Arthroscopic Treatment of Type II SLAP Lesions: Biceps Tenodesis as an Alternative to Reinsertion (SS-54)

Bicknell, Ryan T.; Parratte, S.; Chuinard, Christopher; Jacquot, N.; Trojani, Christophe; Boileau, Pascal

doi:10.1016/j.arthro.2007.03.068

Cited by 3 publications

(2 citation statements)

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“…A review of data from the American Board of Orthopaedic Surgery 14) showed that orthopedic surgery residency graduates report rates of SLAP repairs that are 3 times higher than the published incidence of SLAP tears, suggesting that these operations may be done when not clinically indicated. Several studies have suggested that patients with SLAP tears who are older than 40 years may be better treated with arthroscopic biceps tenodesis 15 16 17) (CPT code 29828). Arthroscopic SLAP repairs generate 40% and 130% higher payments (NSQIP payment/minute) compared with arthroscopic and open biceps tenodesis, respectively ( Supplementary Table 2 ).…”

Section: Discussionmentioning

confidence: 99%

Reassessment of Relative Value in Shoulder and Elbow Surgery: Do Payment and Relative Value Units Reflect Reality?

et al. 2021

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Backgroud Many U.S. health care institutions have adopted compensation models based on work relative value units (wRVUs) to standardize payments and incentivize providers. A major determinant of payment and wRVU assignments is operative time. We sought to determine whether differences in estimated operative times between the Centers for Medicare & Medicaid Services (CMS) and the National Surgical Quality Improvement Program (NSQIP) contribute to payment and wRVU misvaluation for the most common shoulder/elbow procedures. Methods We collected data on wRVUs, payments, and operative times from CMS for 29 types of isolated arthroscopic and open shoulder/elbow procedures. Using regression analysis, we compared relationships between these variables, in addition to median operative times reported by NSQIP (2013–2016). We then determined the relative valuation of each procedure based on operative time. Results Seventy-nine percent of CMS operative time were longer than NSQIP time ( R 2 = 0.58), including, but not limited to, shoulder arthroplasty and arthroscopic shoulder surgery. The correlation between payments and operative times was stronger between CMS data ( R 2 = 0.61) than NSQIP data ( R 2 = 0.43). Similarly, the correlation between wRVUs and operative times was stronger when using CMS data ( R 2 = 0.87) than NSQIP data ( R 2 = 0.69). Nearly all arthroscopic shoulder procedures (aside from synovectomy, debridement, and decompression) were highly valued according to both datasets. Per NSQIP, compensation for revision total shoulder arthroplasty ($10.14/min; 0.26 wRVU/min) was higher than that for primary cases ($9.85, 0.23 wRVU/min) and nearly twice the CMS rate for revision cases ($5.84/min; 0.13 wRVU/min). Conclusions CMS may overestimate operative times compared to actual operative times as recorded by NSQIP. Shorter operative times may render certain procedures more highly valued than others. Case examples show that this can potentially affect patient care and incentivize higher compensating procedures per operative time when less-involved, shorter operations have similar patient-reported outcomes.

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Section: Discussionmentioning

confidence: 99%

Reassessment of Relative Value in Shoulder and Elbow Surgery: Do Payment and Relative Value Units Reflect Reality?

et al. 2021

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“…The suggested treatment is repair of the superior labrum with suture anchors. Because of possible postoperative pain and stiffness after SLAP repair, some authors have suggested biceps tenodesis instead of labral repair and reported better results with this technique 56. Other authors preferred conservative treatment of isolated SLAP II lesions in patients older than 40 years who were not overhead athletes 57.…”

Section: Pathlogymentioning

confidence: 99%

Disorder of the long head of the biceps tendon

et al. 2010

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This paper focuses on biceps injuries in shoulder surgery. This topic is currently of great interest, and there has been much discussion about diagnosis, treatment and prevention. Biceps tendon pathology exists in many forms and is frequently associated with other shoulder disorders. These facts must be taken into consideration in the evaluation and treatment of patients with long head of the biceps pathology. There is much controversy about the long head of the biceps tendon (LHBT). The clinical significance to shoulder function, diagnosis and treatment are still a source of debate. The purpose of this review is to discuss the anatomy, function, pathology, clinical manifestation, physical examination, imaging and treatment of disorders of the LHBT.

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Surgical Management of the Failed SLAP Repair

Weber¹

2010

Sports Medicine and Arthroscopy Review

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Repair of superior labral tears anterior to posterior (SLAP) lesions has become an increasingly common procedure, despite the low incidence rates reported in the literature. As the incidence of these procedures increases, the surgeons will be increasingly confronted with patients with painful shoulders after SLAP repair. Persistent pain after SLAP repair is multifactorial; careful preoperative workup is necessary to elucidate the cause of pain. Simple failure of the prior SLAP repair will rarely be the cause of persistent pain. Use of tacks is especially worrisome, and suture anchor repair is preferable. Articular cartilage injuries because of either bioabsorbable or metal hardware will often create significant residual disability. Recent literature suggests that older patients may be better served by primary biceps tenodesis rather than SLAP repair.

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Arthroscopic Treatment of Type II SLAP Lesions: Biceps Tenodesis as an Alternative to Reinsertion (SS-54)

Cited by 3 publications

References 0 publications

Reassessment of Relative Value in Shoulder and Elbow Surgery: Do Payment and Relative Value Units Reflect Reality?

Reassessment of Relative Value in Shoulder and Elbow Surgery: Do Payment and Relative Value Units Reflect Reality?

Disorder of the long head of the biceps tendon

Surgical Management of the Failed SLAP Repair

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