Long-term Results After SLAP Repair: A 5-Year Follow-up Study of 107 Patients With Comparison of Patients Aged Over and Under 40 Years.
PURPOSE: The aims of this prospective cohort study were to assess the long-term results after isolated superior labral repair and to determine whether the results were associated with age. METHODS: One hundred seven patients underwent repair of isolated SLAP tears. There were 36 women and 71 men with a mean age of 43.8 years (range, 20 to 68 years). Mean follow-up was 5.3 years (range, 4 to 8 years). Of the patients, 62 (57.9%) were aged 40 years or older. Follow-up examinations were performed by an independent examiner; 102 patients (95.3%) had a 5-year follow-up. RESULTS: The Rowe score improved from 62.8 (SD, 11.4) preoperatively to 92.1 (SD, 13.5) at follow-up (P < .001). Satisfaction was rated excellent/good for 90 patients (88%) at 5 years. There was no significant difference in the results for patients aged 40 years or older and those aged under 40 years. Difficulty with postoperative stiffness and pain was reported by 14 patients (13.1%). CONCLUSIONS: Our results suggest that long-term outcomes after isolated labral repair for SLAP lesions are good and independent of age. Postoperative stiffness was registered in 13.1% of the patients. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
Available from: Øystein Skare
- "In a 5-year follow-up study of arthroscopic repair in patients with SLAP lesions , the clinical Rowe Score (1988 version) was used as the main effect variable. This score has been reported to have considerable limitations  and results  would have been strengthened applying a self-report outcome with acceptable measurement properties. "
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ABSTRACT: Having an estimate of the measurement error of self-report questionnaires is important both for assessing follow-up results after treatment and when planning intervention studies. Specific questionnaires have been evaluated for patients with shoulder instability, but not in particular for patients with SLAP (superior labral anterior posterior) lesions or recurrent dislocations. The aim of this study was to evaluate the agreement, reliability, and validity of two commonly questionnaires developed for patients with shoulder instability and a generic questionnaire in patients with SLAP lesions or recurrent anterior shoulder dislocations.
Seventy-one patients were included, 33 had recurrent anterior dislocations and 38 had a SLAP lesion. The patients filled in the questionnaires twice at the same time of the day (+/- 2 hours) with a one week interval between administrations. We tested the Oxford Instability Shoulder Score (OISS) (range 12 to 60), the Western Ontario Shoulder Instability Index (WOSI) (0 to 2100), and the EuroQol: EQ-5D (-0.5 to 1.0) and EQ-VAS (0 to 100). Hypotheses were defined to test validity.
ICC ranged from 0.89 (95 % CI 0.83 to 0.93) to 0.92 (0.87 to 0.95) for OISS, WOSI, and EQ-VAS and was 0.66 (0.50 to 0.77) for EQ-5D. The limits of agreement for the scores were: -7.8 to 8.4 for OISS; -339.9 to 344.8 for WOSI; -0.4 to 0.4 for EQ-5D; and -17.2 and 16.2 for EQ-VAS. All questionnaires reflect the construct that was measured. The correlation between WOSI and OISS was 0.73 and ranged from 0.49 to 0.54 between the shoulder questionnaires and the generic questionnaires. The divergent validity was acceptable, convergent validity failed, and known group validity was acceptable only for OISS.
Measurement errors and limitations in validity should be considered when change scores of OISS and WOSI are interpreted in patients with SLAP lesions or recurrent shoulder dislocations. EQ-5D is not recommended as a single outcome.
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ABSTRACT: Since the initial recognition of injury patterns specific to the superior labrum/ biceps tendon complex nearly 30 years ago, our understanding of the SLAP lesion continues to grow. Much research has gone into understanding the relevant anatomy, biomechanics, pathophysiology, clinical presentation, diagnosis and treatment of these injuries. Despite this, conflicting data and a lack of level I and II outcomes data leaves many questions unanswered and many topics in this area controversial. So what can we conclude based on the available evidence, in 2013, about the diagnosis, evaluation and management of SLAP tears? • The superior labrum/biceps tendon complex is a loose, mobile interface with variable attachments to the glenoid. Recognition of these common anatomic variants is crucial to proper diagnosis and treatment. Repair of sublabral foramen, recesses or other "normal" variants is unnecessary and may be of detriment to the patient. • The diagnosis of SLAP tears remains a difficult task and must be based on a combination of the appropriate data gleaned from the clinical history, presenting symptoms, physical exam and imaging studies. There remains no single provocative test to isolate SLAP lesions, however, the concept of "the suspicious exam" proposed by Burns and Synder  is a useful step in the diagnostic algorithm. • MR arthrography is the standard in imaging for diagnosing SLAP tears, while arthroscopic evaluation remains the gold standard in diagnosis. • For all patients with or without a confirmed diagnosis, initial non-operative management with a rehabilitation course focused on scapular stabilization and RTC strengthening should be employed, as this may be successful in up to 70 % of patients. Only after failed conservative treatment should surgery be considered. • Surgical management remains controversial and is dependent on multiple factors including the type of SLAP tear, age of the patient, activity level, and whether or not the patient participates in overhead throwing sports. Though not conclusive, current evidence is more and more suggestive of better results for biceps tenodesis and debridement in patients over age 40, especially those with biceps tendon damage and/or concomitant rotator cuff tears. • For type II SLAP repairs, no biomechanical or clinical data exists to suggest that a certain suture anchor configuration or suture type provides better results. Data does support use of suture anchors over bioabsorbable tacks. • Long term outcomes data suggest that excellent outcome results and return to play can be expected for type II SLAP repairs. There is some conflict over whether or not this holds true for patients over 40. Patients receiving worker's compensation, and those participating in overhead sports, especially throwers consistently have less robust outcomes and return to pre-injury activity level. • Patients undergoing revision procedures have lower functional scores and patient satisfaction • Complication incidence is 4.4 % and SLAP repair is not a benign procedure. Stiffness, iatrogenic rotator cuff tear, and suprascapular nerve injury are well recognized, manageable, and potentially avoidable issues. • More prospective, randomized controlled trials are necessary to delineate better diagnostic criteria, normal anatomic variants versus age related degenerative changes, advantageous repair configurations, rehabilitation protocols, repair versus tenodesis based on age and/or activity level, and ways to minimize iatrogenic complications. Current evidence has provided a solid framework for the diagnosis and management of SLAP tears. Areas of controversy and conflicting data emphasize the need for focused, well-designed research to answer remaining questions. The popularity of this topic is highlighted by the increasing incidence of SLAP repair, however, care must be taken not to over-diagnose or treat this relatively uncommon injury. Stronger, conclusive research will help identify the patient-specific, evidence based indications for proper treatment of SLAP tears in the future.
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