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Archives of Orthopaedic and Trauma Surgery

, Volume 138, Issue 9, pp 1273–1285 | Cite as

Outcome of arthroscopic SLAP repair using knot-tying-suture anchors compared with knotless-suture anchors in athletes

  • Y. Reinig
  • F. Welsch
  • R. Hoffmann
  • D. Müller
  • K. F. Schüttler
  • E. Zimmermann
  • Thomas Stein
Arthroscopy and Sports Medicine
  • 165 Downloads

Abstract

Introduction

Arthroscopic repair is one option for the surgical treatment of type II superior labrum tears from anterior to posterior (SLAP) lesions in athletes’ shoulders.

Materials and methods

Sixty-one of 78 (78.2%) athletes were retrospectively examined after isolated arthroscopic SLAP repair (group 1/G1: 28x knot-tying anchors; group 2/G2: 33 knotless anchors; follow-up 24 months) and compared to two specific, separate matched volunteer athlete control groups (group 3/G3: 28 athletes matched to G1; group 4/G4: 33 athletes matched to G2). The assessment of G1–4 included numerical analogue scales (NASs: 1–15 scales) and the Athletic Shoulder Outcome Scoring System (ASOSS) score, and the Shoulder Sport Activity Score (SSAS). The preinjury status (FU-1), the status before surgery (FU0), and at follow-up (FU1) were assessed.

Results

High external rotation at abduction (hER) was significantly worse in G1 than G2 (FU1: G1, 86.6° ± 7.7° versus = vs G2, 91.1° ± 10.7°; p = 0.03). The ASOSS and SSAS revealed significant impairment in G1–2 compared to G3–4 (ASOSS FU1: 83.9 ± 19.9 G1 vs 94.6 ± 7.7 G3; p = 0.002 and 80.3 ± 17.7 G2 vs 91.8 ± 9.1 G4; p = 0.002; SSAS 5.9 ± 2.7 G1 vs 6.9 ± 1.8 G3; p = 0.02 and 6.3 ± 2.5 G2 vs 7.4 ± 1.4 G4; p = 0.06), with 17–20% loss on ASOSS and 23–25% deficits on SSAS. The NAS analysis detected for pain (4 ± 3.5 vs 3.2 ± 2.6), satisfaction (2 ± 0.8 vs 1.8 ± 0.9), reduction of function (4.6 ± 3.9 vs 3.9 ± 3.8) and proficiency (9.6 ± 4.7 vs 10.9 ± 3.9) similar impairments in G1–2 (p > 0.05) and better results in G3 and G4 (all p < 0.001).

Conclusions

After SLAP repair, athletes showed underestimated impairment of shoulder sport resumption and proficiency with high rates of shoulder sports cessation. The present data favor the knotless fixation technique, because this fixation technique allowed bilaterally equivalent ranges of motions. The uninjured shoulder athletes also showed functional deficits with significant shoulder sport impairments, which must be considered in outcome analysis and for the rehabilitation program.

Level of evidence

III, retrospective cohort study.

Keywords

SLAP lesion Athlete shoulder Suture anchor horizontal knot Knotless 

Notes

Acknowledgements

The authors appreciate the assistance of Dr. rer. med. Hanns Ackermann for collection and analyzing the data.

References

  1. 1.
    Andrews JR, Carson WG Jr, McLeod WD (1985) Glenoid labrum tears related to the long head of the biceps. Am J Sports Med 13(5):337–341PubMedCrossRefGoogle Scholar
  2. 2.
    Snyder SJ, Banas MP, Karzel RP (1995) An analysis of 140 injuries to the superior glenoid labrum. J Shoulder Elbow Surg 4(4):243–248PubMedCrossRefGoogle Scholar
  3. 3.
    Burkhart SS, Morgan CD, Kibler WB (2003) The disabled throwing shoulder: spectrum of pathology. Part II: evaluation and treatment of SLAP lesions in throwers. Arthroscopy 19(5):531–539PubMedCrossRefGoogle Scholar
  4. 4.
    Sayde WM, Cohen SB, Ciccotti MG, Dodson CC (2012) Return to play after type II superior labral anterior–posterior lesion repairs in athletes: a systematic review. Clin Orthop Relat Res 470(6):1595–1600.  https://doi.org/10.1007/s11999-012-2295-6 PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Zhang AL, Kreulen C, Ngo SS, Hame SL, Wang JC, Gamradt SC (2012) Demographic trends in arthroscopic SLAP repair in the United States. Am J Sports Med 40(5):1144–1147.  https://doi.org/10.1177/0363546512436944 PubMedCrossRefGoogle Scholar
  6. 6.
    Ek ET, Shi LL, Tompson JD, Freehill MT, Warner JJ (2014) Surgical treatment of isolated type II superior labrum anterior–posterior (SLAP) lesions: repair versus biceps tenodesis. J Shoulder Elbow Surg 23(7):1059–1065.  https://doi.org/10.1016/j.jse.2013.09.030 PubMedCrossRefGoogle Scholar
  7. 7.
    McCormick F, Bhatia S, Chalmers P, Gupta A, Verma N, Romeo AA (2014) The management of type II superior labral anterior to posterior injuries. Orthop Clin North Am 45(1):121–128.  https://doi.org/10.1016/j.ocl.2013.08.008 PubMedCrossRefGoogle Scholar
  8. 8.
    Erickson J, Lavery K, Monica J, Gatt C, Dhawan A (2015) Surgical treatment of symptomatic superior labrum anterior–posterior tears in patients older than 40 years: a systematic review. Am J Sports Med 43(5):1274–1282.  https://doi.org/10.1177/0363546514536874 PubMedCrossRefGoogle Scholar
  9. 9.
    Maier D, Jaeger M, Ogon P, Bornebusch L, Izadpanah K, Suedkamp NP (2013) Suture anchors or transglenoidal sutures for arthroscopic repair of isolated SLAP-2 lesions? A matched-pair comparison of functional outcome and return to sports. Arch Orthop Trauma Surg 133(2):227–235.  https://doi.org/10.1007/s00402-012-1657-6 PubMedCrossRefGoogle Scholar
  10. 10.
    Yang HJ, Yoon K, Jin H, Song HS (2016) Clinical outcome of arthroscopic SLAP repair: conventional vertical knot versus knotless horizontal mattress sutures. Knee Surg 24(2):464–469.  https://doi.org/10.1007/s00167-014-3449-8 CrossRefGoogle Scholar
  11. 11.
    Chalmers PN, Monson B, Frank RM, Mascarenhas R, Nicholson GP, Bach BR Jr, Verma NN, Cole BJ, Romeo AA (2016) Combined SLAP repair and biceps tenodesis for superior labral anterior–posterior tears. Knee Surg 24(12):3870–3876.  https://doi.org/10.1007/s00167-015-3774-6 CrossRefGoogle Scholar
  12. 12.
    Brockmeier SF, Voos JE, Williams RJ III, Altchek DW, Cordasco FA, Allen AA (2009) Outcomes after arthroscopic repair of type-II SLAP lesions. J Bone Joint Surg Am 91(7):1595–1603.  https://doi.org/10.2106/JBJS.H.00205 PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Soldatis JJ, Moseley JB, Etminan M (1997) Shoulder symptoms in healthy athletes: a comparison of outcome scoring systems. J Shoulder Elbow Surg 6(3):265–271PubMedCrossRefGoogle Scholar
  14. 14.
    Stein T, Buckup J, Efe T, von Eisenhart-Rothe R, Hoffmann R, Zimmermann E, Welsch F (2015) Structural and clinical integrity of the rotator cuff in athletes after arthroscopic Bankart repair using the three-portal technique. Arch Orthop Trauma Surg 135(3):369–382.  https://doi.org/10.1007/s00402-015-2158-1 PubMedCrossRefGoogle Scholar
  15. 15.
    Vangsness CT Jr, Jorgenson SS, Watson T, Johnson DL (1994) The origin of the long head of the biceps from the scapula and glenoid labrum. An anatomical study of 100 shoulders. J Bone Joint Surg Br 76(6):951–954PubMedCrossRefGoogle Scholar
  16. 16.
    Chokshi BV, Kubiak EN, Jazrawi LM, Ticker JB, Zheng N, Kummer FJ, Rokito AS (2006) The effect of arthroscopic suture passing instruments on rotator cuff damage and repair strength. Bull Hosp Jt Dis 63(3–4):123–125PubMedGoogle Scholar
  17. 17.
    Allain J, Goutallier D, Glorion C (1998) Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder. J Bone Joint Surg Am 80(6):841–852PubMedCrossRefGoogle Scholar
  18. 18.
    Tibone JE, Bradley J (1993) Evaluation of treatment outcomes for the athletes shoulder. The shoulder: a balance of mobility and stability. The American Academy of Othropaedic Surgeons, RosemontGoogle Scholar
  19. 19.
    Zeichen J, Meller R, Siegel A, Gehrke A, Hecker H, Krettek C (2004) Is the shoulder sport activity after shoulder injuries quantifiable? Implementation of a new Shoulder Sport Activity Score. German Congress for Orthopaedics and Traumatology, Berlin,Google Scholar
  20. 20.
    Barber FA, Dockery WD, Cowden CH III (2013) The degradation outcome of biocomposite suture anchors made from poly l-lactide-co-glycolide and beta-tricalcium phosphate. Arthroscopy 29(11):1834–1839.  https://doi.org/10.1016/j.arthro.2013.08.004 PubMedCrossRefGoogle Scholar
  21. 21.
    Walch G (1987) Walch-Duplay rating sheet for anterior instability of the shoulder. Paper presented at the SESEC/ESSE, ParisGoogle Scholar
  22. 22.
    Schroder CP, Skare O, Reikeras O, Mowinckel P, Brox JI (2017) Sham surgery versus labral repair or biceps tenodesis for type II SLAP lesions of the shoulder: a three-armed randomised clinical trial. Br J Sports Med.  https://doi.org/10.1136/bjsports-2016-097098 PubMedCentralCrossRefPubMedGoogle Scholar
  23. 23.
    Slenker NR, Lawson K, Ciccotti MG, Dodson CC, Cohen SB (2012) Biceps tenotomy versus tenodesis: clinical outcomes. Arthroscopy 28(4):576–582.  https://doi.org/10.1016/j.arthro.2011.10.017 PubMedCrossRefGoogle Scholar
  24. 24.
    Frost A, Zafar MS, Maffulli N (2009) Tenotomy versus tenodesis in the management of pathologic lesions of the tendon of the long head of the biceps brachii. Am J Sports Med 37(4):828–833.  https://doi.org/10.1177/0363546508322179 PubMedCrossRefGoogle Scholar
  25. 25.
    McCulloch PC, Andrews WJ, Alexander J, Brekke A, Duwani S, Noble P (2013) The effect on external rotation of an anchor placed anterior to the biceps in type 2 SLAP repairs in a cadaveric throwing model. Arthroscopy 29(1):18–24.  https://doi.org/10.1016/j.arthro.2012.06.021 PubMedCrossRefGoogle Scholar
  26. 26.
    Gorantla K, Gill C, Wright RW (2010) The outcome of type II SLAP repair: a systematic review. Arthroscopy 26(4):537–545.  https://doi.org/10.1016/j.arthro.2009.08.017 PubMedCrossRefGoogle Scholar
  27. 27.
    Boileau P, Parratte S, Chuinard C, Roussanne Y, Shia D, Bicknell R (2009) Arthroscopic treatment of isolated type II SLAP lesions: biceps tenodesis as an alternative to reinsertion. Am J Sports Med 37(5):929–936.  https://doi.org/10.1177/0363546508330127 PubMedCrossRefGoogle Scholar
  28. 28.
    O’Brien SJ, Allen AA, Coleman SH, Drakos MC (2002) The trans-rotator cuff approach to SLAP lesions: technical aspects for repair and a clinical follow-up of 31 patients at a minimum of 2 years. Arthroscopy 18(4):372–377PubMedCrossRefGoogle Scholar
  29. 29.
    Morgan CD, Burkhart SS, Palmeri M, Gillespie M (1998) Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears. Arthroscopy 14(6):553–565PubMedCrossRefGoogle Scholar
  30. 30.
    Yung PS, Fong DT, Kong MF, Lo CK, Fung KY, Ho EP, Chan DK, Chan KM (2008) Arthroscopic repair of isolated type II superior labrum anterior–posterior lesion. Knee Surg Sports Traumatol Arthrosc 16(12):1151–1157.  https://doi.org/10.1007/s00167-008-0629-4 PubMedCrossRefGoogle Scholar
  31. 31.
    Thorsness R, Alland JA, McCulloch CB, Romeo A (2016) Return to play after shoulder surgery in throwers. Clin Sports Med 35(4):563–575.  https://doi.org/10.1016/j.csm.2016.05.003 PubMedCrossRefGoogle Scholar
  32. 32.
    Fedoriw WW, Ramkumar P, McCulloch PC, Lintner DM (2014) Return to play after treatment of superior labral tears in professional baseball players. Am J Sports Med 42(5):1155–1160.  https://doi.org/10.1177/0363546514528096 PubMedCrossRefGoogle Scholar
  33. 33.
    Kim SH, Ha KI, Kim SH, Choi HJ (2002) Results of arthroscopic treatment of superior labral lesions. J Bone Joint Surg Am 84-A(6):981–985PubMedCrossRefGoogle Scholar
  34. 34.
    Cohen DB, Coleman S, Drakos MC, Allen AA, O’Brien SJ, Altchek DW, Warren RF (2006) Outcomes of isolated type II SLAP lesions treated with arthroscopic fixation using a bioabsorbable tack. Arthroscopy 22(2):136–142.  https://doi.org/10.1016/j.arthro.2005.11.002 PubMedCrossRefGoogle Scholar
  35. 35.
    Coleman SH, Cohen DB, Drakos MC, Allen AA, Williams RJ, O’Brien SJ, Altchek DW, Warren RF (2007) Arthroscopic repair of type II superior labral anterior posterior lesions with and without acromioplasty: a clinical analysis of 50 patients. Am J Sports Med 35(5):749–753.  https://doi.org/10.1177/0363546506296735 PubMedCrossRefGoogle Scholar
  36. 36.
    Neuman BJ, Boisvert CB, Reiter B, Lawson K, Ciccotti MG, Cohen SB (2011) Results of arthroscopic repair of type II superior labral anterior posterior lesions in overhead athletes: assessment of return to preinjury playing level and satisfaction. Am J Sports Med 39(9):1883–1888.  https://doi.org/10.1177/0363546511412317 PubMedCrossRefGoogle Scholar
  37. 37.
    Yoneda M, Hirooka A, Saito S, Yamamoto T, Ochi T, Shino K (1991) Arthroscopic stapling for detached superior glenoid labrum. J Bone Joint Surg Br 73(5):746–750PubMedCrossRefGoogle Scholar
  38. 38.
    Brockmeier SF, Voos JE, Williams RJ III, Altchek DW, Cordasco FA, Allen AA, Sports M, Shoulder S (2009) Hospital for special surgery. Outcomes after arthroscopic repair of type-II SLAP lesions. J Bone Joint Surg Am 91(7):1595–1603.  https://doi.org/10.2106/JBJS.H.00205 PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Ide J, Maeda S, Takagi K (2005) Sports activity after arthroscopic superior labral repair using suture anchors in overhead-throwing athletes. Am J Sports Med 33(4):507–514.  https://doi.org/10.1177/0363546504269255 PubMedCrossRefGoogle Scholar
  40. 40.
    Baltaci G, Johnson R, Kohl H III (2001) Shoulder range of motion characteristics in collegiate baseball players. J Sports Med Phys Fit 41(2):236–242Google Scholar
  41. 41.
    Bigliani LU, Codd TP, Connor PM, Levine WN, Littlefield MA, Hershon SJ (1997) Shoulder motion and laxity in the professional baseball player. Am J Sports Med 25(5):609–613PubMedCrossRefGoogle Scholar
  42. 42.
    Stein T, Linke RD, Buckup J, Efe T, von Eisenhart-Rothe R, Hoffmann R, Jager A, Welsch F (2011) Shoulder sport-specific impairments after arthroscopic Bankart repair: a prospective longitudinal assessment. Am J Sports Med 39(11):2404–2414.  https://doi.org/10.1177/0363546511417407 PubMedCrossRefGoogle Scholar
  43. 43.
    Ide J, Maeda S, Takagi K (2004) Arthroscopic Bankart repair using suture anchors in athletes: patient selection and postoperative sports activity. Am J Sports Med 32(8):1899–1905PubMedCrossRefGoogle Scholar
  44. 44.
    Lephart SM, Henry TJ (1995) Functional rehabilitation for the upper and lower extremity. Orthop Clin North Am 26(3):579–592PubMedGoogle Scholar
  45. 45.
    Myers JB, Lephart SM (2000) The role of the sensorimotor system in the athletic shoulder. J Athl Train 35(3):351–363PubMedPubMedCentralGoogle Scholar
  46. 46.
    Myers JB, Lephart SM (2002) Sensorimotor deficits contributing to glenohumeral instability. Clin Orthop Relat Res 400:98–104CrossRefGoogle Scholar
  47. 47.
    Myers JB, Wassinger CA, Lephart SM (2006) Sensorimotor contribution to shoulder stability: effect of injury and rehabilitation. Man Ther 11(3):197–201PubMedCrossRefGoogle Scholar
  48. 48.
    Swanik CB, Lephart SM, Rubash HE (2004) Proprioception, kinesthesia, and balance after total knee arthroplasty with cruciate-retaining and posterior stabilized prostheses. J Bone Joint Surg Am 86-A(2):328–334PubMedCrossRefGoogle Scholar
  49. 49.
    Warner JJ, Lephart S, Fu FH (1996) Role of proprioception in pathoetiology of shoulder instability. Clin Orthop Relat Res 330:35–39Google Scholar
  50. 50.
    Matsen FA, Lippit SB, Sidles JA, Harryman DT (1994) Practical evaluation and management of the shoulder. Saunders, PhiladelphiaGoogle Scholar
  51. 51.
    Oh JH, Jo KH, Kim WS, Gong HS, Han SG, Kim YH (2009) Comparative evaluation of the measurement properties of various shoulder outcome instruments. Am J Sports Med 37(6):1161–1168.  https://doi.org/10.1177/0363546508330135 PubMedCrossRefGoogle Scholar
  52. 52.
    Placzek JD, Lukens SC, Badalanmenti S, Roubal PJ, Freeman DC, Walleman KM, Parrot A, Wiater JM (2004) Shoulder outcome measures: a comparison of 6 functional tests. Am J Sports Med 32(5):1270–1277.  https://doi.org/10.1177/0363546503262193 PubMedCrossRefGoogle Scholar
  53. 53.
    Burkhart SS, Morgan CD, Kibler WB (2003) The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. Arthroscopy 19(4):404–420.  https://doi.org/10.1053/jars.2003.50128 PubMedCrossRefGoogle Scholar
  54. 54.
    Burkhart SS, Morgan CD (1998) The peel-back mechanism: its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation. Arthroscopy 14(6):637–640PubMedCrossRefGoogle Scholar
  55. 55.
    Walch G, Liotard JP, Boileau P, Noel E (1993) Postero-superior glenoid impingement. Another impingement of the shoulder. J Radiol 74(1):47–50PubMedGoogle Scholar
  56. 56.
    Jobe CM (1995) Posterior superior glenoid impingement: expanded spectrum. Arthroscopy 11(5):530–536PubMedCrossRefGoogle Scholar
  57. 57.
    Kibler WB (1998) The role of the scapula in athletic shoulder function. Am J Sports Med 26(2):325–337PubMedCrossRefGoogle Scholar
  58. 58.
    Kibler WB, McMullen J (2003) Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg 11(2):142–151PubMedCrossRefGoogle Scholar
  59. 59.
    Merolla G, De Santis E, Campi F, Paladini P, Porcellini G (2010) Supraspinatus and infraspinatus weakness in overhead athletes with scapular dyskinesis: strength assessment before and after restoration of scapular musculature balance. Musculoskelet Surg 94(3):119–125.  https://doi.org/10.1007/s12306-010-0082-7 PubMedCrossRefGoogle Scholar
  60. 60.
    Lajtai G, Pfirrmann CW, Aitzetmuller G, Pirkl C, Gerber C, Jost B (2009) The shoulders of professional beach volleyball players: high prevalence of infraspinatus muscle atrophy. Am J Sports Med 37(7):1375–1383.  https://doi.org/10.1177/0363546509333850 PubMedCrossRefGoogle Scholar
  61. 61.
    Lippitt S, Matsen F (1993) Mechanisms of glenohumeral joint stability. Clin Orthop Relat Res (291):20–28Google Scholar
  62. 62.
    FA M (1994) Stability in “Practical evaluation and management of the shoulder”. SaundersGoogle Scholar
  63. 63.
    Yildiz F, Bilsel K, Pulatkan A, Uzer G, Aralasmak A, Atay M (2017) Reliability of magnetic resonance imaging versus arthroscopy for the diagnosis and classification of superior glenoid labrum anterior to posterior lesions. Arch Orthop Trauma Surg 137(2):241–247.  https://doi.org/10.1007/s00402-016-2605-7 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Sports Orthopedics, Knee- and Shoulder-SurgeryBerufsgenossenschaftliche Unfallklinik Frankfurt am MainFrankfurt am MainGermany
  2. 2.Department of Trauma and Orthopedic SurgeryBerufsgenossenschaftliche Unfallklinik Frankfurt am MainFrankfurt am MainGermany
  3. 3.Department of Sports MedicineUniversity of BielefeldBielefeldGermany
  4. 4.Department of Orthopaedics and RheumatologyUniversity Hospital MarburgMarburgGermany
  5. 5.Department of Trauma, Hand and Reconstructive SurgeryUniversity HospitalFrankfurt am MainGermany

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