Surgical Trends in the Treatment of Superior Labrum Anterior and Posterior (SLAP) Lesions of the Shoulder. Analysis of Data from the American Board of Orthopaedic Surgery Certification Examination Database

Abstract

Objectives:After failure of conservative treatment, surgical repair has long been the primary treatment option for unstable superior labrum anterior and posterior (SLAP) lesions of the shoulder. There is growing evidence supporting both biceps tenotomy and tenodesis as effective alternative treatments for SLAP lesions. The surgical trends among recent graduates, however, have not been evaluated. The goal of this study was to determine the rates of SLAP repair, biceps tenodesis, and biceps tenotomy for patients with isolated SLAP tears. As a secondary goal, we aimed to determine the rates of SLAP repair, biceps tenodesis, and biceps tenotomy for patients with SLAP tears undergoing concomitant rotator cuff repair.Methods:A query of the American board of orthopaedic surgery (ABOS) certification examination database was performed from 2002-2011. The database was searched for patients with isolated SLAP lesions undergoing SLAP repair, biceps tenodesis, or biceps tenotomy. The database was then queried a second time for patients with SLAP lesions undergoing concomitant arthroscopic rotator cuff repair, to determine the rates of SLAP repair, biceps tenodesis, or biceps tenotomy.Results:From 2002-2011 there were 8,963 cases reported for treatment of an isolated SLAP lesion, and 1540 cases reported for the treatment of SLAP lesion with concomitant rotator cuff repair. Over the study period, for patients with isolated SLAP lesions the proportion of SLAP repairs decreased from 69.3% to 44.8% (p<0.0001), while the proportion of biceps tenodesis increased from 0.2% to 9.3% (p<0.0001) and the proportion of biceps tenotomy increased from 0.4% to 1.7% (p=0.018). For patients undergoing concomitant rotator cuff repair, similar trends were observed as the proportion of SLAP repairs decreased from 60.2% to 15.3% (p<0.0001), while the proportion of those undergoing biceps tenodesis or tenotomy increased from 1.2% to 20.3% (p<0.0001). There was also a significant difference in the mean age of patients undergoing SLAP repair (37.1 years of age) vs biceps tenodesis (48.7 years of age) vs biceps tenotomy (55.7 years of age) (p <0.0001). Surgeons with a declared subspecialty in Shoulder and Elbow surgery performed biceps tenodesis for 17% of isolated SLAP tears, whereas candidates with a declared subspecialty in Hand and Upper Extremity, Sports Medicine, and General Orthopaedics utilized biceps tenodesis in 2-3% of cases involving isolated SLAP tears (p<0.05).Conclusion:Practice trends for orthopaedic board candidates indicate the proportion of SLAP repairs has decreased over time with an expected increase in biceps tenodesis and tenotomy. Increased patient age correlates with likelihood of treatment with biceps tenodesis or tenotomy versus SLAP repair. Candidate surgeons with subspecialty training in Shoulder and Elbow surgery perform more biceps tenodesis for isolated SLAP tears as compared to other subspecialty trained surgeons.