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Posterior repair of isolated type 2 superior labrum anterior–posterior lesion prevents external rotation deficiency: long-term outcome study

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study aimed to evaluate the outcomes of arthroscopic type 2 superior labrum anterior–posterior (SLAP) lesion repair in the general population and compare clinical outcomes according to patient age and repair site.

Methods

Between 2005 and 2018, patients who underwent arthroscopic repair for isolated type 2 SLAP lesions were retrospectively reviewed. Baseline characteristics, pre- and postoperative [1-year and > 2-year (final)] shoulder range-of-motion, and functional scores, comprising the pain visual analogue scale (PVAS), functional VAS, and American Shoulder and Elbow Surgeons (ASES) score, were evaluated. Return to overhead activities and subjective satisfaction were assessed at the final follow-up, and patients were divided by age [group YB (< 40 years] and group OB (≥ 40 years)] and repair site [group P (only posterior labrum repair) and group AP (anterior and posterior labrum repair)]. Overall patient outcomes were analysed and compared between groups.

Results

This study included 54 patients (45 men) with a mean age of 37.1 ± 8.3 years. The mean follow-up was 90.8 ± 51.3 months. Two patients experienced early failure, and one patient had a ruptured biceps tendon during the follow-up period. Final functional scores improved compared to their preoperative scores in all patients, except three (all p < 0.001). Fifty patients (98.0%) were satisfied, and 39 patients (76.5%) were able to perform overhead sports without restriction. In 25 patients who attended more than 7 years of follow-up (mean, 11.3 ± 2.7 years), 21 patients (84%) had an ASES score ≥ 80, and all patients had PVAS ≤ 2. There was no significant difference in clinical outcomes between groups YB and OB. The final median external rotation was significantly more restricted in group AP than in group P (40 [25–65] vs. 60 [50–70], p = 0.002).

Conclusion

Arthroscopic type 2 SLAP repair induced good short- and long-term clinical outcomes, return to overhead activities, and subjective satisfaction in the general population, regardless of age, due to the careful evaluation of patient history, physical examination, and imaging studies. However, performing only posterior repair seems sufficient since anterior labral SLAP lesion repair can limit ER. Isolated type 2 SLAP lesion posterior repair only is, thus, recommended to reduce external rotation deficit risk and increase satisfaction, regardless of patient age.

Study design

Case series.

Level of evidence

Level IV.

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References

  1. Abdul-Rassoul H, Defazio M, Curry EJ, Galvin JW, Li X (2019) Return to sport after the surgical treatment of superior labrum anterior to posterior tears: a systematic review. Orthop J Sports Med 7(5):2325967119841892

    Article  Google Scholar 

  2. Alpert JM, Wuerz TH, O’Donnell TF, Carroll KM, Brucker NN, Gill TJ (2010) The effect of age on the outcomes of arthroscopic repair of type II superior labral anterior and posterior lesions. Am J Sports Med 38(11):2299–2303

    Article  Google Scholar 

  3. 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):337–341

    Article  CAS  Google Scholar 

  4. Arroyo W, Misenhimer J, Cotter EJ, Wang KC, Heida K, Pallis MP, Waterman BR (2019) Effect of anterior anchor on clinical outcomes of type II SLAP repairs in an active population. Orthopedics 42(1):e32–e38

    Article  Google Scholar 

  5. 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):637–640

    Article  CAS  Google Scholar 

  6. 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):531–539

    Article  Google Scholar 

  7. Cvetanovich GL, Gowd AK, Agarwalla A, Forsythe B, Romeo AA, Verma NN (2019) Trends in the management of isolated SLAP tears in the United States. Orthop J Sports Med 7(3):2325967119833997

    Article  Google Scholar 

  8. Cvetanovich GL, Gowd AK, Frantz TL, Erickson BJ, Romeo AA (2020) Superior labral anterior posterior repair and biceps tenodesis surgery: trends of the American Board of Orthopaedic Surgery database. Am J Sports Med 48(7):1583–1589

    Article  Google Scholar 

  9. Denard PJ, Ladermann A, Burkhart SS (2012) Long-term outcome after arthroscopic repair of type II SLAP lesions: results according to age and workers’ compensation status. Arthroscopy 28(4):451–457

    Article  Google Scholar 

  10. Dunne KF, Knesek M, Tjong VK, Riederman BD, Cogan CJ, Baker HP, Kahlenberg CA, Gryzlo S, Terry MA (2021) Arthroscopic treatment of type II superior labral anterior to posterior (SLAP) lesions in a younger population: minimum 2-year outcomes are similar between SLAP repair and biceps tenodesis. Knee Surg Sports Traumatol Arthrosc 29(1):257–265

    Article  Google Scholar 

  11. Erickson BJ, Jain A, Abrams GD, Nicholson GP, Cole BJ, Romeo AA, Verma NN (2016) SLAP lesions: trends in treatment. Arthroscopy 32(6):976–981

    Article  Google Scholar 

  12. Fitzpatrick S, Bishop JY, Cvetanovich GL (2021) SLAP tear diagnosis and management. The management of biceps pathology. Springer, pp 125–136

    Chapter  Google Scholar 

  13. Freijomil N, Peters S, Millay A, Sinda T, Sunset J, Reiman MP (2020) The success of return to sport after superior labrum anterior to posterior (slap) tears: a systematic review and meta-analysis. Int J Sports Phys Ther 15(5):659–670

    Article  Google Scholar 

  14. Gorantla K, Gill C, Wright RW (2010) The outcome of type II SLAP repair: a systematic review. Arthroscopy 26(4):537–545

    Article  Google Scholar 

  15. Hong KJ, Kim DS, Shin JS, Kang SK (2017) A comparison between arthroscopic biceps tenodesis and arthroscopic repair in isolated type 2 superior labrum anterior and posterior lesions. Clin Shoulder Elbow 20(1):24–29

    Article  Google Scholar 

  16. Hurley ET, Fat DL, Duigenan CM, Miller JC, Mullett H, Moran CJ (2018) Biceps tenodesis versus labral repair for superior labrum anterior-to-posterior tears: a systematic review and meta-analysis. J Shoulder Elbow Surg 27(10):1913–1919

    Article  Google Scholar 

  17. Jo YH, Oh HK, Jeong SY, Lee BG (2020) National trends in the repair of isolated superior labral tear from anterior to posterior in Korea. J Korean Med Sci 35(34):e285

    Article  Google Scholar 

  18. Kartus J, Kartus C, Brownlow H, Burrow G, Perko M (2004) Repair of type-2 SLAP lesions using Corkscrew anchors. A preliminary report of the clinical results. Knee Surg Sports Traumatol Arthrosc 12(3):229–234

    Article  Google Scholar 

  19. Katz LM, Hsu S, Miller SL, Richmond JC, Khetia E, Kohli N, Curtis AS (2009) Poor outcomes after SLAP repair: descriptive analysis and prognosis. Arthroscopy 25(8):849–855

    Article  Google Scholar 

  20. Kwon J, Kim YH, Yeom TS, Oh JH (2015) Age-related outcome of arthroscopic repair of isolated type ii superior labral anterior to posterior lesions. Clin Shoulder Elbow 18(1):36–42

    Article  Google Scholar 

  21. Lim S, Kim SK, Kim YS (2020) Comparison between SLAP repair and biceps tenodesis with concomitant rotator cuff repair in patients older than 45 years: minimum 2-year clinical and imaging outcomes. Clin Orthop Surg 12(3):364–370

    Article  Google Scholar 

  22. 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

    Article  Google Scholar 

  23. McReynolds JG, Bonner KF, Akehi K, Friesen L, Hilliard A, Crockett HC (2020) Superior labrum tear anterior to posterior repair versus biceps tenodesis with concomitant rotator cuff repair in patients older than 40 years of age: no difference in outcomes. J Orthop Physician Assist 8(3):e19

    Google Scholar 

  24. Michener LA, McClure PW, Sennett BJ (2002) American shoulder and elbow surgeons standardized shoulder assessment form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg 11(6):587–594

    Article  Google Scholar 

  25. Molnar S, Hunya Z, Pavlik A, Bozsik A, Shadgan B, Maffulli N (2020) SLAP lesion and injury of the proximal portion of long head of biceps tendon in elite amateur wrestlers. Indian J Orthop 54(3):310–316

    Article  Google Scholar 

  26. Murphy GT, Lam P, Murrell GAC (2021) Stiffness: friend or foe? A cohort study evaluating the effect of early postoperative stiffness on the outcomes of patients who underwent superior labral repair. J Shoulder Elbow Surg 30(5):1018–1024

    Article  Google Scholar 

  27. Neri BR, Vollmer EA, Kvitne RS (2009) Isolated type II superior labral anterior posterior lesions: age-related outcome of arthroscopic fixation. Am J Sports Med 37(5):937–942

    Article  Google Scholar 

  28. Provencher MT, McCormick F, Dewing C, McIntire S, Solomon D (2013) A prospective analysis of 179 type 2 superior labrum anterior and posterior repairs: outcomes and factors associated with success and failure. Am J Sports Med 41(4):880–886

    Article  Google Scholar 

  29. Schroder CP, Skare O, Gjengedal E, Uppheim G, Reikeras O, Brox JI (2012) 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. Arthroscopy 28(11):1601–1607

    Article  Google Scholar 

  30. Seneviratne A, Montgomery K, Bevilacqua B, Zikria B (2006) Quantifying the extent of a type II SLAP lesion required to cause peel-back of the glenoid labrum—a cadaveric study. Arthroscopy 22(11):1163.e1-1163.e6

    Article  Google Scholar 

  31. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ (1990) SLAP lesions of the shoulder. Arthroscopy 6(4):274–279

    Article  CAS  Google Scholar 

  32. Sullivan S, Hutchinson ID, Curry EJ, Marinko L, Li X (2019) Surgical management of type II superior labrum anterior posterior (SLAP) lesions: a review of outcomes and prognostic indicators. Phys Sportsmed 47(4):375–386

    Article  Google Scholar 

  33. Tashjian RZ, Deloach J, Green A, Porucznik CA, Powell AP (2010) Minimal clinically important differences in ASES and simple shoulder test scores after nonoperative treatment of rotator cuff disease. J Bone Jt Surg Am 92(2):296–303

    Article  Google Scholar 

  34. Thayaparan A, Yu J, Horner NS, Leroux T, Alolabi B, Khan M (2019) Return to sport after arthroscopic superior labral anterior-posterior repair: a systematic review. Sports Health 11(6):520–527

    Article  Google Scholar 

  35. Weick JW, Workman WB, Bush CJ, McCollum KA, Sugaya H, Freehill MT (2021) Reported technical aspects of type II SLAP lesion repairs in athletes. Arthroscopy Sports Med Rehabil 3(2):e289–e296

    Article  Google Scholar 

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Acknowledgements

We would like to thank Editage (www.editage.co.kr) for English language editing.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, 06351, Seoul, South Korea

    Su Cheol Kim, Il Su Kim, Sang Min Lee & Jae Chul Yoo

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  1. Su Cheol Kim
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  2. Il Su Kim
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Correspondence to Jae Chul Yoo.

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IRB: Samsung Medical Center IRB no. 2020-11-110-001.

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Kim, S.C., Kim, I.S., Lee, S.M. et al. Posterior repair of isolated type 2 superior labrum anterior–posterior lesion prevents external rotation deficiency: long-term outcome study. Knee Surg Sports Traumatol Arthrosc 29, 2656–2664 (2021). https://doi.org/10.1007/s00167-021-06608-6

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