Superior Labrum Anterior And Posterior Repair Research Articles

SLAP Repair Versus Biceps Tenodesis in Patients Younger Than 40 Years: A Cost-Effectiveness Analysis.

The surgical management of type II superior labrum anterior and posterior (SLAP) tears in patients younger than 40 years is controversial, but growing evidence suggests comparable outcomes between primary SLAP repair and primary biceps tenodesis, with lower rates of reoperations after primary biceps tenodesis. Given the relatively similar patient-reported outcomes, cost-effectiveness analyses of direct and indirect costs associated with the two procedures propound a valuable comparative technique. In this value-based comparison of SLAP repair versus biceps tenodesis, we hypothesized that biceps tenodesis would be more cost-effective than SLAP repair in patients younger than 40 years. Economic and decision analysis; Level of evidence, 4. A 1-month Markov cycle was simulated to reflect 10 years of health outcomes. Health states were selected based on outcomes that are especially important in assessing indirect costs for a younger, active patient population: return-to-sport rates, which demonstrate a return to baseline function, and reoperation rates. Transition state probabilities were obtained through an index systematic review and meta-analysis comparing labral repair and biceps tenodesis for the treatment of type II SLAP lesions in patients younger than 40 years. Health state utility and cost values were obtained from accepted values denoted in existing literature. Both primary SLAP repair and primary biceps tenodesis yielded an average expected 8.1 quality-adjusted life years over the 10-year period. The average cost (in 2021 US$) was $16,619 for biceps tenodesis and $19,388 for SLAP repair. In a younger patient population, SLAP repair and biceps tenodesis had comparable quality-adjusted life years and utility in the treatment of type II SLAP tears; however, SLAP repair cost $19,388, while biceps tenodesis cost $16,619, reflecting a 14% cost savings with biceps tenodesis. These findings can be extrapolated to further establish the role for these procedures in treating SLAP tears.

Biceps Tenodesis Demonstrates Lower Reoperation Rates Compared to SLAP Repair for Treatment of SLAP Tears in a Large Cross-Sectional Population

To use a contemporary cross-sectional data set to evaluate trends in surgical treatment for superior labrum anterior and posterior (SLAP) tears and compare surgical outcomes with respect to 2-year revision surgery rates following index SLAP repair versus biceps tenodesis (BT). Patients diagnosed with a SLAP tear between 2010 and 2017 were queried using the Mariner PearlDiver database and stratified by demographic variables and surgical treatment with arthroscopic SLAP repair or arthroscopic/open BT. From 2015 to 2017, Current Procedural Terminology (CPT) and International Classification of Diseases 10th revision (ICD-10) codes were used to track ipsilateral subsequent reoperation within 2-years of index surgery. Between 2010 to 2017, 16.6% of 377,463 patients diagnosed with a SLAP tear underwent surgery (62.3% SLAP repair vs 37.7% BT). 52.4% of BT procedures were arthroscopic (47.6% open). The frequency of SLAP repairs decreased from 74.0% to 46.2% (61%), while the frequency of BTs increased from 26.0% to 53.8% (202%) during the study period. Patients under age 50 were more likely to undergo SLAP repair, and those undergoing BT were more likely to be over 50 with higher CCI and comorbidity risk. 6.3% of 16,186 patients identified with ICD-10 coding required reoperation within 2-years postoperatively. SLAP repair demonstrated a higher revision rate (6.8%; 95% CI, 6.3-7.4%) than BT (5.7%; 95% CI, 5.2-6.2%; P=.0002), (open 5.8% vs arthroscopic BT 5.5%). Arthroscopic debridement, including biceps tenotomy, revision SLAP repair, and revision BT were the most common subsequent procedures. Patients aged 40 to 49 had the highest rate of revision surgery (7.8%). The treatment trend for SLAP tears is changing, with SLAP repair becoming significantly less utilized and BT now becoming the preferred option, especially in patients over 50. Arthroscopic and open BT demonstrated slightly lower risk for reoperation than SLAP repair. IV, cross-sectional study.

Superior Labral Anterior Posterior Repair and Biceps Tenodesis Surgery: Trends of the American Board of Orthopaedic Surgery Database

Objectives:Recent evidence has specified indications for performing Superior Labrum Anterior and Posterior (SLAP) repair and biceps tenodesis (BT) for the treatment of bicipital-labral lesions in the shoulder. Trends in performance of these procedures are expected to reflect the growing body of research regarding this topic. The purpose of this study was to report practice trends for the surgical treatment of SLAP lesions, particularly in older patients, as the management of isolated SLAP lesions remains controversial.Methods:The American Board of Orthopaedic Surgery (ABOS) database was retrospectively queried between 2012-2017 by Current Procedural Terminology for SLAP repair (29807), open BT (23430), and arthroscopic BT (29828). The patient population was excluded if any concomitant open shoulder procedure was performed. Trends over time were evaluated with respect to case volume, patient age, surgeon subspecialty. Separate trends were evaluated with and without concomitant arthroscopic rotator cuff repair (RCR, CPT: 29827).Results:A total of 9,908 cases met inclusion/exclusion criteria: 4,632 performed with RCR and 5,276 performed without. Mean age of patients without RCR was 40.8 +/- 13.8, while those receiving RCR was 55.0 +/- 9.9 years . In patients without RCR, there was a significant decline in rate of SLAP repairs performed over this period (p < 0.001). No significant change was noted in mean age of patients receiving arthroscopic BT, open BT, SLAP repair, and BT + SLAP. A significantly greater proportion of patients receiving open and arthroscopic BT were over 35 years old, compared to those receiving SLAP repair (p < 0.001). Within the RCR cohort, there was also a significant decline in concomitant SLAP repairs performed (p < 0.001) over the study period. With respect to biceps tenodesis, in the RCR cohort, open was performed in 52.2% of cases while arthroscopic was performed in 47.8%, while in the cohort without RCR open was performed in 74.9% and arthroscopic was performed in 25.9%.Conclusion:The ABOS database reveals significantly reduced rates of SLAP repairs being performed. Trends with age remain consistent over time, in that SLAP repairs were predominantly performed in younger patients. Arthroscopic biceps tenodesis was performed much more frequently with RCR than without.

A 15-Minute Incremental Increase in Operative Duration Is Associated With an Additional Risk of Complications Within 30 Days After Arthroscopic Rotator Cuff Repair.

Background:Operative time is a risk factor for short-term complications after orthopaedic procedures; however, it has yet to be investigated as an independent risk factor for postoperative complications after arthroscopic rotator cuff repair.Purpose:To determine whether operative time is an independent risk factor for complications, readmissions, and extended hospital stays within 30 days after arthroscopic rotator cuff repair.Study Design:Descriptive epidemiology study.Methods:The American College of Surgeons National Surgical Quality Improvement Program was queried for all hospital-based inpatient and outpatient arthroscopic rotator cuff repairs (Current Procedural Terminology code 29827) from 2005 to 2016. Concomitant procedures such as subacromial decompression, biceps tenodesis, superior labrum anterior and posterior (SLAP) repair, labral repair, and distal clavicle excision were also included, whereas patients undergoing arthroplasty were excluded from the study. Operative time was correlated with patient demographics, comorbidities, and concomitant procedures. All adverse events were correlated with operative time, while controlling for the above preoperative variables, using multivariate Poisson regression with a robust error variance.Results:A total of 27,524 procedures met inclusion and exclusion criteria. The mean age of patients was 58.4 ± 10.9 years, the mean operative time was 86.9 ± 37.4 minutes, and the mean body mass index was 30.4 ± 7.0 kg/m2. Concomitant biceps tenodesis, glenohumeral debridement, SLAP repair, labral repair, and distal clavicle excision significantly increased operative time (P < .001) but not the risk of adverse events (P > .05). The overall rate of adverse events was 0.88%. After adjusting for demographic and procedural characteristics, a 15-minute increase in operative duration was associated with an increased risk of anemia requiring transfusion (relative risk [RR], 1.27 [95% CI, 1.14-1.42]; P < .001), venous thromboembolism (RR, 1.17 [95% CI, 1.02-1.35]; P = .029), surgical site infection (RR, 1.13 [95% CI, 1.03-1.24]; P = .011), and extended length of hospital stay (RR, 1.07 [95% CI, 1.00-1.14]; P = .036).Conclusion:Although the rate of short-term complications after arthroscopic rotator cuff repair is low, incremental increases in operative time are associated with an increased risk of adverse events such as surgical site infection, pulmonary embolism, transfusion, and extended length of hospital stay. Efforts should be made to maximize surgical efficiency in the operating room through optimal coordination of the staff or increased preoperative planning.

Injuries of the Biceps and Superior Labral Complex in Overhead Athletes.

To summarize the current anatomy, biomechanics, presentation, treatment, and outcomes of injuries to the biceps and superior labral complex in overhead athletes. The biceps and superior labral complex is composed of anatomically distinct zones. The inability to accurately diagnose biceps lesions contributes to continued morbidity especially as arthroscopy and advanced imaging fail to fully evaluate the entire course of the biceps tendon. Superior labrum anterior and posterior (SLAP) repair, long head of biceps tenodesis, and tenotomy are the most common operative techniques for surgical treatment of biceps-labral complex (BLC) pathology. Labral repair in overhead athletes has resulted in mixed outcomes for athletes and is best indicated for patients under age 40years old. Injuries to the BLC are potentially challenging injuries to diagnose and treat, particularly in the overhead athlete. SLAP repair remains the treatment of choice for high-level overhead athletes and patients younger than 40years of age, while biceps tenodesis and tenotomy are preferred for older patients.

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

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.

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

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.

Superior Capsular Release After Failed Combined Superior Labral Repair And Biceps Tenodesis For Slap Tear

Introduction:Optimal treatment of type II superior labrum anterior and posterior (SLAP) tears is controversial. There has been a recent trend towards biceps tenodesis over SLAP repair in older patients. Few surgeons have performed combined biceps tenodesis and SLAP repair with inferior results.Case Report:This case describes a 46-year-old patient who had persistent pain and stiffness after combined biceps tenodesis and SLAP repair for a type II SLAP tear. His pain and motion improved after arthroscopic superior capsular release.Conclusion:Failed SLAP repair is often multifactorial and a thorough workup is needed. Combined biceps tenodesis and SLAP repair can cause pain, stiffness, and dysfunction which can be successfully treated with arthroscopic superior capsular release.

The Effect of Type II Slap Lesions Repair Technique on the Length of Intratendinous Vascular Supply in Long Head of Biceps Tendon: A Cadaveric Injection Study

Reapiring techniques of SLAP lesion effect the vascular supply of long head of biceps tendon. Type II superior labrum anterior and posterior (SLAP) lesions are usually treated with arthroscopic SLAP repair. A vascular supply of proximal long head of biceps tendon (LHBT) passes through soft tissue nearby SLAP repair site. To evaluate intratendinous vascular supply of proximal LHBT resulting from SLAP repair and compare between each SLAP repair techniques. Forty-five fresh cadaveric shoulders were divided into 3 major groups: normal, created SLAP and repaired SLAP group. SLAP lesions were repaired using 3 common techniques: two-anchors with simple sutures, one-anchor with double sutures and one-anchor with horizontal mattress suture. Each group had 9 shoulders. India-ink was injected into acromial branch of thoracoacromial artery. Proximal LHBT was resected for histological cross-sectional study. Intratendinous vascular distance was measured and compared between each groups. The vascular supply of proximal LHBT was seen macroscopically at anterodorsal surface. It derived from soft tissue lying anterior to LHBT origin. In normal shoulder, intratendinous vascular distance was 16.92 ± 1.49 mm (95%CI: 15.78-18.06). There was no significant difference between normal shoulder and created SLAP group (P=0.503). By comparing non-repaired SLAP to each repair technique, the technique using two-anchors with simple sutures showed no significant difference (P=0.716), while the others showed significant difference disruption of blood supply (P=0.0002). There was significant difference between each techniques (P=0.0001). Main vascular supply of proximal LHBT comes from anterior direction. Some techniques of SLAP repair might disrupt the vascularization. The technique using two-anchors with simple sutures, one anchor at 3-mm anterior to anterior boarder and one at posterior boarder of tendon, can preserve vascularization of LHBT.

Tobacco use is associated with increased rates of infection and revision surgery after primary superior labrum anterior and posterior repair

Although the general health consequences of tobacco use have been well defined, the effects of perioperative tobacco use on arthroscopic shoulder procedures remain largely unknown. The purpose of this study is to use a national database to investigate the relationship between tobacco use and rates of superior labrum anterior and posterior (SLAP) repair failure and postoperative infection after primary SLAP repair compared with matched controls. A national private-payer insurance database was queried for patients who underwent arthroscopic primary SLAP from 2005-2012. These patients were divided into tobacco use and non-tobacco use cohorts using International Classification of Diseases, Ninth Revision coding. The non-tobacco use patients were then matched to the patients with coded tobacco use. Both cohorts were assessed for postoperative infection within 90 days and subsequent ipsilateral revision SLAP repair or biceps tenodesis within up to 7 years postoperatively. The incidences of revision SLAP repair or revision to a biceps tenodesis (P = .023) and postoperative infection (P = .034) were significantly higher in patients who used tobacco versus matched controls. SLAP repair in patients who use tobacco is associated with significantly increased rates of postoperative infection and revision SLAP repair or conversion to a biceps tenodesis.

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

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.

A Prospective Analysis of 179 Type 2 Superior Labrum Anterior and Posterior Repairs

Background: There is a paucity of type 2 superior labrum anterior and posterior (SLAP) surgical outcomes with prospective data. Purpose: To prospectively analyze the clinical outcomes of the arthroscopic treatment of type 2 SLAP tears in a young, active patient population, and to determine factors associated with treatment success and failure. Study Design: Case-control study; Level of evidence, 3. Methods: Over a 4-year period, 225 patients with a type 2 SLAP tear were prospectively enrolled. Two sports/shoulder-fellowship-trained orthopaedic surgeons performed repairs with suture anchors and a vertical suture construct. Patients were excluded if they underwent any additional repairs, including rotator cuff repair, labrum repair outside of the SLAP region, biceps tenodesis or tenotomy, or distal clavicle excision. Dependent variables were preoperative and postoperative assessments with the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Western Ontario Shoulder Instability (WOSI) scores and independent physical examinations. A failure analysis was conducted to determine factors associated with failure: age, mechanism of injury, preoperative outcome scores, and smoking. Failure was defined as revision surgery, mean ASES score below 70, or an inability to return to sports and work duties, which was assessed statistically with the Student t test and stepwise logarithmic regression. Results: There were 179 of 225 patients who completed the follow-up for the study (80%) at a mean of 40.4 months (range, 26-62 months). The mean preoperative scores (WOSI, 54%; SANE, 50%; ASES, 65) improved postoperatively (WOSI, 82%; SANE, 85%; ASES, 88) (P < .01). The mean postoperative range of motion was 159° of flexion, 151° of abduction, and 51° of external rotation at the side, which was less than the mean preoperative range of motion (164° of flexion, 166° of abduction, and 56° of external rotation at the side). Of the 179 patients, 66 patients (36.8%) met failure criteria. Fifty patients elected revision surgery. Advanced age within the cohort (>36 years) was the only factor associated with a statistically significant increase in the incidence of failure. Those who were deemed failed had a mean age of 39.2 years (range, 29-45 years) versus those who were deemed healed with a mean age of 29.7 years (range, 18-36 years) (P < .001). The relative risk for failure for patients older than 36 years was 3.45 (95% CI, 2.0-4.9). Conclusion: Arthroscopic SLAP repair provides a clinical and statistically significant improvement in shoulder outcomes. However, a reliable return to the previous activity level is limited; 37% of patients had failure, with a 28% revision rate. Age greater than 36 years was associated with a higher chance of failure. Additional work is necessary to determine the optimal diagnosis, indications, and surgical management for those with SLAP injuries.

Arthroscopic Repair of Concomitant Type II SLAP Lesions in Large to Massive Rotator Cuff Tears

Background: There are no studies examining superior labrum anterior and posterior (SLAP) repair combined with repair of large to massive rotator cuff tears, and it is unclear whether a combined SLAP repair would lead to better outcomes than biceps tenotomy. Hypothesis: Tenotomy and rotator cuff repair would lead to better outcomes compared with those of combined SLAP and rotator cuff repair. Study Design: Cohort study; Level of evidence, 2. Methods: Our study population consisted of 36 patients who had undergone either combined SLAP and rotator cuff repair (when the biceps was too healthy to cut; group R = 16 patients) or tenotomy and rotator cuff repair (when any fraying or partial tear existed in the biceps tendon; group T = 20 patients) for concomitant type II SLAP lesions and large to massive rotator cuff tears. The cuff repair was performed in a single row for both groups. Outcomes were assessed by comparing range of motion as well as Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), and University of California, Los Angeles (UCLA) scores between the 2 groups. Results: At the 2-year follow-up, both groups demonstrated significant improvements in functional shoulder scores and range of motion. However, group T had better SST scores (group T, 9.3 ± 1.6; group R, 7.8 ± 1.9; P = .012), ASES scores (group T, 88.6 ± 8.9; group R, 80.4 ±8.9; P = .009), UCLA scores (group T, 29.6 ± 3.0; group R, 26.0 ± 4.2; P = .007), and forward flexion (group T, 145.9° ± 13.0°; group R, 132.5° ± 15.3°; P = .008). The mean tear size and the degree of preoperative muscle atrophy and fatty infiltration on magnetic resonance imaging were similar between the groups. Conclusion: For patients with concomitant type II SLAP lesions and large to massive rotator cuff tears, the outcomes of simultaneous arthroscopic SLAP and rotator cuff repair were inferior to those of arthroscopic biceps tenotomy and cuff repair in terms of functional shoulder scores and range of motion. Biceps tenotomy and rotator cuff repair may be a more reliable method to address concomitant type II SLAP lesions and large to massive rotator cuff tears in patients, although a randomized controlled trial is needed to confirm the results.

Ganglion cyst of the spinoglenoid notch: comparison between SLAP repair alone and SLAP repair with cyst decompression

Some authors have described the ganglion cyst of the spinoglenoidal notch as related to repetitive overhead activities and labral tear caused by trauma, while others have explained lesions of the capsulolabral complex and ganglion cysts to have separate pathologies. The purpose of this study is to compare clinical and radiological outcomes between 2 groups: 1 with superior labrum anterior and posterior (SLAP) repair only and the other with SLAP repair and cyst decompression prospectively. From August 2000 to March 2007, 28 patients matching the inclusion criteria were selected for the study. They were divided into 2 groups: 1 who received SLAP repair and the other with concomitant SLAP repair and cyst decompression. A visual analogue scale (VAS) and Rowe and Constant scores were used to make evaluation. Preoperative magnetic resonance images (MRIs) of 2 patient groups were compared with 2 follow-up MRIs taken 3 months after the operation and at final follow-up. Mean VAS and Constant and Rowe scores in groups I and II improved significantly from mean preoperative score compared to last follow-up score; however, there was no statistically significant difference between the 2 groups (P > .05). Preoperative MRI and arthroscopy revealed type II SLAP lesions and a type V lesion, respectively, as accompanying lesions in 24 cases. The hypothesis stating 1-way valve mechanism of SLAP lesion as an initial cause of ganglion cysts has been proved indirectly in this study. Furthermore, direct decompression of the cyst does not lead to different results.

Follow-up Result in Repairing a Type II Superior Labrum Anterior and Posterior (SLAP) Lesion when Associated with Shoulder Impingement Syndrome

Purpose: Type II superior labral anterior posterior (SLAP) lesions can occur in the setting of impingement syndrome. The authors compared the clinical results of patients who had undergone either an isolated acromioplasty or a combined type II SLAP repair and acromioplasty. Materials and Methods: Between 2003 and 2008, a total of 75 cases of SLAP II lesions associated with impingement syndrome were recruited. In 39 patients, the type II SLAP lesion was repaired and acromioplasty was performed. In the other 35 patients, acromioplasty was performed alone. All patients were evaluated using the American Shoulder and Elbow Surgeons (ASES) questionnaire and range of motion. Results: At an average of 33 months postoperatively, the ASES scores significantly increased in both groups (p

Risk of Motion Loss With Combined Bankart and SLAP Repairs

We have performed arthroscopic Bankart procedures using absorbable or metallic suture anchors for traumatic anterior shoulder instability for over a decade. This article describes the frequency, pathology, and therapeutic results of patients treated for superior labrum anterior and posterior (SLAP) lesions concomitant with Bankart lesions. Twenty patients (Group A) had a mean age of 33.8 years at the time of surgery. On arthroscopic findings, SLAP lesions were classified type 2 in 15 patients and type 4 in 5, based on Snyder's criteria. In addition, intra-articular free bodies were present in 2 SLAP lesions, and a capsular tear was present in 1. We performed debridement (Group A1) or reattachment (Group A2) to the superior glenoid edge of these lesions, considering whether they communicated to Bankart lesions. The therapeutic results were evaluated according to the Japanese Orthopaedic Association (JOA) score and Japan Shoulder Society (JSS) shoulder instability score. Mean JOA and JSS shoulder instability scores were 95.1 and 90.8 points, respectively. All Group A patients remained pain free, and no instability recurred in any patient. Meanwhile, mean JSS shoulder instability function and range of motion scores were 18.9 and 15.1 points, respectively, in Group A1, and 17.5 and 10.1 points, respectively, in Group A2. A significant correlation in range of motion was observed in Groups A1 and A2 (P=.04). Regarding postoperative limitation in external rotation with the arm at the side, the difference in range from that on the healthy side was 9.8 degrees in Group A (7.0 degrees in Group A1 and 12.6 degrees in Group A2). When SLAP lesions communicated to Bankart lesions, we had satisfactory results without SLAP repair; therefore, unnecessary repairs for the concomitant pathology should be avoided, and different postoperative care should be performed for patients with Bankart repair with reattachment of a SLAP lesion.

No Advantages in Repairing a Type II Superior Labrum Anterior and Posterior (SLAP) Lesion When Associated with Rotator Cuff Repair in Patients over Age 50

Background Arthroscopic management has been recommended for some superior labrum anterior and posterior (SLAP) lesions, but no studies have focused on patients over 50 years of age with rotator cuff tear and a type II SLAP lesion. Hypothesis In patients over 50 years of age with an arthroscopically confirmed lesion of the rotator cuff and a type II SLAP lesion, there is no difference between (1) repair of both lesions and (2) repair of the rotator cuff tear without repair of the SLAP II lesion but with a tenotomy of the long head of the biceps. Study Design Randomized controlled clinical trial; Level of evidence, 1. Methods We recruited 63 patients. In 31 patients, we repaired the rotator cuff and the type II SLAP lesion (group 1). In the other 32 patients, we repaired the rotator cuff and tenotomized the long head of the biceps (group 2). Seven patients (2 in group 1 and 5 in group 2) were lost to final follow-up. Results At a minimum 2.9 years’ follow-up, statistically significant differences were seen with respect to the University of California, Los Angeles (UCLA) score and range of motion values. In group 1 (SLAP repair and rotator cuff repair), the UCLA showed a statistically significant improvement from a preoperative average rating of 10.4 (range, 6–14) to an average of 27.9 (range, 24–35) postoperatively (P < .001). In group 2 (biceps tenotomy and rotator cuff repair), the UCLA showed a statistically significant improvement from a preoperative average rating of 10.1 (range, 5–14) to an average of 32.1 (range, 30–35) postoperatively (P < .001) There was a statistically significant difference in total postoperative UCLA scores and range of motion when comparing the 2 groups postoperatively (P < .05). Conclusions There are no advantages in repairing a type II SLAP lesion when associated with a rotator cuff tear in patients over 50 years of age. The association of rotator cuff repair and biceps tenotomy provides better clinical outcome compared with repair of the type II SLAP lesion and the rotator cuff.