most commonly
used (35%). Conclusion: We must standardize and clearly describe the use of quantifiable objective
outcome measures to aid clinical interpretation. A concerted effort should
also be made to standardize the use of patient-reported outcome tools after
shoulder stabilization in the athletic population.
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Affiliation(s)
- Edel Fanning
- Sports Surgery Clinic, Sports Medicine, Dublin, Ireland.,University College Cork, Cork, Ireland
| | - Natasha Maher
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, West Yorkshire, UK
| | - Ann Cools
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Gent, Belgium
| | - Eanna C Falvey
- Sports Surgery Clinic, Sports Medicine, Dublin, Ireland.,University College Cork, Cork, Ireland
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MR imaging of the shoulder in youth baseball players: Anatomy, pathophysiology, and treatment. Clin Imaging 2019; 57:99-109. [DOI: 10.1016/j.clinimag.2019.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/01/2019] [Accepted: 05/13/2019] [Indexed: 12/18/2022]
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Sarikaya B, Bozkurt C, Sipahioğlu S, Sarıkaya PZB, Altay MA. İzole Tip 2 Slap Lezyonu Nedeniyle Artroskopik Tamir Uygulanan Hastaların Kısa Dönem Klinik Sonuçlarının Değerlendirilmesi. DICLE MEDICAL JOURNAL 2018. [DOI: 10.5798/dicletip.363929] [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] Open
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Trofa DP, Ahmad CS. The Management of Superior Labrum Anterior-Posterior Tears in the Thrower’s Shoulder. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2016.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Abstract
Throwers, or athletes who engage in repetitive overhead motions, are a unique subset of athletes that experience distinct shoulder injuries. Athletes engaged in baseball comprise the majority of patients seeking orthopedic care for throwing related injuries. Injuries specific to throwers most commonly involve the labrum and the undersurface of the rotator cuff. In addition, tissue changes in both the anterior and posterior glenohumeral capsule are common with repetitive overhead motions. These capsular changes alter. This article will examine the pathomechanics of injuries to throwers, elaborate means of diagnoses of cuff and labral injury and discuss recent advances in both non-operative and operative interventions, including preventative principles.
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Affiliation(s)
- Stuart D Kinsella
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Stephen J Thomas
- Division of Nursing and Health Sciences, Neumann University, 1 Neumann Drive, Aston, PA 19104, USA
| | - G Russell Huffman
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 34th and Spruce Street, Philadelphia, PA 19104, USA
| | - John D Kelly
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 34th and Spruce Street, Philadelphia, PA 19104, USA.
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Suture anchors or transglenoidal sutures for arthroscopic repair of isolated SLAP-2 lesions? A matched-pair comparison of functional outcome and return to sports. Arch Orthop Trauma Surg 2013. [PMID: 23179479 DOI: 10.1007/s00402-012-1657-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
PURPOSE Presumably, the technique of SLAP refixation has significant influence on outcome. This study analyzes and compares functional outcome and return to sports after arthroscopic suture anchor (SA) and arthroscopic transglenoidal suture (TS) repair of isolated SLAP-2 lesions. METHODS Twenty-four competitive amateur athletes constituted the two treatment groups of this retrospective matched-pair analysis. In the SA group (n = 12), the mean age was 39.1 years (±12.0) and the mean follow-up period was 4.0 years (±0.6). In the TS group (n = 12), the mean age was 33.8 years (±12.0) and the mean follow-up period was 3.7 years (±0.9). The minimum follow-up period was 2.0 years. Primary outcome measures were the absolute constant-score (CS), the subjective shoulder value (SSV) as well as the ability to return to sports. RESULTS The mean CS in the SA group was 91.6 (±5.5) compared to 81.3 (±15.5) in the TS group (p = 0.04). The mean SSV after SA repair was 96.9 (±4.6) compared to 80.0 (±20.8) after TS repair (p = 0.01). Both scores showed significantly higher standard deviations within the TS group (p < 0.05). Twelve of eighteen patients (67 %) were able to return to their overhead sports without restrictions (5/9 in the SA group and 7/9 in the TS group; p > 0.05). Fourteen of twenty-four patients (58 %) achieved their preinjury sports levels (8/12 in the SA group and 6/12 in the TS group; p > 0.05). CONCLUSIONS Superior objective and subjective shoulder function was obtained following arthroscopic SA repair compared to arthroscopic TS repair of isolated SLAP-2 lesions. In addition, results of SA repair were more predictable. However, nearly half of the athletes did not achieve full return to sports regardless of the applied technique of refixation.
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Knesek M, Skendzel JG, Dines JS, Altchek DW, Allen AA, Bedi A. Diagnosis and management of superior labral anterior posterior tears in throwing athletes. Am J Sports Med 2013; 41:444-60. [PMID: 23172004 DOI: 10.1177/0363546512466067] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Injury to the superior glenoid labrum is increasingly recognized as a significant source of shoulder pain and dysfunction in the throwing athlete. Several theories have been proposed to explain the pathogenesis of superior labral anterior posterior (SLAP) tears. The clinical examination of the superior labrum-biceps tendon complex remains challenging because of a high association of other shoulder injuries in overhead athletes. Many physical examination findings have high sensitivity and low specificity. Advances in soft tissue imaging such as magnetic resonance arthrography allow for improved detection of labrum and biceps tendon lesions, although correlation with history and physical examination is critical to identify symptomatic lesions. Proper treatment of throwers with SLAP tears requires a thorough understanding of the altered biomechanics and the indications for nonoperative management and arthroscopic treatment of these lesions.
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Affiliation(s)
- Michael Knesek
- Department of Orthopaedic Surgery, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby A, Ann Arbor, MI 48106, USA
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Arthroscopic "cuff-sparing" percutaneous (CUSP) technique for posterior instability repair in the beach-chair position. Tech Hand Up Extrem Surg 2012; 16:173-9. [PMID: 22914001 DOI: 10.1097/bth.0b013e31825fd6f8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Arthroscopic posterior labral repair and capsular shift procedures are technically difficult in the beach-chair position as compared with the lateral decubitus position. Optimal visualization in the beach-chair position, and anchor placement in the posterior glenoid rim, necessitate various lateral trans-cuff portals, and these may result in damage to the rotator cuff tendons. The author has devised a new technique for posterior labral repair in the beach-chair position; the technique involves visualization of the posterior capsulolabral complex through a 70-degree arthroscope placed in the posterior axillary pouch portal, and labral repair is performed through percutaneous medial portals. The cuff-sparing and percutaneous (CUSP) nature of the technique utilizes safe anatomic zones for visualization and percutaneous repair of the entire posterior labrum, and lateral portals that may potentially damage the rotator cuff tendons are avoided. Technical variants of the procedure include: (1) a "CUSP shift" technique (combined labral repair and capsular shift); (2) a "CUSP-stitch" technique (isolated labral repair without a capsular shift); and (3) a "posterior labroplasty" technique for reconstruction of deficient posterior labral tissue. Technical tips to avoid neurological injury, and a detailed rehabilitation protocol are presented.
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Silberberg JM, Moya-Angeler J, Martín E, Leyes M, Forriol F. Vertical versus horizontal suture configuration for the repair of isolated type II SLAP lesion through a single anterior portal: a randomized controlled trial. Arthroscopy 2011; 27:1605-13. [PMID: 22014698 DOI: 10.1016/j.arthro.2011.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 07/07/2011] [Accepted: 07/13/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the clinical and functional outcomes of the repair of an isolated type II SLAP lesion by 2 different configuration techniques (vertical v horizontal suture) through a single anterior portal. METHODS We designed a prospective, double-blinded, randomized clinical trial. A junior orthopaedic surgeon, who made the initial diagnosis, used a 10-point visual analog scale for pain and subjective instability and the American Shoulder and Elbow Surgeons (ASES) scoring system and evaluated the range of motion. After a diagnostic arthroscopy that ascertained the presence of an isolated type II SLAP lesion, patients were randomized to receive either vertical suture configuration (group 1) or horizontal suture configuration (group 2), both through a single anterior portal. Thirty-two patients were included in the study. The mean follow-up time was 37 months. RESULTS The mean postoperative ASES score was 91.9 in group 1 versus 95.8 in group 2 (P > .05). The differences observed from preoperative ASES score for both groups to postoperative ASES score were statistically significant. The differences observed in preoperative range of motion from the contralateral healthy shoulder and the affected shoulder in both groups were all clinically and statistically significant. Comparing the overall range of motion of the affected limb postoperatively with the range of motion of the contralateral healthy shoulder and between both groups, we found no statistically significant differences in forward flexion (P = .067), external rotation (P = .101), or internal rotation (P = .343). CONCLUSIONS The results of this study suggest that the repair of an isolated type II SLAP lesion through a single anterior portal is clinically and functionally beneficial to patients regardless of the suture configuration performed (vertical or horizontal suture) because no differences were observed between these configurations after repair of an isolated type II SLAP lesion. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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