Arthroscopic SLAP repair yields mostly favorable outcomes

Although most patients with type II superior labral anterior posterior (SLAP) lesions who are treated arthroscopically can expect good results, athletes with a distinct traumatic etiology have a significantly greater likelihood of a successful return to sports, said the authors of a study presented at the AAOS 75th Annual Meeting.

“The return to competition in the traumatic cohort was 92 percent,” reported primary author Stephen F. Brockmeier, MD, “as compared to only 64 percent in those patients without an inciting trauma.” He pointed out that these results may be used to more accurately guide patient and physician expectations regarding outcomes and return to activities after arthroscopic SLAP repair.

The patient cohort
From an institutional review board-approved prospective labral repair/shoulder stabilization registry composed of patients who were diagnosed preoperatively with a symptomatic labral tear (Fig. 1) and treated with arthroscopic labral repair using suture anchor fixation and arthroscopic knot-tying techniques, researchers identified a consecutive series of 79 patients who underwent arthroscopic repair of a type II SLAP lesion (Fig. 2). Patients with concomitant comorbidities (shoulder instability or rotator cuff tears) treated at the time of surgery were excluded, leaving 61 patients in the study group, 47 of whom were available for follow-up at a minimum of 2 years (mean 2.69, years; range, 2.01 to 4.06 years).

Of the 47 participants, 34 participated in athletics prior to their injury, including 28 overhead athletes. A distinct traumatic injury was reported by 25 patients, while the remaining 22 patients noted an insidious onset of symptoms with no inciting trauma. Each of these patients had been involved in athletics, 20 of them in overhead sports.

Prior to surgery, patients completed a series of questionnaires and validated outcomes measures, including the American Shoulder and Elbow Surgeons (ASES) and L’Insalata outcomes tools, which served as the baseline data for comparison to the postoperative findings.

At the 2-year follow-up evaluations, patients again completed the ASES and L’Insalata questionnaires, and underwent evaluation by an independent examiner.

Majority of patients returned to former level of activity
Researchers found a significant improvement in mean ASES and L’Insalata scores at the 2-year follow-up (Table 1). Patient-reported satisfaction averaged 8.3 (of 10); there were 41 (87 percent) good-to-excellent outcomes. Average patient-reported satisfaction was significantly higher in patients with a discrete trauma etiology (9.01 versus 7.48); however, there was no significant difference in ASES or L’Insalata outcome scores when comparing these groups.

Statistical analysis did not reveal any significant differences in outcomes due to gender, sidedness, arm dominance, number of anchors utilized, use of metal or bioabsorbable anchors, or performance of concomitant procedures such as bursectomy, acromioplasty, or rotator cuff débridement.

Overall, 74 percent of patients involved in athletics were able to return to their prior level of competition; among patients with a distinct traumatic etiology, 92 percent returned to sports. Five patients had complications, including 4 cases of refractory postoperative stiffness, one of which required surgical intervention to regain motion; 1 patient had a traumatic reinjury that required repeat repair.

Dr. Brockmeier’s coauthors are James E. Voos, MD; Riley J. Williams, MD; David W. Altchek, MD; Stephen J. O’Brien, MD; Frank A. Cordasco, MD; and Answorth A. Allen, MD.

Disclosure information for the authors can be found at www.aaos.org/disclosure

Jennie McKee is a staff writer for AAOS Now. She can be reached at mckee@aaos.org