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: A Randomized Controlled Trial

Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Rome, Italy.
The American Journal of Sports Medicine (Impact Factor: 4.36). 03/2008; 36(2):247-53. DOI: 10.1177/0363546507308194
Source: PubMed


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.
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.
Randomized controlled clinical trial; Level of evidence, 1.
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.
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).
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.

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    • "If a SLAP lesion and a rotator cuff tear were both present, Abbot found better clinical results with SLAP debridement and cuff repair.[7] Franceschi found the same with tenotomy and cuff repair rather than repair of the SLAP.[8] For isolated type II SLAP lesions, Boileau reported significantly better results after tenodesis than suture anchor repair.[9] "
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    ABSTRACT: To assess whether patients above 50 years of age, particularly female, would benefit from repair of their SLAP tears. Review of patients' records followed by telephone interview at a minimum of two years after surgery. Seventy-two consecutive patients who had their SLAP repaired were retrospective reviewed by an independent examiner. Follow up was by telephone interview with pain and functional results measured according to the Oxford Shoulder Questionnaire. The patients were asked whether they would undergo the same operation if they had a similar injury. OKS - One way ANOVA, followed by Tukey HSD multiple comparisons were used to assess the Oxford Shoulder score. Kruskal-Wallis Test was used to assess the final VAS Pain Score. Student's T tests for Oxford scores before and after surgery. Between 2007-2008, 38 male patients and 34 female patients with an average age of 53 (19-75) years had their SLAP repair. Good to excellent results in Oxford shoulder scores were reported in 94%. 68 0f 72 patients would undergo the same if they had a similar injury. No statistical correlation was found between the patient's age, gender and outcome scores. Neither the patients' gender nor their age above 50 affected the outcome after surgery.
    International Journal of Shoulder Surgery 03/2012; 6(4):112-115. DOI:10.4103/0973-6042.106223 · 0.65 Impact Factor
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    • "To optimize the healing process, it seems to be important to attempt restoration of the original anatomy of the insertion of the rotator cuff, which would provide larger area for bony incorporation and healing, and to develop constructs that provide increased compression of the tendon on the footprint which may affect the mechanical strength and function of the repaired tendon [1-4,8,18-20]. This is especially important at the early stages of rehabilitation, when the tendon-bone interface is still weak, and complete functional recovery has yet to take place [19,21,22]. With the development of new biological enhancement techniques, it might prove important to maintain a large area of contact between tendon and bone, allowing more fibers to participate in the healing process. "
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    ABSTRACT: With advances in arthroscopic surgery, many techniques have been developed to increase the tendon-bone contact area, reconstituting a more anatomic configuration of the rotator cuff footprint and providing a better environment for tendon healing. We present an arthroscopic rotator cuff repair technique which uses suture bridges to optimize rotator cuff tendon-footprint contact area and mean pressure. Two medial row 5.5-mm Bio-Corkscrew suture anchors (Arthrex, Naples, FL), which are double-loaded with No. 2 FiberWire sutures (Arthrex, Naples, FL), are placed in the medial aspect of the footprint. Two suture limbs from a single suture are both passed through a single point in the rotator cuff. This is performed for both anchors. The medial row sutures are tied using the double pulley technique. A suture limb is retrieved from each of the medial anchors through the lateral portal, and manually tied as a six-throw surgeon's knot over a metal rod. The two free suture limbs are pulled to transport the knot over the top of the tendon bridge. Then the two free suture limbs that were used to pull the knot down are tied. The end of the sutures are cut. The same double pulley technique is repeated for the other two suture limbs from the two medial anchors, but the two free suture limbs are used to produce suture bridges over the tendon, by means of a Pushlock (Arthrex, Naples, FL), placed 1 cm distal to the lateral edge of the footprint. This technique maximizes the advantages of two techniques. On the one hand, the double pulley technique provides an extremely secure fixation in the medial aspect of the footprint. On the other hand, the suture bridges allow to improve pressurized contact area and mean footprint pressure. In this way, the bony footprint in not compromised by the distal-lateral fixation, and it is thus possible to share the load between fixation points. This maximizes the strength of the repair and provides a barrier preventing penetration of synovial fluid into the healing area of tendon and bone.
    BMC Musculoskeletal Disorders 02/2007; 8(1):123. DOI:10.1186/1471-2474-8-123 · 1.72 Impact Factor
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