SLAP Repairs With Combined Procedures Have Lower Failure Rate Than Isolated Repairs in a Military Population

Waterman, Brian R.; Arroyo, William; Heida, Kenneth A.; Burks, Robert T.; Pallis, Mark

doi:10.1177/2325967115599154

Cited by 30 publications

(34 citation statements)

References 35 publications

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“…It is widely accepted that combined repair of a SLAP lesion and a Bankart lesion produce better clinical outcome than isolated repairs. 2 15 16) Furthermore, in a study by Waterman et al, 17) SLAP repair combined with Bankart repair showed a higher rate of functional return than isolated SLAP repair. Burkart et al 3) reported in their biomechanical study that the repair of type II SLAP lesions only partially restored translations to the same degree of an intact shoulder joint.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Waterman et al reported a failure in 13% (n = 31) of patients with SLAP repair, of whom six patients required revision SLAP repair and 25 patients underwent subpectoral biceps tenodesis. They demonstrated that majority of patients who underwent biceps tenodesis (76%) returned to active duty as compared with those who underwent revision SLAP repair (17%) [8].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of biceps tenodesis versus SLAP repair for surgical treatment of isolated SLAP lesions: A systemic review and meta-analysis

Shaikh

Sun

et al. 2019

Journal of Orthopaedic Translation

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BackgroundType II superior labrum anterior and posterior (SLAP) lesions could induce chronic shoulder pain and impaired movement. Current management of Type II SLAP lesions consists of two well-established surgical procedures: arthroscopic biceps tenodesis and SLAP repair. However, which technique is preferred over the other is still a controversy.MethodsWe performed a systematic electronic database search on Cochrane Central Register of Controlled Trials, MEDLINE and Embase to identify articles equating superior labral repair with biceps tenodesis, which were reported before August 2017 which included the phrase “superior labral anterior posterior” or “SLAP.” The randomised controlled clinical trials that met our criteria were evaluated for quality of methodology. The results obtained were further analysed and correlated to present the benefits and drawbacks comparing the two SLAP repair surgical procedures.ResultBased on our inclusion and exclusion criteria, we identified five articles (204 patients) that were included in this meta-analysis. The results indicate that prevalence of patients return to preinjury sports level and the patients satisfaction were found to be significantly better in tenodesis group than in the SLAP repair group (p < 0.05). As for the patient age, VAS score, American Shoulder and Elbow Surgeons score, University of California at Los Angeles score, postoperative stiffness and reoperation rates, no significant differences were evident among the two groups, thus supporting the results reported in the current literatures (p > 0.05).ConclusionsBoth the surgical treatments, SLAP repair and the biceps tenodesis, are efficacious in pain alleviation and recovery of shoulder function. But, compared with SLAP repair, biceps tenodesis showed higher rate of patient satisfaction and return to preinjury sports participation.The translational potential of this articleImpart better understanding regarding discrepancies in the outcomes between biceps tenodesis and SLAP repair in treating patients with isolated Type II SLAP lesions.

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“…Some authors have demonstrated better results with LHB tenodesis compared with superior labrum repair, 4 , 9 , 14 , 54 , 56 with even worse results for repair in older patients. 54 In spite of this, there is no consensus about a minimum age to decide between labrum repair and LHB tenodesis. In our series, the youngest patient was a 27-year-old male bodybuilder who presented with a superior and anterior labrum lesion.…”

Section: Discussionmentioning

confidence: 99%

Intra-articular arthroscopic biceps tenodesis with interference screw: clinical and isokinetic evaluation

et al. 2020

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Background Although biceps tenodesis has been widely used to treat its pathologies, few studies looked at the objective evaluation of elbow strength after this procedure. The purpose of this study is to clinically evaluate patients submitted to long head of the biceps (LHB) tenodesis with interference screws through an intra-articular approach and analyze the results of an isokinetic test to measure elbow flexion and forearm supination strengths. Methods Patients who had biceps tenodesis were included in the study if they had a minimum follow-up of 24 months. Patients were excluded if they had concomitant irreparable cuff tears or previous or current contralateral shoulder pain or weakness. Postoperative evaluation was based on University of California–Los Angeles (UCLA) shoulder score and on measurements of elbow flexion and supination strength, using an isokinetic dynamometer. Tests were conducted in both arms, with velocity set at 60º/s with 5 concentric-concentric repetitions. Results Thirty-three patients were included and the most common concomitant diagnosis were rotator cuff tear (69%) and superior labrum anterior to posterior (SLAP) lesions (28%). The average UCLA score improved from 15.1 preoperatively to 31.9 in the final follow-up ( P < .001). Isokinetic tests showed no difference in peak torque between the upper limbs. One patient had residual pain in the biceps groove. None of the patients had Popeye deformity. UCLA score and follow-up length did not demonstrate correlation with peak torque. Conclusion Arthroscopic proximal biceps tenodesis with interference screw, close to the articular margin, yielded good clinical results. Isokinetic tests revealed no difference to the contralateral side in peak torque for both supination and elbow flexion.

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SLAP Repairs With Combined Procedures Have Lower Failure Rate Than Isolated Repairs in a Military Population

Cited by 30 publications

References 35 publications

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

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

Effectiveness of biceps tenodesis versus SLAP repair for surgical treatment of isolated SLAP lesions: A systemic review and meta-analysis

Intra-articular arthroscopic biceps tenodesis with interference screw: clinical and isokinetic evaluation

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