Arthroscopic Repair of Type II SLAP Lesions: Clinical and Magnetic Resonance Imaging Arthrogram Follow-up (SS-12)

Abstract

Outcomes of arthroscopically repaired type II SLAP lesions were examined clinically and using MR-arthrography in this study. Twenty-five patients were reviewed and 20 agreed to have a postoperative MRI arthrogram to assess the integrity of the repair. Clinical outcomes following arthroscopic repair of type II SLAP lesions showed statistically significant improvement in shoulder scores (ASES, SST, patient satisfaction) from pre to post-operative. However, MRI arthrogram results did not necessarily correlate with clinical outcome. Arthroscopic repair of type II SLAP lesions can lead to improved clinical outcomes. However, the structural integrity of arthroscopically repaired type II SLAP lesions is unknown. The purpose of this study was to evaluate the clinical outcome of arthroscopically repaired type II SLAP lesions, and to evaluate the appearance of the repair on MRI arthrogram performed at least 1 year post-operatively. Between March 2003 and June 2006, the senior author performed isolated repairs of 25 type II SLAP lesions in 25 patients (18 male, 7 female) with a mean age of 40 +/- 12 years. The mean duration of symptoms was 32 months. None of the patients had undergone previous surgery on the affected shoulder. All tears were repaired using standard arthroscopic suture anchor repair to bone. All patients were reviewed using a standardized clinical examination by a blinded, independent observer, and using the ASES shoulder index and the Simple Shoulder test (SST). In addition, 20 of the 25 patients were evaluated by MRI arthrography at least 1 year post-operatively which was interpreted by a musculoskeletal trained radiologist who was blinded to the patients' clinical outcome. Paired and unpaired t-tests were used to determine significant differences between pre-operative and post-operative scores and re-torn and intact SLAP repairs, respectively. A p<0.05 was considered statistically significant. Follow-up was an average of 24.9 months. The mean ASES scores improved from 51.7 pre-operatively to 86.3 post-operatively (p<0.0001) and the SST scores from 7.76 to 10.76 (p<0.001). Twenty-two out of the 25 patients stated that they would have surgery again and there was a mean patient satisfaction of 8.7+/- 1.4 out of 10. Of the 20 patients who had post-operative MRI arthrograms, no patient had an obvious recurrent type II SLAP lesion, 8 patients had equivocal MRI arthrograms with a small amount of Gadolium insinuating between labrum and bone, and 12 patient had a completely intact superior labrum. There was no significant difference in ASES, SST and patient satisfaction scores between patients with equivocal or completely intact repairs (ASES= 87.7 versus 85.4; p = 0.71; SST = 10.8 versus 10.8; p = 0.97; Pt satisfaction = 8.2 versus 8.8; p = 0.40). However, of the three patients who were not satisfied with the procedure (i.e. would not have the surgery again) two had postoperative MRI arthrograms and both had equivocal SLAP repairs. Clinical outcomes following arthroscopic repair of type II SLAP lesions showed statistically significant improvement in shoulder scores from pre to post-operative. MRI arthrogram results do not necessarily correlate with clinical outcome. Level of Evidence Level IV case series.