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
ABSTRACT 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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ABSTRACT: Although nonoperative options exist for the treatment of mild symptoms or lesser abnormalities such as tendinopathy of the long head of the biceps, surgical intervention has been shown to be appropriate therapy for symptomatic partial tears of the long head of the biceps, subluxation of the long head of the biceps, biceps pulley lesions, and some superior labrum anterior-posterior (SLAP) lesions. » Biceps tenodesis can be performed with use of open or arthroscopic methods and has emerged as a preferred technique for the treatment of abnormalities of the long head of the biceps in younger persons, athletes, laborers, and those wishing to avoid likely cosmetic deformity. » Numerous studies comparing outcomes between biceps tenotomy and tenodesis have demonstrated that although biceps tenotomy is a much simpler procedure and requires less rehabilitation, it may result in a cosmetic deformity, possible cramping and fatigue pain of the biceps, and a decrease in elbow flexion and supination power. » Open subpectoral tenodesis and arthroscopic biceps tenodesis both provide favorable outcomes, and neither technique has been shown to be superior to the other. L esions of the intra-articular long head of the biceps tendon have long been considered impor-tant pain generators in the shoulder 1-3 . Despite considerable research into the anatomy of the long head of the biceps and the various abnormalities that affect it, controversy remains regarding the function of the long head of the biceps and, most importantly, appropriate treatment of its disorders 4 . Although nonoperative options exist for the treatment of mild symptoms or tendinopathy of the long head of the biceps, operative intervention may be indicated for symptomatic partial tears of the long head of the biceps, subluxation of the long head of the biceps, biceps pulley lesions, and some superior labrum anterior-posterior (SLAP) lesions 2,5-19 . Biceps tenotomy and biceps tenodesis are two procedures that have emerged as quick, simple, and cost-effective methods for the treatment of isolated ab-normalities of the long head of the biceps, isolated superior glenoid labral abnormali-ties in patients who are more than forty years of age, and combined lesions of the biceps-labrum complex 1,4-6,10,12,17,20-23 . Biceps tenotomy can be performed relatively simply and reproducibly andThe Journal of Bone and Joint Surgery 12/2014; 2(12). DOI:10.2106/JBJS.RVW.N.00020 · 4.31 Impact Factor
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ABSTRACT: While a vast body of literature exists describing biceps tenodesis techniques and evaluating the biomechanical aspects of tenodesis locations or various implants, little literature presents useful clinical outcomes to guide surgeons in their decision to perform a particular method of tenodesis.The American Journal of Sports Medicine 09/2014; DOI:10.1177/0363546514547226 · 4.70 Impact Factor
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ABSTRACT: Arthroscopic repair of type II superior labrum anterior to posterior (SLAP) tears yields variable results. In this study, the clinical outcomes of arthroscopic knotless horizontal mattress repair were compared to those of conventional vertical knot repair. Forty-six patients treated arthroscopically for isolated SLAP lesions were assessed. Forty-one of those patients underwent follow-up evaluations for a minimum of 2 years: 21 received vertical knot (group 1), while 20 received horizontal mattress (group 2). In group 1, an anchor was inserted at the superior glenoid. After relaying the sutures, knotting over the labral tissue was performed. In group 2, two strands were passed through the labrum and fixed into the glenoid with a bioabsorbable knotless anchor. Functional scores were evaluated preoperatively and at the final follow-up assessment. A visual analogue scale (VAS) for pain and range of motion (ROM) were assessed preoperatively, 2 months postoperatively and at the last follow-up visit. There were no significant differences in functional scores between groups (n.s.). However, external rotation at the side, internal rotation at abduction and total ROM were better in group 2 at the last follow-up visit. At 2 months postoperatively, the VAS for pain and ROM of internal rotation at abduction were better in group 2. At the final assessment, there were no significant differences in functional scores between the two groups. However, external rotation at the side, internal rotation at abduction and total ROM were better in group 2. Case-control study, Level III.Knee Surgery Sports Traumatology Arthroscopy 11/2014; DOI:10.1007/s00167-014-3449-8 · 2.84 Impact Factor