Superior Labrum Research Articles

Concomitant Arthroscopic Superior Labral and Rotator Cuff Repair: A Systematic Review.

The aim of this study was to systematically review the literature on concomitant repair of superior labral and rotator cuff tears, in light of the paucity of published clinical evidence. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses compliant search of PubMed, Embase, and Cochrane Library databases was performed for clinical studies of patients undergoing combined repairs of the rotator cuff and superior labrum. Ten studies comprising 241 shoulders were included, with a mean age of 52.6 years and mean follow-up of 29.0 months; 67.9% were male patients. Functional outcomes included the mean postoperative American Shoulder and Elbow Surgeons Standardized Shoulder Score of 88.6, University of California at Los Angeles Shoulder Score of 30.6, constant score of 90.4, Simple Shoulder Test score of 8.6, and visual analog scale score of 1.1. Range of motion outcomes demonstrated mean postoperative forward flexion of 159°, external rotation of 68°, and internal rotation of 17°. The overall return-to-play rate was 76.8%, with 67.9% returning to preinjury level. The overall complication rate was 4.1% with an 18.9% rate of rotator cuff retear and 2.4% reoperation rate. Arthroscopic concomitant repair of superior labral and rotator cuff tears results in good functional outcomes and range of motion, along with a low reoperation rate. Among athletes, there are moderate rates of return but lower rates of return to the same level of play. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Establishing Clinical Significance for Patients Undergoing Arthroscopic Repair of Type II SLAP Lesions.

Type II superior labrum anterior to posterior (SLAP) lesions may be treated with either arthroscopic repair or biceps tenodesis. There are no previous reports of measures of clinically significant improvement after arthroscopic repair of SLAP lesions. To establish the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) for patients undergoing arthroscopic repair for type II SLAP lesions. Case series; Level of evidence, 4. A total of 69 arthroscopic repair procedures for isolated type II SLAP lesions were performed in a military population. The mean age was 28.1 ± 4.7 years, 97.1% were male, and the mean follow-up was 99.5 ± 19.7 months. The MCID, PASS, and SCB were calculated for each patient-reported outcome measure, consisting of the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) for pain, using anchor- and distribution-based models. Factors associated with achieving a clinically relevant improvement were also determined. The MCID, PASS, and SCB for each measure were as follows: 7.7, 70, and 34 for the ASES score, respectively; 10.4, 80, and 45 for the SANE, respectively; and 1.0, 4, and 6 for the VAS pain, respectively. At least 85% of patients achieved the MCID for each measure; however, PASS rates were lower, with 50.7% for the SANE and 69.6% for both the ASES score and VAS pain. The ASES score had the highest percentage of patients achieving the SCB at 44.9%, followed by the SANE (26.1%) and VAS pain (10.1%). Greater forward flexion at final follow-up was associated with achieving the MCID and PASS for both the ASES score and SANE. Internal rotation stiffness at final follow-up was negatively associated with achieving the PASS for the VAS pain. Combat arms military occupational specialty was associated with a lesser likelihood of achieving the SCB for the ASES score. Clinical metrics of improvement were defined for the ASES score, SANE, and VAS pain using the MCID, PASS, and SCB for patients undergoing arthroscopic repair of type II SLAP lesions. Better final range of motion was positively associated with achieving improvement, while high-intensity military duty was negatively associated.

Correlation between magnetic resonance imaging and arthroscopic findings in superior labral from anterior to posterior injuries of shoulder joint

Background: The aim of our study was to identify the accuracy of the magnetic resonance imaging (MRI) in detecting superior labral from anterior to posterior (SLAP) lesions when compared to arthroscopic findings, considering arthroscopy as the gold standard. Methods: This is a retrospective study conducted between January 2015 to July 2021 that focuses on SLAP lesions to evaluate the accuracy of its magnetic resonance imaging (MRI) reporting. All patients who had shoulder arthroscopy were included, and their intra-operative pathology was recorded and compared to their pre-operative MRI reports. Accuracy was assessed by calculating the sensitivity and specificity of MRI in comparison to the standard shoulder arthroscopy. Results: 60 patients were included in the study. In diagnosing SLAP lesions this study showed that MRI was 54% sensitivity, 67% specificity with 79% positive predictive value and 39% negative predictive value. Accuracy was found to be 55%. Conclusions: In this study, the MRI did not detect SLAP lesions at a rate as high as arthroscopy, which is considered the gold standard. When performing arthroscopy, it is important to be diligent in detecting actual SLAP lesions that may not have been identified by traditional MRI scans.

Arthroscopic shoulder surgery for gouty long head of biceps tendinitis: a case report

ObjectiveThe objective of the case report is to analyze the clinical manifestations and imaging features of gouty long head of biceps tendinitis, and to summarize the methods and effects of shoulder arthroscopic surgery.Clinical presentation and interventionThe clinical data of a 39-year-old Han Chinese female with gouty long head of the biceps tendinitis was retrospectively analyzed, and the clinical manifestations, imaging features, and diagnosis and treatment were analyzed. The patient presented with pain and limited movement of right shoulder joint. Computed tomography showed irregular high-density shadows above the glenoid and adjacent to the coracoid process of the right shoulder. Magnetic resonance imaging revealed superior labrum anterior and posterior injury with edema in the upper recess and axillary sac. After arthroscopic surgery, the “tofu residue” tissue of the long head of the biceps was removed, and the postoperative pathological examination proved that it was gout stone.ConclusionGouty long head of the biceps tendinitis is a rare disease. Arthroscopic surgery can probe the structural lesions of shoulder cavity in all aspects, improve the surgical accuracy, and reduce the trauma.

Magnetic resonance imaging of the shoulder in symptomatic professional rugby players: a retrospective analysis.

Shoulder injuries in rugby players are common due to frequent high-impact collisions and tackles. This study aimed to describe the spectrum and pattern of shoulder MRI findings in professional rugby players. Single-center retrospective study of shoulder MRI was carried out between 2012 and 2016 in symptomatic professional male rugby league and rugby union players. One hundred ten shoulder MRIs were scored for rotator cuff and long head of biceps tendons, labral, bursal, joint, and osseous abnormalities. MRI features were compared using the chi-square or Fisher's exact tests for categorical variables. There were a total of one hundred ten professional male rugby players (80 rugby league and 30 rugby union), with a mean age of 24.6 (range 17-38) and 23.7 (range 17-33) years old, respectively. Rotator cuff or long head biceps abnormality was found in 36 (33%) players, of which 22 (20%) were either partial or full-thickness tears. Glenoid labral tears were present in 63 (57%) players. There was no significant difference (p > 0.05) in the frequency of tears of the superior (24%), anterior inferior (25%), posterior superior (25%), and posterior inferior (32%) labrum. Forty-seven percent of players presented with two or more abnormalities of the rotator cuff tendons and glenoid labrum. There were significantly more osseous abnormalities in backs compared to forwards (48% vs. 21%; p = 0.01). There is a wide spectrum of shoulder abnormalities on MRI in professional rugby players, and many have two or more abnormalities. In common with other contact sports, posterior labral injury was a common finding and may relate to sub-clinical trauma, without an association with instability.

Anterior cable reconstruction using subpectoral biceps tenodesis with biceps transfer in rotator cuff tears: a surgical technique

Massive rotator cuff tears (MRCTs) constitute approximately 20% of all rotator cuff tears. Poor tissue quality or significant retraction can lead to failure of the repair. The anterior rotator cuff cable is essential in transmitting force to the proximal humerus and serves as the main load-bearing structure within the supraspinatus. Utilizing the long head of the biceps tendon (LHBT) for anterior cable reconstruction in the setting of rotator cuff tears, known as biceps augmentation, has the potential for improved biomechanical and healing properties. Importantly, the proximal LHBT remains attached to the superior glenoid labrum, serving as a viable collagen scaffold, a structural scaffold for the cable, and potentially as a conduit for living tenocytes to migrate into the hypovascular region of the rotator cuff, promoting repair healing. Similar methods utilize the transfer of the intact LHBT into the rotator cuff without a biceps tenodesis. While this accomplishes the aforementioned goals, it may create a source of biceps pain in these patients, and it changes the length-tension relationship of the LHBT distal to the transfer site. In this technical note, we detail an anterior cable reconstruction employing an autologous LHBT to reinforce a repaired MRCT with concurrent subpectoral tenodesis of the LHBT to achieve goals of 1) rotator cuff augmentation and grafting and, importantly, 2) securing the LHBT in a subpectoral position to mitigate pain and maintain supination strength while maintaining the anatomic length-tension relationship of the biceps. We feel this approach is superior in ensuring sufficient tendon is retained for an effective transfer and allows for a subpectoral tenodesis to prevent biceps symptoms.

Repair of Isolated Subscapularis Tears With Concurrent Biceps Tenodesis Using a Single Anchor Results in Satisfactory Clinical Outcomes: Minimum 2-Year Follow-Up

PurposeThe aim of the present study was to investigate the clinical outcomes of patients treated with isolated subscapularis tear repair and biceps tenodesis using a single anchor. MethodsPatients diagnosed with subscapularis tear and underwent arthroscopic surgery by a single surgeon between February 2017 and January 2022 were retrospectively evaluated. Inclusion criteria were patients who underwent repair of isolated subscapularis tear along with tenodesis for LHBT pathologies such as superior labrum anterior posterior (SLAP) lesion, instability, partial tear or tenosynovitis, with a minimum follow-up of 24 months. Assessment included active and passive range of motion (ROM), single-assessment numeric evaluation (SANE), visual analog scale (VAS),Constant-Murley score (CMS), and specific subscapularis and biceps tests. Improvements were analyzed using Minimum Clinically Important Difference (MCID) values. ResultsA total of 20 patients were included. The mean age was 48.5±7 years, and the follow-up period was 43.1±12.7 months. Significant improvements were observed at the final follow-up in active forward flexion, active abduction, active internal rotation, as well as VAS, SANE, and CMS (p< 0.001). The MCID analysis showed that 100% of patients met the MCID for CMS, 90% for SANE, and 100% for VAS. ConclusionIn the presence of an isolated subscapularis tear associated with LHBT pathologies, favorableclinical outcomes could be achieved by performing both tear repair and biceps tenodesis with a double-loaded single anchor. A majority of patients (>90%) achieved the MCID for the CMS, SANE and VAS, indicating significant clinical improvement and satisfactory patient outcomes. Level of EvidenceLevel IV, Case series

Inter-rater and intrarater reliability of superior labrum anterior to posterior lesion classification using magnetic resonance arthrography

BackgroundThe glenoid labrum is a fibrocartilaginous ring that affixes the joint capsule and ligaments of the glenohumeral joint2. Superior labrum anterior to posterior (SLAP) lesions are a subset of injuries that affect the superior glenoid labrum, most common in laborers and overhead-throwing athletes11. In 1990, Snyder et al classified SLAP lesions into one of four types10. Later, Maffet et al expanded this scale to include three additional subclassifications8. At present, arthroscopy is considered the gold standard for SLAP tear diagnosis5. Classification under arthroscopy has demonstrated low to moderate inter-rater reliability3. MRa is an alternate, less invasive test for diagnosing SLAP lesions. The reliability of MRa for diagnosing slap tears is uncertain. MethodsMR arthrograms were identified using the Picture Archiving and Communication System (PACS). In total, 273 shoulder arthrograms were reviewed, and 20 were selected with the desired pathology. Three orthopedic surgeons and three musculoskeletal radiologists were asked to classify the SLAP lesions into one of seven categories (Snyder & Maffet classification systems). Data was collected on two separate occasions at an interval of at least two months. Inter- and intra-rater reliability were calculated using Fleiss Kappa and Cohen's Kappa, respectively. ResultsBetween all raters, there was poor inter-rater reliability for each round of data collection (κ = .177, κ = .124 for rounds 1 and 2, respectively). Between orthopedic surgeons, there were poor levels of agreement (κ = -.056, κ = .114), whereas, between radiologists, there was fair to moderate agreement (κ = 0.479, κ = 0.340). Within orthopedic raters, κ values ranged from -0.059 to 0.125, indicating, at best, poor intra-rater reliability. Within radiologists, κ values ranged from 0.545 to 0.553, indicating moderate agreement within raters. The analysis determined that none of the orthopedic values for inter or intra-rater reliability could be deemed statistically different from zero. ConclusionOverall, classification using MRa resulted in significant disagreement between and within raters. Trained radiologists demonstrated higher overall levels of agreement than orthopedic surgeons. In summary, when using MRa to assess SLAP lesions, Snyder and Maffet classification demonstrates poor reliability by orthopedic surgeons and moderate reliability when used by musculoskeletal radiologists.

Does the Extent of Tear Influence Pseudoparesis in Patients With Isolated Subscapularis Tears?

Surgeons tend to associate pseudoparesis with massive rotator cuff tears. However, little is known about the degree to which isolated subscapularis tears might be associated with pseudoparesis of the shoulder. Is the extent of subscapularis tears associated with pseudoparesis? A retrospective analysis identified all patients with subscapularis tears from 2010 to 2021 in the longitudinally maintained shoulder arthroscopy archive of one university hospital's shoulder section of the orthopaedic department. After exclusion, 106 of 152 patients with isolated subscapularis tears who underwent arthroscopic surgery were included in the study. Sixty percent of the patients were women, and the mean ± SD age was 52 ± 11 years. Patients who were scheduled for arthroscopic surgery were divided into two groups according to the presence or absence of pseudoparesis preoperatively. Pseudoparesis was considered to be active forward elevation > 45º but < 90º, which is a simple and reproducible measurement that can be taken using a goniometer, and demonstrated complete passive forward elevation. Pseudoparesis was present in 41% (43 of 106) of patients with an isolated subscapularis tear. Data on tear severity (according to Lafosse type, noted during arthroscopy), integrity of the subscapularis tendon (noted during arthroscopy), fatty degeneration (using the Goutallier grading system on MRI), arthroscopic findings of biceps disorder, superior labrum anterior to posterior (SLAP) lesions, and pain severity (measured by VAS score) were recorded. We used logistic regression analysis to examine the relationship between pseudoparesis and disruption of the tendinous part of the subscapularis. After accounting for potentially confounding factors such as biceps disorders and muscle atrophy, we found that pseudoparesis was associated with decreased tear severity according to the Lafosse classification (adjusted OR 0.2 [95% CI 0.1 to 0.7]; p = 0.01) and with disruption of the tendinous portion of the subscapularis (adjusted OR 21 [4 to 128]; p = 0.001). Patients with less severe tears (Lafosse type I) have lower odds of experiencing pseudoparesis compared with those with more severe tears (Lafosse types II, III, and IV), and patients with disruption of the tendinous portion of the subscapularis have substantially higher odds of pseudoparesis compared with those with an intact tendinous portion. No association was found between pseudoparesis and subscapularis fatty degeneration, biceps disorder, or SLAP lesions. This study provides initial evidence suggesting that isolated subscapularis tears are associated with pseudoparesis. The main finding of this study is that isolated subscapularis tears that involve the tendon extending to the inferior part of the subscapularis have higher odds of being found with pseudoparesis. These findings highlight the importance of maintaining the integrity of the superior tendinous part of the subscapularis for active forward elevation > 90°. Level III, therapeutic study.

Location of Shoulder Glenoid Labral Tears: A Study of 1763 Consecutive Patients

Background: Anterior shoulder labral tearing has historically been considered the most common location of shoulder labral pathology. Recently, smaller studies have reported that posterior labral involvement may be more common than previously recognized. Purpose: To examine the location of surgically repaired labral tears by a single surgeon over a consecutive 23-year period. Study Design: Case series; Level of evidence, 4. Methods: A total of 1763 consecutive patients who underwent arthroscopic or open shoulder labral repair by a single seniorsports medicine fellowship–trained orthopaedic surgeon between April 2000 and April 2023 were retrospectively reviewed. Current Procedural Terminology codes were used to identify patients, which included 29806, 29807, 29822, and 29823. Exclusion criteria included isolated shoulder manipulation or glenohumeral joint or labral debridement that did not include repair. Intraoperative glenoid labral tears observed were categorized into 7 broad categories: (1) anterior labral tears, (2) posterior labral tears, (3) superior labral anterior posterior (SLAP) type II tears (A, B, or C), (4) SLAP type V tears, (5) SLAP type VIII tears, or (6) circumferential labral tears (combined SLAP, anterior, and posterior labral tear). Shoulders diagnosed with multiple tear patterns (ie, anterior and posterior) were also noted. Results: During the 23-year period, 1763 patients underwent arthroscopic or open labral repair; they included 1295 male and 468 female patients, ranging in age from 12 to 70 years, with a mean age of 23.2 years and median age of 19 years. Overall, 28.4% of tears involved the anterior labrum, 64.9% involved the posterior labrum, and 59.6% involved the superior labrum. Regarding isolated tears, 9.3% were isolated anterior labral tears, 19.7% were isolated posterior labral tears, 11.5% involved the anterior and posterior labrum, 22.2% were isolated superior (SLAP type II-IV) tears, 3.63% were isolated SLAP type V tears, 29.8% were isolated SLAP type VIII tears, and 4.1% were circumferential tears. Conclusion: Posterior shoulder labral tearing was more common than anterior tearing in a large consecutive series of 1763 patients who underwent surgical repair. This highlights the importance of posterior labral pathology, which sometimes may be overlooked because of more vague complaints, with pain and loss of function being the most common.

Calcific tendinitis of the superior glenoid labrum of the shoulder joint.

Calcific tendinitis of the superior glenoid labrum of the shoulder joint.

Arthroscopic Biceps Tenodesis With Interference Screw Fixation: A Technique Video

Background: Management of long head of the biceps tendon (LHBT) pathology is accomplished through a biceps tenotomy or tenodesis. While both modalities provide beneficial outcomes, a biceps tenodesis may confer improved cosmesis, functional outcomes, and decreased muscle cramping postoperatively. Many procedural considerations are undertaken prior to a tenodesis, such as the surgical approach and fixation device. While similar clinical outcomes are achieved between an open subpectoral and arthroscopic suprapectoral biceps tenodesis (ASPBT) with interference screw (IS) fixation, the latter technique offers a minimally invasive modality. Indications: The primary indications for an ASPBT include superior labrum anterior posterior (SLAP) tears, LHBT tears, biceps instability, bicipital tunnel disease, biceps pulley lesions, and biceps tenosynovitis. Contraindications to the arthroscopic approach include a distal lesion of the biceps tendon below the pectoralis major tendon (PMT). The IS may be used to create a biomechanically stiffer construct. Technique Description: With the arthroscope in the lateral portal, the distal aspect of the bicipital groove proximal to the superior border of the PMT is identified and opened. The LHBT is subsequently mobilized and released. An anterosuperolateral portal is localized with a spinal needle positioned perpendicular to the bicipital tunnel, 1.5 cm proximal to the superior border of the PMT. The biceps is then removed ex vivo and whip-stitches are sewn beginning 1 cm proximal to the myotendinous junction of the LHBT. After firmly associating the LHBT with the tip of the IS, a guidewire is placed 1.5 cm superior to the superior border of the PMT, perpendicular to the humerus, and a reamer is used to prepare a 6-, 7-, or 8-mm diameter socket. The tendon is inserted through the accessory portal into the tunnel, followed by screw fixation. Suture tails are tied with 5 alternating half hitches, each secured via an arthroscopic knot pusher. Results: ASPBT with IS fixation provides significant pain relief, improves range of motion (ROM), and enhances quality of life. Discussion: ASPBT with IS fixation provides significant improvements in patient-reported and functional outcomes and thus can be an acceptable treatment for LHBT pathology. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Current Evidence Based Recommendations on Rehabilitation following Arthroscopic Shoulder Surgery: Rotator Cuff, Instability, Superior Labral Pathology, and Adhesive Capsulitis.

Arthroscopy has become increasingly popular for a addressing a wide variety of shoulder pathology. However, despite increasing interest, there is still much uncertainty and variability amongst providers regarding optimal post-operative rehabilitation. This review provides an overview of the evidence underlying common rehab protocols used following arthroscopic interventions for rotator cuff disease, shoulder instability, superior labral anterior to posterior (SLAP) tears and adhesive capsulitis. For small and medium sized rotator cuff tears, early motion protocols do not seem to affect healing or retear rates, however there is no difference with regards to long term functional outcomes when compared to standard motion protocols. For larger tears (> 3cm), early active motion may be associated with impaired tendon integrity. Early range of motion following arthroscopic Bankart repair has not been shown to increase rate of recurrence, however the data on return to sport requires more granularity to effectively guide care. Further research needs to be done to compare rehab protocols following SLAP repair and arthroscopic capsular release. Rehabilitation protocols following rotator cuff surgery and anterior shoulder stabilization have garnered the most research interest. However, there is still a need for larger higher-level studies examining the long-term effects of different rehab protocols. Regarding the arthroscopic management of other types of shoulder instability, SLAP tears and adhesive capsulitis, there is paucity of high-quality evidence. This knowledge gap likely underpins the variability in different rehab protocols seen in clinical practice, highlighting the need for more research.

Superior labrum anterior to posterior (SLAP) repair is associated with increased rate of subsequent rotator cuff diagnoses and revision surgery: a propensity-matched comparison

Surgical management of superior labral anterior to posterior (SLAP) tears remains controversial. Current management utilizes 2 well-established procedures: biceps tenodesis and SLAP repair. This study evaluates the complications associated with arthroscopic SLAP repair vs. an open or arthroscopic biceps tenodesis to further elucidate optimal surgical management. In this retrospective cohort study, the TriNetX database was utilized to evaluate patients who underwent repair of SLAP lesions (International Classification of Diseases, Tenth Revision code: S43.43) from May 15, 2003, to May 15, 2023. Three patient cohorts were evaluated: those who underwent arthroscopic SLAP repair (Current Procedural Terminology [CPT] code: 29807), those who underwent arthroscopic biceps tenodesis (CPT code: 29828), and those who underwent open tenodesis of the biceps (CPT code: 23430). Cohorts were propensity matched for type 2 diabetes, nicotine dependence, alcohol-related disorders, body mass index, and demographic factors such as age at event, ethnicity, race, and sex. The outcomes evaluated were disruption of surgical wound, deep vein thrombosis, mononeuropathy of upper limb, shoulder contusion, humeral fracture, sepsis, deceased, acute postoperative pain, revision, shoulder stiffness, and rotator cuff strain. All outcomes were evaluated within 1 year postprocedure. A total of 11,081 arthroscopic SLAP repairs, 9960 arthroscopic biceps tenodesis, and 9420 open biceps tenodesis were matched. Compared with patients who underwent arthroscopic biceps tenodesis, those who underwent arthroscopic SLAP repair were 1.8 times more likely to undergo revision (2.9% vs. 1.6%, P<.0001). Compared with those who underwent open biceps tenodesis, patients who had SLAP repair performed were 1.4 times more likely to undergo revision (3.1% vs. 2.3%, P=.013) and 1.6 times more likely to have a subsequent rotator cuff strain diagnosis (5.1% vs. 3.2%, P=.0002). Compared with patients who underwent SLAP repair, those who underwent arthroscopic biceps tenodesis exhibited 1.3 times more instances of acute postoperative pain (5.2% vs. 4.0%, P=.011). Similarly, open biceps tenodesis exhibited 1.8 times more instances of acute postoperative pain (6.9% vs. 3.8%, P<.0001) and 1.3 times more shoulder stiffness (11.8% vs. 9.0%, P<.0001). In the last 20 years, patients who underwent SLAP repair were associated with higher risk of revision surgery and subsequent rotator cuff strain diagnosis. Conversely, patients who underwent biceps tenodesis were associated with higher rates of acute postoperative pain and shoulder stiffness.

Biceps Rerouting Regardless of a Biceps-Labral Lesion During Rotator Cuff Repair Results in Lower Retear Rates and Comparable Clinical Outcomes to Subpectoral Biceps Tenodesis

PurposeTo evaluate the radiographic and clinical outcomes when rerouting a pathologic biceps during arthroscopic rotator cuff repair, by comparing it with concomitant subpectoral biceps tenodesis. MethodsThis retrospective, historical cohort study was conducted with patients who underwent an arthroscopic repair of a full-thickness rotator cuff tear, with intraoperative confirmation of biceps pathology including partial tears, subluxation, pulley lesions, or type II superior labrum anterior to posterior (SLAP) lesions. Until May 2018, such patients were treated with concomitant subpectoral tenodesis (group SPBT). Afterward, biceps rerouting was done regardless of biceps pathology (group BR) without biceps or SLAP repair. Radiographic parameters, including fatty degeneration, acromiohumeral distance, Sugaya classification, and retears, were evaluated using preoperative and one-year postoperative MRI. Clinical evaluation with a minimum two-year follow-up included pain visual analogue scale, American Shoulder and Elbow Surgeons, Simple Shoulder Test, and Constant-Murley scores. Whether individual patients exceeded these scores' minimal clinically important difference was also determined. ResultsA total of 64 patients (group SPBT, 32; group BR, 32) were included in the final analysis. The duration of clinical follow-up was 36.2 ± 9.3 months in group SPBT and 29.4 ± 6.9 months in the BR group (P=0.002). Compared to group SPBT, group BR demonstrated a significantly lower retear rate (SPBT vs. BR: 34.4% vs. 12.5%, P=0.039). In the BR group, 8/32 (25%) patients demonstrated a postoperative LHBT tear. The four cuff retears in group BR only took place within these patients. Other postoperative radiographic and clinical outcomes were comparable between the groups. Within each group, significant postoperative improvements were demonstrated (P<0.05 for all clinical scores). ConclusionEven in the presence of a pathologic LHBT and/or a type II SLAP lesion, augmenting the rotator cuff repair with BR significantly reduced retear rates while achieving clinical scores comparable to SPBT in a minimum two-year follow-up.

The Association between SLAP Lesions and Critical Shoulder Angle and Glenoid Depth.

The critical shoulder angle (CSA) is formed by the combination of glenoid inclination and acromial index and has been shown related to rotator cuff tears and glenohumeral osteoarthritis. SLAP lesions today have an important place among bicipitolabral pathologies that cause intensive shoulder pain. We aimed to investigate the relationship between CSA and glenoid depth and SLAP lesions. Between March 2017 and January 2022, 279 consecutive shoulder arthroscopy patients' MRI images were retrospectively examined. After the exclusion criteria, 191 patients were eligible. Patients with SLAP lesions (n=37) were assembled as the study group (Group 1), and patients with intact superior labrum (n=154) were named as the control group (Group 2). Critical shoulder angle (CSA) and glenoid depth measurements were performed using the preoperative MRI images. A total of 191 patients, of whom 84 were male (44%) were included. The mean age was 49.9±14.96 (range 18-79). There was a statistically signifi cant difference between the SLAP group (Group 1) and the control group (Group 2) in terms of CSA (p=0.032). The mean CSA was 31.66°±3.51° in Group 1 and 33.57° ±5.01° in Group 2. The cut-off value for CSA in patients with SLAP lesions was calculated as 32.85° and the area under the curve was 0.61, therefore a satisfactory association was observed between the groups. The mean glenoid depth was 4.32 ±1.25 mm in Group 1, and 4.39 ±0.32 mm in Group 2. There was no statistically signifi cant difference between the groups in terms of glenoid depth (p=0.136) and also no association between the glenoid depth and SLAP lesions was observed (cut-off=4.45 mm, AUC=0.32). Low CSA is associated with SLAP lesions, just as in glenohumeral osteoarthritis. Further prospective clinical studies are needed to enlighten the predisposing effect of CSA to SLAP lesions and the success of superior labral repairs. Retrospective comparative study, Level III.

Acromioclavicular joint dislocation and concomitant labral lesions: a systematic review.

Acromioclavicular (AC) joint dislocations frequently co-occur with intra-articular glenohumeral pathologies. Few comprehensive studies have focused on labral tears specifically associated with AC joint trauma. This systematic review will address this gap. A comprehensive electronic search was conducted across PubMed, Cochrane Library, and Google Scholar (pages 1-20) spanning from 1976 to May 19, 2023. Seven studies met the inclusion criteria for this systematic review, consisting of three retrospective studies and four case series. These studies collectively involved 1,044 patients, of whom 282 had concomitant labral lesions. The pooled prevalence of intra-articular labral injuries associated with acute AC joint dislocation was 27%. The prevalence of these labral lesions varied significantly between studies, ranging from 13.9% to 84.0% of patients, depending on the study and the grade of AC joint dislocation. Various types of labral tears were reported, with superior labrum anterior to posterior (SLAP) lesions being the most common. The prevalence of SLAP lesions ranged from 7.2% to 77.4%, with higher grades of AC joint dislocations often associated with a higher prevalence of SLAP tears. Moreover, grade V dislocations exhibited a complete correlation with SLAP tears. The studies yielded contradictory findings regarding older age and higher grades of AC joint dislocation as risk factors for concurrent labral lesions. This review underscores the frequent association between labral lesions and AC joint dislocations, particularly in cases of lower-grade injuries. Notably, SLAP lesions emerged as the predominant type of labral tear.

Spontaneous resolution of spinoglenoid ganglion cyst: a case series

BackgroundSpontaneous resolution of a spinoglenoid notch ganglion cyst (SGC) without surgical treatment has been rarely reported; however, we have encountered this phenomenon occasionally. Therefore, we aimed to describe a case series of consecutive patients with SGC in whom it spontaneously resolved without surgical treatment. MethodsWe retrospectively reviewed 12 patients with magnetic resonance imaging (MRI)-confirmed SGC in whom it resolved without surgical treatment between January 2011 and March 2023. We included patients without abnormally increased signal intensity or muscle atrophy due to denervation from suprascapular neuropathy on MRI. Resolution of the SGC was confirmed via MRI or ultrasound at the follow-up visit, and suprascapular neuropathy was assessed using electromyography and nerve conduction studies when needed. For functional assessments, the visual analog scale (VAS) for pain and active range of motion of the shoulder were used to compare pre- and post-resolution follow-ups. ResultsEleven men and one woman with a median age of 54.0 years (interquartile range [IQR] 37.0–65.3) were included in this study. The SGCs resolved spontaneously at a median of 13.2 months with an IQR of 8.2–23.0 after initial evaluation using MRI. The SGCs were multiloculated cysts with superior labrum anterior and posterior (SLAP) II–IX lesions, with a median diameter of 2.5 cm (IQR 2.0–2.8). The median VAS for pain (pre-resolution 5.0 [IQR 4.0–7.0] vs. post-resolution 1.0 [IQR 0.0–1.0], P = 0.002) and internal rotation at the back (pre-resolution 8.0 [IQR 7.0–10.3] vs. post-resolution 7.5 [IQR 7.0–8.0], P = 0.034) were significantly improved after the resolution. ConclusionsSurgical treatment may not be necessary in all cases of SGC. Nonsurgical treatment may be a viable option in the absence of suprascapular nerve involvement or SLAP-related physical findings.

Treatment of Concomitant SLAP Lesion in Patients Aged 45 and Above Who Underwent Arthroscopic Rotator Cuff Repair: Tenotomy versus Labral Repair?

Background: The current study aimed to compare the clinical and functional outcomes of the long-head biceps tendon (LHBT) tenotomy or labrum repair for the biceps-labral complex in the presence of superior labrum anterior-posterior (SLAP) lesion accompanying Goutallier type 0-I-II rotator cuff injury in patients aged 45 and above who underwent arthroscopic repair. Method: A retrospective analysis was conducted on 1148 patients who underwent arthroscopic shoulder surgery. A total of 223 patients, who underwent arthroscopic repair for Goutallier type 0, I, and II rotator cuff tears (RCT) and received simultaneous treatment for SLAP lesions through either LHBT tenotomy or labral repair, were included in the study. Patients were divided into two groups according to the treatment of SLAP lesions such as tenotomy (n=78) and repair (n=145). Demographic data, pre-operative, post-operative 3-month, and 12-month range of motion, visual analog scale (VAS), and Constant Murley Scale (CMS) were compared. Results: Flexion and external rotation were significantly higher in the tenotomy group, and internal rotation in the repair group (p&lt;0.001, &lt;0.001, 0.005, respectively). Although the VAS score was significantly lower in the tenotomy group compared to the repair group in the 3rd-month postoperative control (p&lt;0.001), the difference between the two groups disappeared in the 12th-month control (p=0.081). The CMS score was low in the tenotomy group preoperatively (p=0.015), by the 12-month follow-up, although there was a severe increase in both groups, there was no statistically significant difference between them (p=0.071). Conclusion: The study determined that both LHBT tenotomy and labral repair treatments for SLAP lesions, performed in conjunction with arthroscopic rotator cuff repair, are successful methods in terms of function, pain, and range of motion changes. It was observed that flexion and external rotation outcomes were better in tenotomy patients, while internal rotation was more favorable in patients undergoing labral repair.

Arthroscopic findings after manipulation under anesthesia in idiopathic capsulitis of the shoulder: A prospective study.

Manipulation under anesthesia (MUA) of the shoulder joint is a commonly used method for the treatment of adhesive capsulitis. Though it has been known to be associated with a variety of complications, there is a paucity of studies describing the arthroscopic findings after MUA. To describe the arthroscopic findings in patients with idiopathic adhesive capsulitis of the shoulder after MUA. We recruited 28 patients with idiopathic adhesive capsulitis who underwent arthroscopic capsular release. Manipulation of the shoulder was performed under anesthesia in all of these patients before capsular release. Intra-articular findings were recorded during arthroscopic capsular release in these patients. All patients showed the presence of synovitis. Twenty-seven patients showed tears in the capsule on the anterior aspect. One patient had an avulsion of the anterior rim of the glenoid and labrum following the manipulation. Four patients had partial rotator cuff tears, and one patient showed a superior labrum anterior posterior lesion, which was not diagnosed preoperatively on magnetic resonance imaging. MUA leads to rupture of the capsule, which is the desired outcome. However, the site of rupture of the capsule is dependent on the maneuvers of MUA. In addition, partial tears of the rotator cuff and osteochondral fractures of the glenoid can also occur.