Risk Factors for Revision Surgery After Superior Labral Anterior-Posterior Repair: A National Perspective

Taylor, Samuel A.; Degen, Ryan M.; White, Alexander E.; McCarthy, Moira M.; Gulotta, Lawrence V.; O’Brien, Stephen J.; Werner, Brian C.

doi:10.1177/0363546517691950

Cited by 26 publications

(33 citation statements)

References 30 publications

(32 reference statements)

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“…However, this database has high selection bias because it is constructed from case logs of candidate orthopaedic surgeons sitting for the Part II examination. 30 Using the PearlDiver database, Taylor et al 35 found that age older than 40 years was a risk factor for revision surgery, along with female sex, obesity, smoking, and a concomitant diagnosis of biceps tendinitis at or before the time of surgery.…”

Section: Discussionmentioning

confidence: 99%

Trends in the Management of Isolated SLAP Tears in the United States

Cvetanovich

Gowd

Agarwalla

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background:The management of superior labrum anterior and posterior (SLAP) tears remains controversial, with surgical treatment options including SLAP repair, debridement, and open or arthroscopic biceps tenodesis (BT), based on patient factors and the type of tear.Hypothesis:We hypothesized that SLAP repair has become less frequently performed over time, while BT is more frequently performed, particularly in patients ≥ 40 years.Study Design:Descriptive epidemiology study.Methods:A retrospective query was performed using the Humana insurance database from years 2007 to 2016. For the management of a SLAP tear diagnosis (International Classification of Diseases–Ninth Edition [ICD-9] code: 840.7), independent and exclusive cohorts were formed using Current Procedural Terminology (CPT) codes for debridement (29822, 29823), SLAP repair (29807), open or arthroscopic BT (29828, 23430), and SLAP repair combined with BT (29828 OR 23430 AND 29807).Results:Of 46,650 diagnoses of a SLAP tear, there were 3347 patients who underwent operative management for an isolated SLAP tear from 2007 to 2016. There was a linear increase of SLAP tear diagnoses per year (r 2 = 0.800, P < .001) during this period. Overall, SLAP repair was performed in 1629 patients (48.7%), debridement was performed in 1076 patients (32.1%), BT was performed in 552 patients (16.5%), and combined SLAP repair and BT was performed in 90 patients (2.7%). There was a 69.3% decrease in isolated SLAP repair from 2007 to 2016 (r 2 = 0.882, P < .001). BT for the diagnosis of an isolated SLAP tear increased by 370.0% over the same period (r 2 = 0.800, P < .001). SLAP repair had an equivalent percentage of being performed in patients both older and younger than 40 years (P = .218). There was a 1500.0% increase in BT performed in patients older than 40 years during the study period. There were no statistical differences in the postoperative incidence of stiffness, surgical site infections, and reoperations between all surgical treatment groups (P > .05).Conclusion:An analysis of a large private-payer database revealed that surgical treatment of isolated SLAP tears in the United States has shifted from 2007 to 2016, with an increase in the frequency of BT and a decline in the frequency of SLAP repair, particularly in patients older than 40 years.

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Section: Discussionmentioning

confidence: 99%

Trends in the Management of Isolated SLAP Tears in the United States

Cvetanovich

Gowd

Agarwalla

et al. 2019

Orthopaedic Journal of Sports Medicine

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“…Numerous studies to date have linked the outcomes of SLAP repair versus tenodesis to the patient’s age [ 22 , 23 , 25 - 27 , 35 , 41 , 61 , 69 ]. The cohort studies of Alpert et al [ 22 ] and Schrøder et al [ 35 ] documented in the long-term, patients older and younger than forty years of age perform as well in terms of functional scores and outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…One of the largest cohort studies (179 patients), albeit a military population, found the relative risk for failure to be 3.45 in patients older than 36 years of age [ 34 ]. Taylor et al [ 69 ] performed a database study that demonstrated age greater than 40 (OR 1.5), Female Sex (OR 1.5), obesity (OR 1.8), smoking (OR 2.0) were all significant risk factors for failure following SLAP repair. Frank et al [ 70 ] analysis of a 62 patient cohort found similar risk factors for failure of SLAP repairs including age, smoking, diabetes, high demand labor and concomitant biceps symptoms.…”

Section: Introductionmentioning

confidence: 99%

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An Age and Activity Algorithm for Treatment of Type II SLAP Tears

Charles

Christian

Cole

2018

TOORTHJ

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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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“…Age has been found to be a risk factor for revisions, 40,47 as has concomitant diagnosis of biceps tendinitis or biceps tendon tear. 47 There are many possible underlying reasons for failed SLAP repair and revision surgery, including incorrect diagnosis, altered biomechanics, 13,27 hardware complications or prominent suture knots, 20,35,41,49,52,55 lack of healing, 43,52 and persistent pain, inflammation, and stiffness.…”

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confidence: 99%

Biceps Tenodesis for Superior Labrum Anterior-Posterior Tear in the Overhead Athlete: A Systematic Review

et al. 2020

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Background: Superior labrum anterior-posterior (SLAP) lesion is a common shoulder injury, particularly in overhead athletes. While surgical management has traditionally consisted of SLAP repair, high rates of revision and complications have led to alternative techniques, such as biceps tenodesis (BT). While BT is commonly reserved for older nonoverhead athletes, indications for its use have expanded in recent years. Purpose: To determine functional outcomes and return-to-sport rates among overhead athletes after BT for SLAP tear. Study Design: Systematic review. Methods: A systematic review was performed for any articles published before July 2019. The search phrase “labral tear” was used to capture maximum results, followed by keyword inclusion of “SLAP tear” and “biceps tenodesis.” Inclusion criteria included outcome studies of BT for isolated SLAP tear in athletes participating in any overhead sports, not limited to throwing alone. Abstracts and manuscripts were independently reviewed to determine eligibility. When clearly delineated, outcome variables from multiple studies were combined. Results: After full review, 8 articles met inclusion criteria (99 athletes; mean age, 19.8-47 years), with baseball and softball players the most common among them (n = 62). Type II SLAP tear was the most common diagnosis, and 0% to 44% of athletes had a failed previous SLAP repair before undergoing BT. Only 1 study included patients with concomitant rotator cuff repair. Open subpectoral BT was most commonly used, and complication rates ranged from 0% to 14%, with wound erythema, traumatic biceps tendon rupture, brachial plexus neurapraxia, and adhesive capsulitis being reported. Combined reported postoperative functional scores were as follows: American Shoulder and Elbow Surgeons, 81.7 to 97; 12-Item Short Form Health Survey physical, 50 to 54; visual analog scale for pain, 0.8-1.5; Kerlan Jobe Orthopaedic Clinic, 66 to 79; and satisfaction, 80% to 87%. The overall return-to-sports rate for overhead athletes was 70% (60 of 86). For studies that clearly delineated outcomes based on level of play/athlete, the combined return-to-sports rate was 69% (11 of 16) for recreational overhead athletes, 80% (4 of 5) for competitive/collegiate athletes, and 60% (18 of 30) for professionals. Conclusion: BT in the overhead athlete offers encouraging functional outcomes and return-to-sports rates, particularly in the recreational athlete. It can be successfully performed as an index operation rather than SLAP repair, as well as in a younger patient population. Careful consideration should be given to elite overhead athletes, particularly pitchers, who tend to experience poorer outcomes.

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Risk Factors for Revision Surgery After Superior Labral Anterior-Posterior Repair: A National Perspective

Cited by 26 publications

References 30 publications

Trends in the Management of Isolated SLAP Tears in the United States

Trends in the Management of Isolated SLAP Tears in the United States

An Age and Activity Algorithm for Treatment of Type II SLAP Tears

Biceps Tenodesis for Superior Labrum Anterior-Posterior Tear in the Overhead Athlete: A Systematic Review

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