Retrospective Analysis of Arthroscopic Superior Labrum Anterior to Posterior Repair: Prognostic Factors Associated with Failure

Frank, Rachel M.; Nho, Shane J.; McGill, Kevin C.; Grumet, Robert C.; Cole, Brian J.; Verma, Nikhil N.; Romeo, Anthony A.

doi:10.1155/2013/125960

Cited by 22 publications

(15 citation statements)

References 28 publications

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“…Two techniques were included in the literature review: tacks and suture anchors. 11,41,57,59,86,122 In both techniques, the glenoid neck is debrided, and the labrum and biceps anchor are reduced and then fixated. Knots or knotless fixation is used to grasp and repair the tissue.…”

Section: Operative Managementmentioning

confidence: 99%

National Athletic Trainers' Association Position Statement: Evaluation, Management, and Outcomes of and Return-to- Play Criteria for Overhead Athletes With Superior Labral Anterior-Posterior Injuries

Michener

Abrams²,

Bliven

et al. 2018

Journal of Athletic Training

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Physical examination tests may aid diagnosis; 6 tests are recommended for confirming and 1 test is recommended for ruling out a SLAP lesion. Combinations of tests may be helpful to diagnose SLAP lesions. Clinical trials directly comparing outcomes between surgical and nonoperative management are absent; however, in cohort trials, the reports of function and return-to-sport outcomes are similar for each management approach. Nonoperative management that includes rehabilitation, nonsteroidal anti-inflammatory drugs, and corticosteroid injections is recommended as the first line of treatment. Rehabilitation should address deficits in shoulder internal rotation, total arc of motion, and horizontal-adduction motion, as well as periscapular and glenohumeral muscle strength, endurance, and neuromuscular control. Most researchers have examined the outcomes of surgical management and found high levels of satisfaction and return of shoulder function, but the ability to return to sport varied widely, with 20% to 94% of patients returning to their sport after surgical or nonoperative management. On average, 55% of athletes returned to full participation in prior sports, but overhead athletes had a lower average return of 45%. Additional work is needed to define the criteria for diagnosing and guiding clinical decision making to optimize outcomes and return to play.

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Section: Operative Managementmentioning

confidence: 99%

National Athletic Trainers' Association Position Statement: Evaluation, Management, and Outcomes of and Return-to- Play Criteria for Overhead Athletes With Superior Labral Anterior-Posterior Injuries

Michener

Abrams²,

Bliven

et al. 2018

Journal of Athletic Training

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“…The prevalence of SLAP lesions is approximately 6% in the patients undergoing shoulder arthroscopy. 1) Many studies reported the outcome of SLAP repair using clinical tests, postoperative satisfaction, functional scores, and return to sports or work. 1 2) Despite advancements in imaging technology and surgical techniques for arthroscopic SLAP repair, nearly one third of patients still remain unsatisfied, and significant controversy exists regarding the management of this lesion.…”

mentioning

confidence: 99%

“… 1) Many studies reported the outcome of SLAP repair using clinical tests, postoperative satisfaction, functional scores, and return to sports or work. 1 2) Despite advancements in imaging technology and surgical techniques for arthroscopic SLAP repair, nearly one third of patients still remain unsatisfied, and significant controversy exists regarding the management of this lesion. 1) Burkart et al 3) reported that isolated SLAP repair would not bring sufficient restoration of translation.…”

mentioning

confidence: 99%

Is Anatomical Healing Essential for Better Clinical Outcome in Type II SLAP Repair? Clinico-Radiological Outcome after Type II SLAP Repair

et al. 2018

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BackgroundWe hypothesized that anatomical healing in superior labrum anterior to posterior (SLAP) repair is associated with good clinical outcome. The purposes of this study were to assess the failure rate of anatomical healing after arthroscopic repair of SLAP lesions using computed tomography arthrography (CTA), investigate correlation of the rate with clinical outcomes, and identify prognostic factors for anatomical failure following SLAP repair.MethodsWe retrospectively evaluated the outcome of 43 patients at a minimum follow-up of 1 year after arthroscopic surgery for SLAP lesions or SLAP lesions associated with Bankart lesions. Twenty-eight patients underwent isolated SLAP repair and 15 patients underwent Bankart repair with SLAP repair. The anatomical outcome was assessed using CTA at 1 year after surgery. Clinical outcomes including visual analogue scale for pain and satisfaction and Constant score were assessed at the final follow-up. We investigated clinical failure that was defined as stiffness, loss of maximum rotation, deterioration of pain, and/or need for revision of surgery.ResultsAnatomical failure occurred in 32.6% of patients (14/43), whereas 16.3% of patients (7/43) had clinical failure. Clinicoradiological assessment revealed that clinical failure occurred only in 7.1% of patients (1/14) with unhealed SLAP lesions, whereas it occurred in 20.7% of patients (6/29) with healed SLAP lesions. Isolated SLAP repair resulted in a higher risk of anatomical failure (risk ratio, 7.0) than combined SLAP repair (p = 0.015). Nonoverhead activities were associated with higher risk of anatomical failure (risk ratio, 2.9; p = 0.041). Patients above 35 years of age had more risk of anatomical failure (risk ratio, 3.5; p = 0.010). Clinical outcomes significantly improved regardless of anatomical failure (p < 0.001) and were not significantly different between unhealed and healed repairs (all p > 0.05).ConclusionsSince patients with unhealed SLAP lesions had less clinical failure than patients with healed SLAP lesions, anatomical healing does not seem essential for better clinical outcome of SLAP II repair, especially in patients with higher healing failure risk (isolated SLAP repair, nonoverhead activities, and above 35 years of age). Therefore, we believe the indications of SLAP repair should be narrowed to avoid overtreatment.

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“…The SLAP tear was not addressed in the case demonstrated in our video since both age greater than 40 and diabetes are risk factors significantly associated with SLAP tear repair failure. 37 The Hill-Sachs lesion was nonengaging and therefore was also not addressed. In this scenario, the long head of the biceps was managed with a biceps tenodesis, although a tenotomy would also be a reasonable option.…”

Section: Discussionmentioning

confidence: 99%

Lesser Tuberosity Avulsion Fracture Repair Using Knotless Arthroscopic Fixation

Cregar

MacLean

Verma

et al. 2018

Arthroscopy Techniques

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Although some literature may suggest that acute nondisplaced lesser tuberosity fractures should undergo nonoperative management, there is a body of evidence that supports surgical stabilization of these injuries due to concern for fracture displacement, nonunion and malunion, anteromedial impingement, and possible biceps tendon subluxation or dislocation. In this Technical Note, we introduce a novel technique for arthroscopic fixation of lesser tuberosity avulsion fractures using a knotless repair. In the lateral decubitus position using standard arthroscopic portals, with the addition of the biceps accessory portal, 2 ULTRATAPE sutures are fixed to the avulsed fragment in luggage-tag fashion to create a secure, knotless fixation. These are used to mobilize and anatomically approximate the lesser tuberosity to the avulsion bed and are held in place with suture anchors placed immediately adjacent to the fracture bed. This technique provides good anatomic reduction with maximal surface area for bone-to-bone healing.

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Retrospective Analysis of Arthroscopic Superior Labrum Anterior to Posterior Repair: Prognostic Factors Associated with Failure

Cited by 22 publications

References 28 publications

National Athletic Trainers' Association Position Statement: Evaluation, Management, and Outcomes of and Return-to- Play Criteria for Overhead Athletes With Superior Labral Anterior-Posterior Injuries

National Athletic Trainers' Association Position Statement: Evaluation, Management, and Outcomes of and Return-to- Play Criteria for Overhead Athletes With Superior Labral Anterior-Posterior Injuries

Is Anatomical Healing Essential for Better Clinical Outcome in Type II SLAP Repair? Clinico-Radiological Outcome after Type II SLAP Repair

Lesser Tuberosity Avulsion Fracture Repair Using Knotless Arthroscopic Fixation

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