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Bajaj S, Kumar S, Vattoth AL, Singh S, Bajaj M, Barfoot G, Bajaj G. Imaging of Shoulder Labral Injuries in Athletes: A Comprehensive Review. Semin Ultrasound CT MR 2025:S0887-2171(25)00010-1. [PMID: 40204115 DOI: 10.1053/j.sult.2025.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2025]
Affiliation(s)
- Suryansh Bajaj
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR - 72211.
| | - Shruti Kumar
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR - 72211
| | | | - Shiva Singh
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR - 72211
| | - Mahek Bajaj
- Royal College of Surgeons in Ireland, Dublin 2, D02, YN77
| | - Garrett Barfoot
- Ross University School of Medicine, Lloyd Erskine Sandiford Centre at Two Mile Hill, St. Michael, Barbados, BB11093
| | - Gitanjali Bajaj
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR - 72211
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Garrett CH, Dugas JR. Superior Labrum Anterior to Posterior Lesions and Capsular Injuries in the Throwing Athlete. Clin Sports Med 2025; 44:215-231. [PMID: 40021253 DOI: 10.1016/j.csm.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2025]
Abstract
This article focuses on the history, pathoanatomy, clinical examination, management, and rehabilitation of superior labrum anterior to posterior (SLAP) tears in throwing athletes. Additionally, the authors have outlined how to identify and manage capsular injuries in throwing athletes. The study goes into detail about the different surgical options for SLAP lesions including the evolution of SLAP repairs and the role of biceps tenodesis in these patients.
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Affiliation(s)
- Christopher H Garrett
- Andrews Sports Medicine and Orthopaedic Center, 805 St. Vincent's Drive, Suite 100, Birmingham, AL 35205, USA.
| | - Jeffrey R Dugas
- Andrews Sports Medicine and Orthopaedic Center, 805 St. Vincent's Drive, Suite 100, Birmingham, AL 35205, USA. https://twitter.com/JeffDugasMD
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Rowe DG, Hurley ET, Bethell MA, Lorentz SG, Meyer AM, Klifto CS, Lau BC, Taylor DC, Dickens JF. Return to Play After Arthroscopic Superior Labral Repair: A Systematic Review. Am J Sports Med 2025; 53:727-733. [PMID: 39751378 DOI: 10.1177/03635465241246122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Abstract
BACKGROUND Superior labral tears are common shoulder injuries among athletes, and for athletes undergoing surgical intervention, one of the main priorities is to return to preinjury levels of activity in a timely manner. However, the literature surrounding return to play after superior labral repair presents inconsistent results, with limited studies evaluating the timing of return to play. PURPOSE To systematically review the rate and timing of return to play in athletes after arthroscopic superior labral repair. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic literature search was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using the PubMed, EMBASE, and Cochrane Library databases. Eligible for inclusion were clinical studies reporting on return to play after arthroscopic superior labral repair. Subgroup analysis was conducted for overhead and collision athletes as well as for return to duty among military personnel. Meta-analysis was performed using Review Manager to compare superior labral repair to biceps tenodesis in the subset of studies comparing these treatments directly. A P value <.05 was considered to be statistically significant. RESULTS This review identified 42 studies including 1759 unique cases meeting the inclusion criteria. The majority of patients were male (76.7%), with a mean age of 31.5 years (range, 15-75 years) and a mean follow-up of 50.4 months. The overall rate of return to sport was 77.5%, with 68.2% returning to the same level at a mean of 8.2 months. In overhead athletes, the overall rate of return to play was 69.9% and the rate of return to preinjury level was 55.5%. In collision and contact athletes, the overall rate of return to play was 77.2% and the rate of return to preinjury level was 70.2%. Among military personnel, the overall rate of return to duty was 83.4%, and 81.7% returned to preinjury level at a mean of 4.4 months. In the studies comparing return to play after superior labral repair and biceps tenodesis, a nonsignificant difference was found (risk ratio, 0.92; 95% CI, 0.85-1.00; I2 = 13%; P = .05). CONCLUSION Overall, nearly a quarter of athletes were unable to return to play after arthroscopic superior labral repair. However, a high rate of return to duty was found among the military population treated with arthroscopic superior labral repair.
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Affiliation(s)
- Dana G Rowe
- Duke University School of Medicine, Durham, North Carolina, USA
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Eoghan T Hurley
- Duke University School of Medicine, Durham, North Carolina, USA
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Mikhail A Bethell
- Duke University School of Medicine, Durham, North Carolina, USA
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Samuel G Lorentz
- Duke University School of Medicine, Durham, North Carolina, USA
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Alex M Meyer
- Duke University School of Medicine, Durham, North Carolina, USA
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Christopher S Klifto
- Duke University School of Medicine, Durham, North Carolina, USA
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Brian C Lau
- Duke University School of Medicine, Durham, North Carolina, USA
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Dean C Taylor
- Duke University School of Medicine, Durham, North Carolina, USA
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jonathan F Dickens
- Duke University School of Medicine, Durham, North Carolina, USA
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Peng Y, Zhang F, Fu Y, Qi W, Li J, Luo J, Liu X, Tang X, Zhang Q. The Superior Glenoid Humeral Ligament's Role in Superior Labrum Anterior-Posterior Lesions and Subtype Classification Based on Arthroscopic Views: A Multicenter, Retrospective Study. Orthop J Sports Med 2025; 13:23259671241303464. [PMID: 39839980 PMCID: PMC11748399 DOI: 10.1177/23259671241303464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 06/04/2024] [Indexed: 01/23/2025] Open
Abstract
Background Superior labrum anterior-posterior (SLAP) lesions are common shoulder injuries. The 10-type classification system has been widely used to diagnose SLAP lesions since it was proposed. However, growing evidence from arthroscopic studies indicates the existence of many SLAP lesions, especially those associated with superior glenoid humeral ligament (SGHL) injuries, that were not included in the initial classification. Purpose To introduce a SLAP classification associated with SGHL injury based on arthroscopic views and discuss the injury mechanism and corresponding treatment options. Study Design Cross-sectional study; Level of evidence, 3. Methods Patients with SLAP lesions who underwent shoulder arthroscopic surgical treatment between June 2011 and January 2017 in 6 level 1 centers were evaluated in this study. Preoperative radiographs and magnetic resonance imaging scans were used to diagnose SLAP lesions, and arthroscopic views from the standard posterior portal were recorded. The traditional 10-type classification system for SLAP was used to classify these cases. A classification method for SLAP lesions associated with SGHL injury was introduced. This classification system was investigated by 4 observers to evaluate inter- and intraobserver reliability (kappa coefficient [κ]). Results A total of 828 patients were included in this analysis; 61 patients (7.4%) could not be classified by the 10-type traditional classification, and 44 patients (5.3%) had SGHL lesions. A novel classification for 3 subtypes of SLAP with SGHL lesions was introduced. The mean κ value of the interobserver reliability for the classification approach was 0.796 (range, 0.678-0.854), indicating substantial agreement. The mean κ value for the intraobserver reliability was 0.883 (range, 0.779-0.964), indicating excellent agreement. Conclusion This study demonstrated a novel classification system for SLAP lesions associated with SGHL injury by introducing a series of cases with characteristics that showed high inter- and intraobserver reliability. Such cases have not been reported before, and the classification correlates with surgical treatment. This classification may be used as a supplement to the traditional 10-type classification.
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Affiliation(s)
- Ye Peng
- Department of Orthopaedic Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Fei Zhang
- Department of Orthopaedic Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Yangmu Fu
- Department of Orthopaedic Surgery, Hainan Hospital of Chinese People’s Liberation Army General Hospital, Sanya, China
| | - Wei Qi
- Department of Orthopaedic Surgery, Fourth Medical Center of People’s Liberation Army General Hospital, Beijing, China
| | - Ji Li
- Department of Orthopaedic Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Jiwei Luo
- Department of Orthopaedics, Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xinwei Liu
- Department of Orthopaedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Xin Tang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopaedics, West China Hospital, Chengdu, China
| | - Qiang Zhang
- Department of Orthopaedic Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
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Yaka H, Erdem TE, Özer M, Kanatli U. Can the presence of SLAP-5 lesions be predicted by using the critical shoulder angle in traumatic anterior shoulder instability? Skeletal Radiol 2025; 54:49-55. [PMID: 38758391 DOI: 10.1007/s00256-024-04708-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/03/2024] [Accepted: 05/12/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE Although SLAP-5 lesions are associated with recurrent dislocations, their causes and pathomechanisms have not been fully elucidated. This study aimed to investigate the association between SLAP-5 lesions and scapular morphology in traumatic anterior shoulder instability (ASI). We hypothesized that there may be a relationship between SLAP-5 lesions and scapular morphology in traumatic ASI patients. MATERIALS AND METHODS The study included 74 patients with isolated Bankart lesions and 69 with SLAP-5 lesions who underwent arthroscopic labral repair for ASI. Critical shoulder angle (CSA) was measured on the roentgenograms, while glenoid inclination (GI) and glenoid version (GV) were measured on magnetic resonance imaging (MRI) by two observers in two separate sessions blinded to each other. Both groups were compared in terms of CSA, GI, and GV. RESULTS The mean ages of Bankart and SLAP-5 patients were 28.4±9.1 and 27.9±7.7 (P=0.89), respectively; their mean CSA values were 33.1°±2.6° and 28.2°±2.4°, respectively (P<0.001). The ROC analysis's cut-off value was 30.5°, with 75.0% sensitivity and 76.7% specificity (AUC = 0.830). SLAP-5 lesions were more common on the dominant side than isolated Bankart lesions (P=0.021), but no difference was found between the groups in terms of GI and GV (P=0.334, P=0.081, respectively). CONCLUSIONS In ASI, low CSA values appeared to be related to SLAP-5 lesions, and the cut-off value of CSA for SLAP lesion formation was 30.5° with 75.0% sensitivity and 76.7% specificity. Scapula morphology may be related to the SLAP-5 lesions, and CSA can be used as an additional parameter in provocative diagnostic tests and medical imaging techniques for the detection of SLAP lesions accompanying Bankart lesions. LEVEL OF EVIDENCE III retrospective case-control study.
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Affiliation(s)
- Haluk Yaka
- Department of Orthopaedics & Traumatology, School of Medicine, Necmettin Erbakan University, Konya, Turkey.
| | - Turgut Emre Erdem
- Department of Orthopaedics & Traumatology, Pazarcık State Hospital, Kahraman Maraş, Turkey
| | - Mustafa Özer
- Department of Orthopaedics & Traumatology, School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ulunay Kanatli
- Department of Orthopaedics & Traumatology, Gazi University School of Medicine, Ankara, Turkey
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Mitsui Y, Funakoshi T, Miyamoto A, Higuchi K, Hara K, Nakamura H, Gotoh M. Clinical outcomes and return-to-play in dynamic anterior glenohumeral capsular ligament tensioning procedure for overhead-throwing athletes with traumatic shoulder dislocation on the throwing side. J Shoulder Elbow Surg 2024:S1058-2746(24)00866-8. [PMID: 39622356 DOI: 10.1016/j.jse.2024.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 09/24/2024] [Accepted: 09/24/2024] [Indexed: 02/04/2025]
Abstract
BACKGROUND Although arthroscopic Bankart repair for shoulder instability after a traumatic shoulder dislocation is a standard procedure, return-to-play rates for overhead-throwing athletes with shoulder instability on the throwing side have been reported to be lower than those in nonoverhead athletes or in nonthrowing shoulders. A recent technical report showed that the dynamic anterior glenohumeral capsular ligament tensioning (DAGHT) procedure in abducted external rotation, which mimics the late cocking phase of the throwing motion during surgery, may provide optimal tensioning of the anterior glenohumeral ligament. This study compared clinical outcomes and return-to-play after arthroscopic Bankart repair between DAGHT and a conventional procedure for overhead-throwing athletes with traumatic dislocation on the throwing side. METHODS We retrospectively examined patients with traumatic anterior shoulder dislocation who underwent arthroscopic Bankart repair. The inclusion criteria were being an overhead-throwing athlete, having the injury on the throwing side, evidence of anterior shoulder dislocation, and evidence of Bankart lesions on magnetic resonance imaging. Clinical scores were evaluated using Jobe's postoperative grading system; the Kerlan-Jobe Orthopaedic Clinic Overhead Athletes Shoulder and Elbow Score; the Western Ontario Shoulder Instability Index; the Disabilities of the Arm, Shoulder, and Hand sports module; return to play; and return to the same level. RESULTS Thirty-four patients (8 females and 26 males; mean age, 18.0 ± 4.0 years) were divided into 2 groups: 16 with shoulder stabilization in the resting position (control group) and 18 with shoulder stabilization with DAGHT (DAGHT group). Jobe's score was significantly greater in the DAGHT group than in the control group (88.9% and 18.8% in excellent rate, respectively; P < .001). External rotation at abduction and the Kerlan-Jobe Orthopaedic Clinic, Western Ontario Shoulder Instability Index, and Disabilities of the Arm, Shoulder, and Hand scores were significantly greater in the DAGHT group than in the control group (94.5 vs. 85.0; 81.1 vs. 55.7; 83.8 vs. 58.4; 11.8 vs. 27.0; P = .008, <.001, <.001, and =.019, respectively). Although return-to-play rates were not significantly different between the control and DAGHT groups (93.8% vs. 100%; P = .47), return-to-the-same-level rates were significantly better in the DAGHT group than in the control group (77.8% vs. 37.5%; P = .035). CONCLUSION Arthroscopic shoulder stabilization with the DAGHT procedure on the throwing side of overhead-throwing athletes resulted in lesser restriction of external rotation, better clinical outcomes, and higher return-to-the-same-level rate than arthroscopic shoulder stabilization with conventional tensioning. The DAGHT procedure in abduction and external rotation may represent a solution for a traumatic shoulder instability on the throwing side in overhead-throwing athletes.
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Affiliation(s)
| | | | - Azusa Miyamoto
- Hyakutake Orthopaedic Hospital, Saga, Japan; Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | | | - Koji Hara
- Hyakutake Orthopaedic Hospital, Saga, Japan
| | - Hidehiro Nakamura
- Department of Orthopaedic Surgery, Kurume University Medical Center, Fukuoka, Japan
| | - Masafumi Gotoh
- Department of Orthopaedic Surgery, Kurume University Medical Center, Fukuoka, Japan
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Parnes N, Magnuson JA, Hettrich CM, Oh LS, Klahs KJ, Moses AD, Scanaliato JP. Establishing Clinical Significance for Patients Undergoing Arthroscopic Repair of Type II SLAP Lesions. Orthop J Sports Med 2024; 12:23259671241286520. [PMID: 39534389 PMCID: PMC11555730 DOI: 10.1177/23259671241286520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/15/2024] [Indexed: 11/16/2024] Open
Abstract
Background Type II superior labrum anterior to posterior (SLAP) lesions may be treated with either arthroscopic repair or biceps tenodesis. There are no previous reports of measures of clinically significant improvement after arthroscopic repair of SLAP lesions. Purpose To establish the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) for patients undergoing arthroscopic repair for type II SLAP lesions. Study Design Case series; Level of evidence, 4. Methods A total of 69 arthroscopic repair procedures for isolated type II SLAP lesions were performed in a military population. The mean age was 28.1 ± 4.7 years, 97.1% were male, and the mean follow-up was 99.5 ± 19.7 months. The MCID, PASS, and SCB were calculated for each patient-reported outcome measure, consisting of the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) for pain, using anchor- and distribution-based models. Factors associated with achieving a clinically relevant improvement were also determined. Results The MCID, PASS, and SCB for each measure were as follows: 7.7, 70, and 34 for the ASES score, respectively; 10.4, 80, and 45 for the SANE, respectively; and 1.0, 4, and 6 for the VAS pain, respectively. At least 85% of patients achieved the MCID for each measure; however, PASS rates were lower, with 50.7% for the SANE and 69.6% for both the ASES score and VAS pain. The ASES score had the highest percentage of patients achieving the SCB at 44.9%, followed by the SANE (26.1%) and VAS pain (10.1%). Greater forward flexion at final follow-up was associated with achieving the MCID and PASS for both the ASES score and SANE. Internal rotation stiffness at final follow-up was negatively associated with achieving the PASS for the VAS pain. Combat arms military occupational specialty was associated with a lesser likelihood of achieving the SCB for the ASES score. Conclusion Clinical metrics of improvement were defined for the ASES score, SANE, and VAS pain using the MCID, PASS, and SCB for patients undergoing arthroscopic repair of type II SLAP lesions. Better final range of motion was positively associated with achieving improvement, while high-intensity military duty was negatively associated.
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Affiliation(s)
- Nata Parnes
- Department of Orthopedic Surgery, Carthage Area Hospital, Carthage, New York, USA
| | | | - Carolyn M. Hettrich
- Department of Orthopedic Surgery, Carthage Area Hospital, Carthage, New York, USA
| | - Luke S. Oh
- Rothman Orthopaedic Institute, Orlando, Florida, USA
| | - Kyle J. Klahs
- William Beaumont Army Medical Center, Fort Bliss, Texas, USA
| | | | - John P. Scanaliato
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
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Shirinskiy IJ, Rutgers C, Sierevelt IN, Priester-Vink S, Ring D, van den Bekerom MP, Verweij LP. Ill-defined Return-to-Sport Criteria and Inconsistent Unsuccessful Return Rates Caused by Various Reasons Not Necessarily Related to Treatment After Superior Labral Treatments: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00778-3. [PMID: 39393428 DOI: 10.1016/j.arthro.2024.09.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 09/23/2024] [Accepted: 09/27/2024] [Indexed: 10/13/2024]
Abstract
PURPOSE To determine (1) which criteria are used to determine return to sport (RTS), (2) the number of patients who are unable to RTS after any superior labral pathophysiology treatment, and (3) which reasons are reported for not returning. METHODS A systematic review was performed across 5 databases, including studies that report rates for RTS after any treatment of superior labral pathophysiology. Study quality was assessed using the Methodological Index for Non-Randomized Studies criteria. Definitions for no return to sport (nRTS) were extracted as reported in the studies. The ranges of nRTS and no return to preinjury level (nRTPL) were summarized. Reasons for nRTS and nRTPL were categorized using a predefined coding scheme. RESULTS Among 45 studies with level of evidence ranging from II to IV, 1,857 patients were involved in sports, 78% (n = 1453) of whom underwent superior labral reattachment, 21% (n = 381) biceps tenodesis, and 9.4% (n = 175) nonoperative treatment. None of the studies provided criteria for RTS, and 2 studies provided criteria for return to preinjury level. The ranges of nRTS and nRTPL varied after superior labral reattachment (0-60%, n = 206; 0-89%, n = 424, respectively), biceps tenodesis (0-25%, n = 43; 3, 8%-48%, n = 78), and nonoperative treatment (11%-75%, n = 62; 18%-100%, n = 78). Reasons for nRTS and nRTPL were related to physical sensations (pain, feeling of instability, discomfort, weakness, lack of motion), psychological factors (fear of reinjury, lack of confidence), personal factors (lifestyle change, social reasons), and injury at another site. CONCLUSIONS Criteria for determining successful RTS and return to preinjury level after superior labral pathophysiology treatment were not reported by most studies. The nRTS and nRTPL rates varied greatly within and between treatments. The reasons for this unsuccessful return were diverse and related to physical sensations, psychological factors, personal factors, and injury unrelated to treatment. LEVEL OF EVIDENCE Level IV, Systematic review of Level II-IV studies.
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Affiliation(s)
- Igor J Shirinskiy
- Faculty of Behavioral and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Shoulder and Elbow Unit, Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands.
| | - Cain Rutgers
- Faculty of Behavioral and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Shoulder and Elbow Unit, Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands; Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands
| | - Inger N Sierevelt
- Department of Orthopaedic Surgery, Xpert Clinics, Amsterdam, The Netherlands; Department of Orthopedic Surgery, Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | | | - David Ring
- The University of Texas at Austin, Austin, Texas, U.S.A
| | - Michel Pj van den Bekerom
- Faculty of Behavioral and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Shoulder and Elbow Unit, Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands; Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands
| | - Lukas Pe Verweij
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands; Amsterdam UMC, Location AMC, Department of Orthopedic Surgery and Sports Medicine, University of Amsterdam, Amsterdam, The Netherlands
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Bowering AW, Bolt BN, Donaghy CG, Smith NC. Inter-rater and intrarater reliability of superior labrum anterior to posterior lesion classification using magnetic resonance arthrography. JSES Int 2024; 8:1051-1054. [PMID: 39280140 PMCID: PMC11401568 DOI: 10.1016/j.jseint.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024] Open
Abstract
Background The glenoid labrum is a fibrocartilaginous ring that affixes the joint capsule and ligaments of the glenohumeral joint. Superior labrum anterior to posterior (SLAP) lesions are a subset of injuries that affect the superior glenoid labrum, most common in laborers and overhead-throwing athletes. In 1990, Snyder et al classified SLAP lesions into one of four types. Later, Maffet et al expanded this scale to include three additional subclassifications. At present, arthroscopy is considered the gold standard for SLAP tear diagnosis. Classification under arthroscopy has demonstrated low to moderate inter-rater reliability. Magnetic resonance arthrography (MRa) is an alternate, less invasive test for diagnosing SLAP lesions. The reliability of MRa for diagnosing slap tears is uncertain. Methods Magnetic resonance arthrograms were identified using the Picture Archiving and Communication System (PACS). In total, 273 shoulder arthrograms were reviewed, and 20 were selected with the desired pathology. Three orthopedic surgeons and three musculoskeletal radiologists were asked to classify the SLAP lesions into one of seven categories (Snyder & Maffet classification systems). Data was collected on two separate occasions at an interval of at least two months. Inter-rater and intrarater reliability were calculated using Fleiss Kappa and Cohen's Kappa, respectively. Results Between all raters, there was poor inter-rater reliability for each round of data collection (κ = .177, κ = .124 for rounds 1 and 2, respectively). Between orthopedic surgeons, there were poor levels of agreement (κ = -.056, κ = .114), whereas, between radiologists, there was fair to moderate agreement (κ = 0.479, κ = 0.340). Within orthopedic raters, κ values ranged from -0.059 to 0.125, indicating, at best, poor intrarater reliability. Within radiologists, κ values ranged from 0.545 to 0.553, indicating moderate agreement within raters. The analysis determined that none of the orthopedic values for inter or intrarater reliability could be deemed statistically different from zero. Conclusion Overall, classification using MRa resulted in significant disagreement between and within raters. Trained radiologists demonstrated higher overall levels of agreement than orthopedic surgeons. In summary, when using MRa to assess SLAP lesions, Snyder and Maffet classification demonstrates poor reliability by orthopedic surgeons and moderate reliability when used by musculoskeletal radiologists.
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Affiliation(s)
- Austin W Bowering
- Department of Orthopedic Surgery, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Brittany N Bolt
- Department of Orthopedic Surgery, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Conall G Donaghy
- Department of Orthopedic Surgery, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Nicholas C Smith
- Department of Orthopedic Surgery, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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Bitar IJ, Allende Nores C, Marangoni LD, Bustos DG, Pezzutti L, Bitar LB. Comparison between arthroscopic Bankart repair versus arthroscopic Bankart/SLAP lesion repair in limited-contact athletes with type V SLAP lesion. A prospective cohort study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:3289-3295. [PMID: 39138668 DOI: 10.1007/s00590-024-04072-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 08/05/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE The aim of this study was to compare the functional outcomes, recurrence rate, range of motion (ROM) and return to sports activities between arthroscopic Bankart repair (ABR) versus arthroscopic Bankart/SLAP repair (ABR/S) in limited contact-athletes with a type V SLAP lesion in the scenario of recurrent anterior shoulder instability (RASI). Our hypothesis was that there is no difference between the two treatments. METHODS Two groups of 45 limited-contact athletes with type V SLAP lesion were created. Group 1 underwent an arthroscopic Bankart repair, while group 2 had an arthroscopic Bankart/SLAP repair. The minimum follow-up period was 2 years. The WOSI and ASES scores were used to assess primary functional outcomes. Recurrence rate, ROM and return to sport were also evaluated. RESULTS Significant differences were reported in the WOSI and ASES scores pre- and post-operatively in each group. There were no significant differences between the two groups (P = 0.78 and 0.43). We reported 4 recurrences (8.8 %) in group 1 and 5 (11.1 %) in group 2, with no difference between them (P = 0.62). There were no significant differences between the range of motion of each of the groups as well as between them. More than 90% of the athletes in both groups returned to their previous sporting activities. CONCLUSIONS Limited-contact athletes with RASI who have a type V SLAP lesion as their primary diagnosis can be treated using either ABR or ABR/S with equal efficacy. Both treatment alternatives preserve athlete's function, stability, ROM and return to sport.
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Affiliation(s)
- Iván José Bitar
- Sanatorio Allende, Avenida Hipólito Irigoyen 384, Nueva Córdoba, CP 5000, Córdoba, Argentina.
- , Córdoba, Argentina.
| | - Christian Allende Nores
- Sanatorio Allende, Avenida Hipólito Irigoyen 384, Nueva Córdoba, CP 5000, Córdoba, Argentina
| | - Lucas Daniel Marangoni
- Sanatorio Allende, Avenida Hipólito Irigoyen 384, Nueva Córdoba, CP 5000, Córdoba, Argentina
| | - Damian Gabriel Bustos
- Sanatorio Allende, Avenida Hipólito Irigoyen 384, Nueva Córdoba, CP 5000, Córdoba, Argentina
| | - Luciano Pezzutti
- Sanatorio Allende, Avenida Hipólito Irigoyen 384, Nueva Córdoba, CP 5000, Córdoba, Argentina
| | - Lucia Belen Bitar
- Sanatorio Allende, Avenida Hipólito Irigoyen 384, Nueva Córdoba, CP 5000, Córdoba, Argentina
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Bethell MA, Hurley ET, Rowe D, Crook BS, Cabell G, Klifto CS, Lau BC, Dickens JF, Taylor DC. Type V superior labrum anterior to posterior repair: a systematic review. J Shoulder Elbow Surg 2024; 33:e443-e450. [PMID: 38522776 DOI: 10.1016/j.jse.2024.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND The purpose of this study is to systematically review the evidence in the literature to ascertain the functional outcomes, recurrence rates, and subsequent revision rates following type V superior labrum anterior to posterior (SLAP) repair. METHODS Two independent reviewers performed a literature search based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, utilizing the EMBASE, MEDLINE, and the Cochrane Library Databases. Studies were included if they had clinical outcomes on the patients undergoing type V SLAP repair. Statistical analysis was performed using SPSS (IBM, Armonk, NY, USA). A P value of <.05 was considered to be statistically significant. RESULTS Our review found 13 studies, including 451 shoulders meeting our inclusion criteria. The majority of patients were males (89.3%), with an average age of 25.9 years (range 15-58) and a mean follow-up of 53.8 months. The Rowe score was the most utilized functional outcome score, with a weighted mean of 88.5. Additionally, the mean Constant score was 91.0, the mean American Shoulder and Elbow Surgeons score was 88.3, the mean subjective shoulder value score was 85.5%, and the mean visual analog scale pain score was 1.2. The overall rate of return to play was 84.8%, with 80.2% returning to the same level of play. The overall reoperation rate was 6.1%, with a recurrent dislocation rate of 8.2%. In the studies comparing type V SLAP and isolated Bankart repair, there were statistically insignificant differences in visual analog scale pain scores (mean difference; 0.15, 95% confidence interval, -0.13 to 0.44, I2 = 0%, P = .29) and recurrence rates (risk ratio; 1.38, 95% confidence interval, 0.88-2.15, I2 = 0%, P = .16). CONCLUSION Arthroscopic repair of type V SLAP tears results in excellent functional outcomes, with high return to play rates in athletes. There are low rates of reoperations and recurrent dislocations. Additionally, in comparison to an isolated Bankart repair, SLAP repair does not increase recurrence rates or postoperative pain.
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Affiliation(s)
| | - Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Dana Rowe
- School of Medicine, Duke University, Durham, NC, USA
| | - Bryan S Crook
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Grant Cabell
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Brian C Lau
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jonathan F Dickens
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Dean C Taylor
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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12
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Linscheid LJ, DeShazo SJ, Pescatore SM, Somerson JS. Superior labrum anterior to posterior (SLAP) repair is associated with increased rate of subsequent rotator cuff diagnoses and revision surgery: a propensity-matched comparison. J Shoulder Elbow Surg 2024; 33:1821-1827. [PMID: 38325557 DOI: 10.1016/j.jse.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/28/2023] [Accepted: 12/17/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Surgical management of superior labral anterior to posterior (SLAP) tears remains controversial. Current management utilizes 2 well-established procedures: biceps tenodesis and SLAP repair. This study evaluates the complications associated with arthroscopic SLAP repair vs. an open or arthroscopic biceps tenodesis to further elucidate optimal surgical management. METHODS In this retrospective cohort study, the TriNetX database was utilized to evaluate patients who underwent repair of SLAP lesions (International Classification of Diseases, Tenth Revision code: S43.43) from May 15, 2003, to May 15, 2023. Three patient cohorts were evaluated: those who underwent arthroscopic SLAP repair (Current Procedural Terminology [CPT] code: 29807), those who underwent arthroscopic biceps tenodesis (CPT code: 29828), and those who underwent open tenodesis of the biceps (CPT code: 23430). Cohorts were propensity matched for type 2 diabetes, nicotine dependence, alcohol-related disorders, body mass index, and demographic factors such as age at event, ethnicity, race, and sex. The outcomes evaluated were disruption of surgical wound, deep vein thrombosis, mononeuropathy of upper limb, shoulder contusion, humeral fracture, sepsis, deceased, acute postoperative pain, revision, shoulder stiffness, and rotator cuff strain. All outcomes were evaluated within 1 year postprocedure. RESULTS A total of 11,081 arthroscopic SLAP repairs, 9960 arthroscopic biceps tenodesis, and 9420 open biceps tenodesis were matched. Compared with patients who underwent arthroscopic biceps tenodesis, those who underwent arthroscopic SLAP repair were 1.8 times more likely to undergo revision (2.9% vs. 1.6%, P < .0001). Compared with those who underwent open biceps tenodesis, patients who had SLAP repair performed were 1.4 times more likely to undergo revision (3.1% vs. 2.3%, P = .013) and 1.6 times more likely to have a subsequent rotator cuff strain diagnosis (5.1% vs. 3.2%, P = .0002). Compared with patients who underwent SLAP repair, those who underwent arthroscopic biceps tenodesis exhibited 1.3 times more instances of acute postoperative pain (5.2% vs. 4.0%, P = .011). Similarly, open biceps tenodesis exhibited 1.8 times more instances of acute postoperative pain (6.9% vs. 3.8%, P < .0001) and 1.3 times more shoulder stiffness (11.8% vs. 9.0%, P < .0001). CONCLUSION In the last 20 years, patients who underwent SLAP repair were associated with higher risk of revision surgery and subsequent rotator cuff strain diagnosis. Conversely, patients who underwent biceps tenodesis were associated with higher rates of acute postoperative pain and shoulder stiffness.
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Affiliation(s)
- Laura J Linscheid
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA.
| | - Sterling J DeShazo
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Sabrina M Pescatore
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Jeremy S Somerson
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
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Mansour J, Nassar JE, Estephan M, Boulos K, Daher M. Acromioclavicular joint dislocation and concomitant labral lesions: a systematic review. Clin Shoulder Elb 2024; 27:247-253. [PMID: 38303595 PMCID: PMC11181061 DOI: 10.5397/cise.2023.00640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 02/03/2024] Open
Abstract
Acromioclavicular (AC) joint dislocations frequently co-occur with intra-articular glenohumeral pathologies. Few comprehensive studies have focused on labral tears specifically associated with AC joint trauma. This systematic review will address this gap. A comprehensive electronic search was conducted across PubMed, Cochrane Library, and Google Scholar (pages 1-20) spanning from 1976 to May 19, 2023. Seven studies met the inclusion criteria for this systematic review, consisting of three retrospective studies and four case series. These studies collectively involved 1,044 patients, of whom 282 had concomitant labral lesions. The pooled prevalence of intra-articular labral injuries associated with acute AC joint dislocation was 27%. The prevalence of these labral lesions varied significantly between studies, ranging from 13.9% to 84.0% of patients, depending on the study and the grade of AC joint dislocation. Various types of labral tears were reported, with superior labrum anterior to posterior (SLAP) lesions being the most common. The prevalence of SLAP lesions ranged from 7.2% to 77.4%, with higher grades of AC joint dislocations often associated with a higher prevalence of SLAP tears. Moreover, grade V dislocations exhibited a complete correlation with SLAP tears. The studies yielded contradictory findings regarding older age and higher grades of AC joint dislocation as risk factors for concurrent labral lesions. This review underscores the frequent association between labral lesions and AC joint dislocations, particularly in cases of lower-grade injuries. Notably, SLAP lesions emerged as the predominant type of labral tear.
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Affiliation(s)
- Jad Mansour
- Division of Orthopedic Surgery and Sports Medicine, McGill University Health Centre, Montreal, QC, Canada
| | | | - Michel Estephan
- Division of Orthopedic Surgery and Sports Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Karl Boulos
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Mohammad Daher
- Department of Orthopedic Surgery, Hôtel Dieu de France, Beirut, Lebanon
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Fariyike B, Neal WH, Bi AS, Owusu-Sarpong S, Colasanti CA, Kirschner N, Azam MT, Butler JJ, Stone JW, Kennedy JG. In-Office Needle Arthroscopy for Superior Labral Tear Debridement. Arthrosc Tech 2024; 13:102956. [PMID: 38835456 PMCID: PMC11144941 DOI: 10.1016/j.eats.2024.102956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 01/15/2024] [Indexed: 06/06/2024] Open
Abstract
SLAP tears are a common cause of shoulder pain in overhead athletes. The benefits of in-office nano-arthroscopy include the ability to diagnosis and treat biceps tendinopathy, quicker patient recovery, reduced health care costs, and improved patient satisfaction. This technique can be particularly advantageous in the management of SLAP tears given that magnetic resonance imaging has poor sensitivity without the use of an invasive arthrogram. The purpose of this technical report is to describe our technique for performing in-office nano-arthroscopy for SLAP tears with special consideration of the technique for obtaining adequate local anesthesia, proper indications, and adequate visualization, as well as the advantages of performing these procedures in the office rather than the operating room.
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Affiliation(s)
- Babatunde Fariyike
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - William H.E. Neal
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Andrew S. Bi
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | | | | | - Noah Kirschner
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Mohammad T. Azam
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - James J. Butler
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - James W. Stone
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - John G. Kennedy
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
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15
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Yel I. [Lesions of the rotator cuff and biceps tendon]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:110-118. [PMID: 38231415 DOI: 10.1007/s00117-023-01251-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/18/2024]
Abstract
CLINICAL/METHODOLOGICAL PROBLEM The rotator cuff is a complex anatomical structure and the integrity is pivotal for the shoulder functionality. The pathologies are often multifactorial, resulting from degenerative, vascular, traumatic and mechanical factors. RADIOLOGICAL STANDARD PROCEDURES Radiography, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) form the pillars of radiological diagnostics. Each modality has specific advantages and limitations in the visualization and assessment of pathologies of the rotator cuff and biceps tendon. METHODOLOGICAL INNOVATIONS The MR arthrography offers additional insights in unclear cases by enhancing the differentiation between complete and partial tears. PERFORMANCE The MRI provides detailed information on tendon quality and associated damages, such as muscle atrophy and fat infiltration, making it the preferred method. The use of MR arthrography can identify defects through increased intra-articular pressure or contrast medium leakage. EVALUATION Muscle damage, as induced by edema in acute injuries or fatty degeneration in chronic conditions, can be evaluated using imaging techniques. Special attention is warranted for the infraspinatus, subscapularis and teres minor muscles due to their unique injury patterns and prevalences.
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Affiliation(s)
- I Yel
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland.
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16
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Della Rotonda G, Guastafierro A, Viglione S, Cozzolino A, Russo F, Polito R, Daniele A, Nigro E, Ciccarelli M, Russo R. Long-term results of arthroscopic repair of type II SLAP lesions in sports: assessment of return to pre-injury playing level and critical risk factors for complication. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:433-440. [PMID: 37573541 PMCID: PMC10771416 DOI: 10.1007/s00590-023-03677-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE The management of isolated SLAP lesions is still debated especially in athletes. Aims of the study were: 1. to analyse our algorithm to treat SLAP lesions starting from the selection of patients for surgery and 2. to correlate the familiarity for diabetes and hypothyroid disorders with post-operative results. METHODS Seventy-eight patients with isolated SLAP lesion were arthroscopically treated using knotless anchors and microfractures. All patients had a pre-operative and post-operative clinical examination according to Walch-Duplay, Constant, Rowe and Dash scores and interviewed for familiarity to diabetes and hypothyroid disorders. RESULTS About 68.8% of patients solved pain with rehabilitation. About 29% of patients returned to the sports activities. About 32% of patients were no responder to physiotherapy and were arthroscopically treated. About 53.9% of patients responded excellent, 34.7% good, 3.8% medium and 7.6% poor results according to Walch-Duplay score. The Constant score increased from 64 to 95, the Rowe score from 48 to 96. The outcomes were significantly worse in patients with familiarity for diabetes. CONCLUSIONS Microfractures and knotless anchor give long-term good results for the treatment of SLAP lesions in athletes. The familiarity for diabetes is an important risk factor that can lead to decreased outcomes.
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Affiliation(s)
- G Della Rotonda
- Orthopaedic Department, Pineta Grande Hospital Castel Volturno, Caserta, Italy
| | - A Guastafierro
- Orthopaedic Department, Pineta Grande Hospital Castel Volturno, Caserta, Italy
| | - S Viglione
- Orthopaedic Department, Pineta Grande Hospital Castel Volturno, Caserta, Italy
| | - A Cozzolino
- Orthopaedic Department, Pineta Grande Hospital Castel Volturno, Caserta, Italy
| | - F Russo
- Orthopaedic Department, Pineta Grande Hospital Castel Volturno, Caserta, Italy
| | - R Polito
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università Degli Studi Della Campania, "Luigi Vanvitelli", Naples, Italy
- CEINGE-Biotecnologie Avanzate Scarl, Naples, Italy
| | - A Daniele
- Dipartimento di Scienze e Tecnologie Ambientali Biologiche Farmaceutiche, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Gaetano Salvatore, 486, 80145, Naples, Italy
- CEINGE-Biotecnologie Avanzate Scarl, Naples, Italy
| | - E Nigro
- Dipartimento di Scienze e Tecnologie Ambientali Biologiche Farmaceutiche, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Gaetano Salvatore, 486, 80145, Naples, Italy.
- CEINGE-Biotecnologie Avanzate Scarl, Naples, Italy.
| | - M Ciccarelli
- Orthopaedic Department, Pineta Grande Hospital Castel Volturno, Caserta, Italy
| | - R Russo
- Orthopaedic Department, Pineta Grande Hospital Castel Volturno, Caserta, Italy
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Marjanovič B, Ušaj T, Mirnik N, Todorov R, Nabergoj M. SLAP lesion type IX: case series and a review of literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3337-3346. [PMID: 37076632 DOI: 10.1007/s00590-023-03547-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/10/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE A type IX SLAP (superior labrum anterior to posterior) lesion involves 360° of the glenohumeral labrum. Only rare reports have been published analyzing the risk factors of this lesion and the success of its arthroscopic management. The aim of our study is to evaluate predisposing factors that lead to SLAP IX and to assess the clinical outcome after arthroscopic treatment. Our treatment algorithm is also presented. METHODS We report on a series of six patients treated in our institution between January 2014 and January 2019 who underwent shoulder arthroscopy and were intraoperatively found to have a SLAP lesion type IX. Arthroscopic labral repair and biceps tenodesis were indicated in all patients. American Shoulder and Elbow Surgeons (ASES) Shoulder Score, Rowe Score and Constant Murley Shoulder Score (CS) were used for clinical evaluation. Patients were evaluated preoperatively and at 12 weeks, 1 year and 2 years postoperatively. RESULTS We analyzed six patients of which 83% were males (5/6 patients). The average age at the time of surgery was 37.16 (range 30-42 years). The dominant arm was affected in 50% of patients (3/6 patients). A significant postoperative improvement was seen in all six patients. 83% (5/6) of patients returned to their pre-injury activity level. Average values of all three measured scores show a significant increase comparing preoperative to postoperative period (P-value < 0.05). All patients were able to return to work. CONCLUSIONS The final diagnosis was established intraoperatively as 83% (5/6) of radiology reports differed from subsequent arthroscopic findings. The mechanism of injury in all our cases was high energy trauma with traction, arm in abduction or anteflexion. We observed great success with arthroscopic treatment as high percentage of our patients returned back to work and sports.
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Affiliation(s)
- Benjamin Marjanovič
- Orthopaedic Hospital Valdoltra, Valdoltra Orthopaedic Hospital, Jadranska Cesta 31, 6280, Ankaran, Slovenia.
| | - Tina Ušaj
- Orthopaedic Hospital Valdoltra, Valdoltra Orthopaedic Hospital, Jadranska Cesta 31, 6280, Ankaran, Slovenia
| | - Nino Mirnik
- Orthopaedic Hospital Valdoltra, Valdoltra Orthopaedic Hospital, Jadranska Cesta 31, 6280, Ankaran, Slovenia
| | - Risto Todorov
- University Clinic for Surgical Diseases "St. Naum Ohridski", Bul. 11th October No. 53, 1000, Skopje, North Macedonia
| | - Marko Nabergoj
- Orthopaedic Hospital Valdoltra, Valdoltra Orthopaedic Hospital, Jadranska Cesta 31, 6280, Ankaran, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
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Mercouris P, Mercouris M. Superior labrum anterior to posterior lesions: Part 2 - Classification with arthroscopic correlation. SA J Radiol 2023; 27:2707. [PMID: 38384982 PMCID: PMC10879901 DOI: 10.4102/sajr.v27i1.2707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/27/2023] [Indexed: 02/23/2024] Open
Abstract
The glenoid labrum deepens the glenoid fossa and allows for the attachment of the long head of the biceps tendon and glenohumeral ligaments, contributing to the stability of the glenohumeral joint. The superior labrum is a common site of labral injury. The acronym SLAP (superior labrum anterior to posterior or anteroposterior) lesion was introduced by Snyder and colleagues in 1990 to describe superior labral tears based on arthroscopic evaluation. This original classification has since been expanded, and there are currently 10 types of SLAP lesions. The article will describe and illustrate the 10 types of SLAP lesions by means of colour illustrations, MRI images and correlative arthroscopy images. A practical approach to the assessment of SLAP lesions will be recommended. Contribution The illustrated review functions as a crucial radiological guide for both radiologists and orthopaedic surgeons. The combination of illustrations, MR and correlative arthroscopic images enhances the comprehensive understanding of labral pathology. The value of the review lies in the presentation of imaging findings and classification, coupled with findings on arthroscopy. This understanding is vital in guiding orthopaedic management for patients, ensuring appropriate treatment strategies.
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Affiliation(s)
- Peter Mercouris
- Diagnotic Radiologist, Lake, Smit and Partners, Gateway Private Hospital, Durban, South Africa
| | - Matthew Mercouris
- Department of Orthopaedic, Mitchell’s Plain District Hospital, Cape Town, South Africa
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19
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Hahn AK, Holmberg K, Hammarstedt JE, Philp F, DeMeo P, Lai VJ, Kindya MC, Paci JM, Farrow LD, Vardiabasis N, Nye D, Frey S, Moutzouros V, Purnell GJ, Wang P, Vaccariello M, Schweizer SK, Phillips DJ, Frank DA, Akhavan S. Intraobserver and Interobserver Reliability of the Snyder and Expanded SLAP Classification System: A Video Study. Orthop J Sports Med 2023; 11:23259671231204851. [PMID: 37954863 PMCID: PMC10638887 DOI: 10.1177/23259671231204851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 11/14/2023] Open
Abstract
Background Superior labral anterior and posterior (SLAP) tears are a common finding in overhead athletes. The original classification system produced by Snyder in 1990 contained 4 types of SLAP tears and was later expanded to 10 types. The classification has been challenging because of inconsistencies between surgeons making diagnoses and treatments based on the diagnosis. Furthermore, patient factors-such as age and sports played-affect the treatment algorithms, even across similarly classified SLAP tears. Purpose To (1) assess the interobserver and intraobserver reliability of the Snyder and expanded SLAP (ESLAP) classification systems and (2) determine the consistency of treatment for a given SLAP tear depending on different clinical scenarios. Study Design Cohort study (diagnosis); Level of evidence, 3. Methods A total of 20 arthroscopic surgical videos and magnetic resonance imaging scans of patients with SLAP tears were sent to 20 orthopaedic sports medicine surgeons at various stages of training. Surgeons were asked to identify the type of SLAP tear using the Snyder and ESLAP classifications. Surgeons were then asked to determine the treatment for a SLAP tear using 4 clinical scenarios: (1) in the throwing arm of an 18-year-old pitcher; (2) in the dominant arm of an 18-year-old overhead athlete; (3) a 35-year-old overhead athlete; (4) or a 50-year-old overhead athlete. Responses were recorded, and the cases were shuffled and sent back 6 weeks after the initial responses. Results were then analyzed using the Fleiss kappa coefficient (κ) to determine interobserver and intraobserver degrees of agreement. Results There was moderate intraobserver reliability in both the Snyder and ESLAP classifications (κ = 0.52) and fair interobserver reliability for both classification systems (Snyder, κ = 0.31; ESLAP, κ = 0.30; P < .0001) among all surgeons. Additionally, there was only fair agreement (κ = 0.30; P < .0001) for the treatment modalities chosen by the reviewers for each case. Conclusion This study demonstrated that SLAP tears remain a challenging problem for orthopaedic surgeons in diagnostics and treatment plans. Therefore, care should be taken in the preoperative discussion with the patient to consider all the possible treatment options because this may affect the postoperative recovery period and patient expectations.
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Affiliation(s)
- Alexander K. Hahn
- Investigation performed at the Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Kyle Holmberg
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Jon E. Hammarstedt
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Frances Philp
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Patrick DeMeo
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Vince J. Lai
- Department of Orthopedic Surgery, Mercy, Saint Louis, Missouri, USA
| | | | | | - Lutul D. Farrow
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Darin Nye
- Mercy Health-Tiffin Hospital, Tiffin, Ohio, USA
| | - Steven Frey
- Reconstructive Orthopedics, Cherry Hill, New Jersey, USA
| | | | - Gregory J. Purnell
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Patrick Wang
- MidJersey Orthopaedics, Flemington, New Jersey, USA
| | | | - Scott K. Schweizer
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Dennis J. Phillips
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Darren A. Frank
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Sam Akhavan
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
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20
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Mercouris P, Mercouris M. Superior labrum anterior to posterior lesions: Part 1 - Imaging and anatomy with arthroscopic classification. SA J Radiol 2023; 27:2706. [PMID: 37928928 PMCID: PMC10623653 DOI: 10.4102/sajr.v27i1.2706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/27/2023] [Indexed: 11/07/2023] Open
Abstract
The glenoid labrum deepens the glenoid fossa and allows for the attachment of the long head of the biceps tendon and the glenohumeral ligaments, contributing to the stability of the glenohumeral joint. The superior labrum is a common site of labral injury, especially in athletic activities involving overhead activity. The acronym SLAP (superior labrum anterior to posterior or anteroposterior) lesion was introduced by Snyder and colleagues in 1990 to describe superior labral tears. The article will review the optimal technique to image the glenoid labrum, covering normal labral anatomy with special emphasis on the anatomic variants of the labrum that can be mistaken for SLAP tears by means of colour illustrations, magnetic resonance imaging and correlative arthroscopy images. Contribution The illustrated review functions as a crucial radiological guide for both radiologists and orthopaedic surgeons. The combination of illustrations, MR and correlative arthroscopic images enhances the comprehension of normal labral anatomy and its variants. The review underscores the significance of understanding anatomic variations that may be misinterpreted as pathology. This understanding is vital in guiding orthopaedic management for patients, ensuring appropriate treatment strategies.
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Affiliation(s)
- Peter Mercouris
- Diagnostic Radiologist, Lake, Smit & Partners, Gateway Private Hospital, Durban, South Africa
| | - Matthew Mercouris
- Department of Orthopaedics, Mitchell’s Plain District Hospital, Cape Town, South Africa
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21
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Simon M, Geffel L, Lutter C, Schöffl V. Functional and Sport-Specific Outcome Following Traumatic First-Time Shoulder Dislocation and Arthroscopic Surgical Repair in Rock Climbers. Wilderness Environ Med 2023; 34:303-310. [PMID: 37301627 DOI: 10.1016/j.wem.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/30/2023] [Accepted: 05/01/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Traumatic shoulder dislocations rank among the most common shoulder injuries in climbers, with rising numbers over the last years. The objective of this study was to analyze the outcome following traumatic first-time shoulder dislocation and subsequent surgical treatment in this population. METHODS In a retrospective study, climbers who experienced a traumatic shoulder dislocation were treated with an arthroscopic repair of the labrum-ligament complex (LLC). The functional outcome was assessed with a standardized questionnaire and clinical examination, including the Constant Murley and Single Assessment Numeric Evaluation scores. The sport-specific outcome was analyzed using the Union Internationale des Associations d'Alpinisme (UIAA) scale of difficulty and a sport-specific outcome score. RESULTS The functional and sport-specific outcome for 27 climbers (20 men; 7 women; 3 with bilateral injuries; age, 34±11 [17-61] y; data presented as mean±SD [range]) was assessed 53±29 (12-103) mo after surgery. The postoperative Constant Murley score was 95±8 (67-100) points. At follow-up, 93% (n=25) of patients had started climbing again. Twenty-one climbers (78%) reached a climbing level within the range of ±0.33 UIAA grades of their initial capability or even exceeded their preinjury grade. Only 7% (n=2) of the patients had a recurrent shoulder dislocation, leading to a secondary surgery, and, therefore, required ongoing postoperative treatment at the time of follow-up. CONCLUSIONS Arthroscopic repair of the LLC following first-time traumatic shoulder dislocation in climbers shows a good outcome and a low recurrence rate. After surgery, most patients are able to regain a high level of rock-climbing ability.
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Affiliation(s)
- Michael Simon
- Department of Trauma and Orthopedic Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany.
| | - Leonid Geffel
- Department of Orthopedics and Traumatology, Sozialstiftung Bamberg, Bamberg, Germany
| | - Christoph Lutter
- Department of Orthopedics, University Medical Center Rostock, Rostock, Germany
| | - Volker Schöffl
- Department of Trauma and Orthopedic Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany; Department of Orthopedics and Traumatology, Sozialstiftung Bamberg, Bamberg, Germany; School of Clinical and Applied Sciences, Leeds Becket University, Leeds, United Kingdom; Section Wilderness Medicine, Department of Emergency Medicine, School of Medicine, University of Colorado, Denver, CO
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22
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Dean RS, Onsen L, Lima J, Hutchinson MR. Physical Examination Maneuvers for SLAP Lesions: A Systematic Review and Meta-analysis of Individual and Combinations of Maneuvers. Am J Sports Med 2023; 51:3042-3052. [PMID: 35997579 DOI: 10.1177/03635465221100977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Superior labrum anterior to posterior (SLAP) lesions are targeted on physical examination using a variety of provocative maneuvers. PURPOSE/HYPOTHESIS The purpose was to conduct a systematic review on the performance of physical examination maneuvers in diagnosing SLAP lesions and to perform a meta-analysis comparing the sensitivity and specificity of these examinations both individually and in combination. The null hypothesis stated that there would be no significant difference in the sensitivity or specificity of the included physical examination tests, neither individually nor in combination. STUDY DESIGN Meta-analysis and systematic review; Level of evidence, 4. METHODS A systematic review was performed with the inclusion criteria of studies that reported either the sensitivities and specificities or the number of true-positive, true-negative, false-positive, or false-negative results for at least 1 maneuver for identifying SLAP lesions. A meta-analysis was performed to determine the sensitivity and specificity of individual maneuvers. Additional analysis determined the performance of these maneuvers when combined in series and parallel. In series, all must be present to be considered positive. In parallel, any single positive test forces the overall combination to be considered positive. Only tests that were included in ≥3 studies were considered in the meta-analysis and those included in ≥4 studies were considered in the combination analysis. RESULTS Overall, 862 studies were identified, 18 of which were included in the systematic review and meta-analysis. The physical examinations included were the O'Brien (n = 16), speed (n = 8), Yergason (n = 6), anterior slide (n = 8), crank (n = 7), Jobe (n = 5), dynamic labral shear (n = 3), Kim 2 (n = 3), and biceps groove tenderness tests (n = 3). All combinations of 2 to 5 maneuvers in both series and parallel were considered. The O'Brien and crank test combination was the most sensitive 2-test combination in both parallel and series. The Yergason and anterior slide test combination was the most specific 2-test combination in parallel and series. CONCLUSION This systematic review and meta-analysis reports an updated meta-analysis considering the sensitivity and specificity of common physical examination maneuvers used in the diagnosis of SLAP lesions and considers these values for tests in both series and parallel combinations. The present analysis demonstrates improved specificities when tests are considered in series and improved sensitivities when considered in parallel combination.
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Affiliation(s)
- Robert S Dean
- Department of Beaumont Health, Royal Oak Hospital, Royal Oak, Michigan, USA
| | - Leonard Onsen
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jeniffer Lima
- Department of Family Medicine, Amita St. Mary and Elizabeth Medical Center, Chicago, Illinois, USA
| | - Mark R Hutchinson
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
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23
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Green CK, Scanaliato JP, Sandler AB, Czajkowski H, Rolf RH, Dunn JC, Parnes N. Midterm Outcomes Following Combined Biceps Tenodesis and Anterior Labral Repair in Active Duty Military Patients Younger than 35 Years. Am J Sports Med 2023:3635465231169238. [PMID: 37196664 DOI: 10.1177/03635465231169238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Superior labrum anterior-posterior (SLAP) lesions and anterior instability are common causes of shoulder pain and dysfunction among active-duty members of the United States military. However, little data have been published regarding the surgical management of type V SLAP lesions. PURPOSE To compare the outcomes of arthroscopic-assisted subpectoral biceps tenodesis and anterior labral repair with those of arthroscopic SLAP repair (defined as contiguous repair spanning from the superior labrum to the anteroinferior labrum) for type V SLAP tears in active-duty military patients younger than 35 years. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All consecutive patients from January 2010 to December 2015 who underwent arthroscopic SLAP repair or combined biceps tenodesis and anterior labral repair for a type V SLAP lesion with a minimum 5-year follow-up were identified. The decision to perform type V SLAP repair versus combined biceps tenodesis and anterior labral repair was based on the condition of the long head of the biceps tendon (LHBT). Labral repair was performed in patients who had a type V SLAP tear with an otherwise clinically and anatomically healthy LHBT. Combined tenodesis and repair was performed in patients with evidence of LHBT abnormalities. Outcomes including the visual analog scale (VAS) score, the Single Assessment Numeric Evaluation (SANE) score, the American Shoulder and Elbow Surgeons (ASES) shoulder score, the Rowe instability score, and range of motion were collected preoperatively and postoperatively, and scores were compared between the groups. RESULTS A total of 84 patients met the inclusion criteria for the study. All patients were active-duty service members at the time of surgery. A total of 44 patients underwent arthroscopic type V SLAP repair, and 40 patients underwent anterior labral repair with biceps tenodesis. The mean follow-up was 102.59 ± 20.98 months in the repair group and 94.50 ± 27.11 months in the tenodesis group (P = .1281). There were no significant differences in preoperative range of motion or outcome scores between the groups. Both groups experienced statistically significant improvements in outcome scores postoperatively (P < .0001 for all); however, compared with the repair group, the tenodesis group reported significantly better postoperative VAS (2.52 ± 2.36 vs 1.50 ± 1.91, respectively; P = .0328), SANE (86.82 ± 11.00 vs 93.43 ± 8.81, respectively; P = .0034), and ASES (83.32 ± 15.31 vs 89.90 ± 13.31, respectively; P = .0394) scores. There were no differences in the percentage of patients who achieved the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state for the SANE and ASES between the groups. Overall, 34 patients in each group returned to preinjury levels of work (77.3% vs 85.0%, respectively; P = .3677), and 32 patients (72.7%) in the repair group and 33 patients (82.5%) in the tenodesis group returned to preinjury levels of sporting activity (P = .2850). There were no significant differences in the number of failures, revision surgical procedures, or patients discharged from the military between the groups (P = .0923, P = .1602, and P = .2919, respectively). CONCLUSION Both arthroscopic-assisted subpectoral biceps tenodesis combined with anterior labral repair and arthroscopic SLAP repair led to statistically and clinically significant increases in outcome scores, marked improvements in pain, and high rates of return to unrestricted active duty in military patients with type V SLAP lesions. The results of this study suggest that biceps tenodesis combined with anterior labral repair produces comparable outcomes to arthroscopic type V SLAP repair in active-duty military patients younger than 35 years.
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Affiliation(s)
- Clare K Green
- The George Washington University, Washington, District of Columbia, USA
| | - John P Scanaliato
- William Beaumont Army Medical Center, Fort Bliss, Texas, USA
- Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Alexis B Sandler
- William Beaumont Army Medical Center, Fort Bliss, Texas, USA
- Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Hunter Czajkowski
- Carthage Area Hospital, Carthage, New York, USA
- Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
| | - Robert H Rolf
- Beacon Orthopaedics & Sports Medicine, Cincinnati, Ohio, USA
- TriHealth, Cincinnati, Ohio, USA
| | - John C Dunn
- William Beaumont Army Medical Center, Fort Bliss, Texas, USA
- Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Nata Parnes
- Carthage Area Hospital, Carthage, New York, USA
- Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
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24
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Althoff AD, Brunette C, Brockmeier S. Postoperative Rehabilitation After Superior Labrum Anterior Posterior Repair. Phys Med Rehabil Clin N Am 2023; 34:377-392. [PMID: 37003659 DOI: 10.1016/j.pmr.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
The 4-phase rehabilitation protocol outlined in this article provides a comprehensive 26-week program to return patients with superior labrum anterior posterior repairs to their preinjury states. It is guided by the principle of gradual return to preinjury function while preserving the integrity of the surgical repair. Objective criteria are present at the conclusion of each phase to ensure patients are progressing appropriately. The goal is to allow patients to return to their previous functional ability in their sport-specific or occupational-specific training.
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Affiliation(s)
- Alyssa D Althoff
- Department of Orthopaedic Surgery, University of Virginia, 2280 Ivy Road, Charlottesville, VA, USA.
| | - Colby Brunette
- Department of Orthopaedic Surgery, University of Virginia, 2280 Ivy Road, Charlottesville, VA, USA
| | - Stephen Brockmeier
- Department of Orthopaedic Surgery, University of Virginia, 2280 Ivy Road, Charlottesville, VA, USA
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25
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Funakoshi T, Takahashi T, Shimokobe H, Miyamoto A, Furushima K. Arthroscopic findings of the glenohumeral joint in symptomatic anterior instabilities: comparison between overhead throwing disorders and traumatic shoulder dislocation. J Shoulder Elbow Surg 2023; 32:776-785. [PMID: 36343790 DOI: 10.1016/j.jse.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/21/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The term shoulder instability refers to a variety of mechanisms and clinical presentations. One of the common pathologies of throwing disorders is internal impingement with anterior instability. Most throwing athletes with symptomatic internal impingement with anterior instability exhibit positive apprehension and relocation test results, whereas those with recurrent anterior shoulder instability display positive apprehension test results. While the glenoid labrum-inferior glenohumeral ligament complex is a significant critical stabilizer for the prevention of anterior shoulder dislocation, the characteristics of the essential lesion in internal impingement with anterior instability have not been determined yet. This study aimed to compare the intra-articular lesion of athletes with internal impingement related to the overhead throwing motion in athletes with a traumatic shoulder dislocation. METHODS Sixty-one athletes (all men; mean age, 25.2 ± 12.6 yr) who underwent an arthroscopic procedure were divided into 2 groups: 25 in the throwing group and 36 in the dislocation group. All shoulders had subtle glenohumeral instability defined by a positive anterior apprehension test and a relocation test. Those with voluntary and multidirectional instability and large glenoid bone loss (more than 25%) were excluded from the current study. All shoulders were evaluated for the following evidence: rotator cuff injury, superior labrum tear anterior and posterior lesions, labral pathologies including Bankart lesions, osteochondral lesions to the humeral head, biceps tendon fraying or rupture, and inferior glenohumeral ligament and middle glenohumeral ligament (MGHL) conditions. RESULTS Arthroscopic findings of the throwing group showed more supraspinatus injuries (92% and 25%, P < .001), type II superior labrum tear anterior and posterior lesions (60% and 3%, P < .001), posterosuperior labral lesions (92% and 39%, P < .001), and hypoplastic MGHLs (56% and 6%, P < .001) and lesser Bankart lesions (8% and 92%, P < .05) than those of the dislocation group. CONCLUSIONS These results indicate that the characteristic lesions of internal impingement with anterior instability in throwing athletes include partial thickness rotator cuff tears, superior labrum tear anterior and posterior lesions, posterosuperior labral tears, and hypoplastic MGHLs. As expected, the physiopathology of internal impingement with anterior instability in throwing athletes may be related to the dysfunction of the anterosuperior glenohumeral capsular ligament, including the MGHL, rather than the inferior glenohumeral ligament as in traumatic anterior shoulder dislocations. These findings would be useful for defining treatment strategies for internal impingement with anterior instability in overhead throwing athletes.
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26
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Surgical Treatment of Superior Labral/Biceps Pathology in the Overhead Thrower. J Am Acad Orthop Surg 2023; 31:e424-e434. [PMID: 36727732 DOI: 10.5435/jaaos-d-21-01199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 12/13/2022] [Indexed: 02/03/2023] Open
Abstract
Symptomatic superior labral anterior and posterior (SLAP) tears have become an increasingly common diagnosis, particularly within the competitive overhead athlete population. Type II SLAP tears are the most encountered variant in overhead throwing athletes. Given the high incidence of false positives on advanced imaging, corroborating the history and physical examination with imaging is paramount to accurately establish a SLAP lesion diagnosis. Previous studies have reported conflicting success rates with conservative management, but the number of pitching athletes able to return to prior level of performance with nonsurgical management strategies has been unsatisfactory. Although there has historically been a notable disconnect between the incidence of SLAP tears in the literature and the number of SLAP repairs in recent investigations, high-grade or unstable tears may be candidates for débridement, labral repair, biceps tenodesis, or less frequently, biceps tenotomy. Biceps tenodesis has been increasingly used for the management of these lesions, with recent studies reporting high rates of return to sport, high satisfaction, and good to excellent patient-reported outcomes in carefully selected athletes.
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27
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Amorim E, Maganinho P, Rodrigues-Gomes D, Rodrigues-Gomes S, Sevivas N. Type IX Superior Labrum Anterior and Posterior Lesion in a Professional Football Player: A Rare Pattern of Shoulder Instability in a Non-throwing Athlete. Cureus 2023; 15:e34753. [PMID: 36909022 PMCID: PMC9999051 DOI: 10.7759/cureus.34753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
Anterior shoulder instability is the most frequent type of glenohumeral instability, especially among young athletes. Superior labral anterior-posterior (SLAP) injuries involve the superior glenoid labrum where the long head of the biceps tendon (LHBT) inserts. There is still some debate regarding the pathogenesis, clinical presentation, and treatment of these lesions. We report a clinical case of an 18-year-old male professional football player with a rare type IX SLAP lesion. Given the recurrence of instability after prior nonoperative management, surgical treatment was seen as the best option, and a pan-labral arthroscopic repair suture anchor fixation was performed. Three months after undergoing a personalized postoperative rehabilitation program, he was able to return to full sport with the same competitive level, and no recurrent instability or other symptoms were reported throughout the 18-month follow-up period.
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Affiliation(s)
- Edgar Amorim
- Physical Medicine and Rehabilitation, Hospital de Braga, Braga, PRT
| | - Pedro Maganinho
- Radiology, Centro Hospitalar Universitário do Porto, Porto, PRT
| | | | | | - Nuno Sevivas
- Orthopedics and Traumatology, Centro Hospitalar do Médio Ave, Braga, PRT
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28
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Shin MH, Baek S, Kim TM, Kim H, Oh KS, Chung SW. Biceps Tenodesis Versus Superior Labral Anterior and Posterior (SLAP) Lesion Repair for the Treatment of SLAP Lesion in Overhead Athletes: A Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:3987-3997. [PMID: 34591715 DOI: 10.1177/03635465211039822] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Superior labral anterior and posterior (SLAP) lesions are common injuries in overhead athletes. As a surgical treatment for SLAP lesions, SLAP repair has been traditionally performed. Recently, biceps tenodesis has been performed as an alternative treatment option; however, there is no review for outcome comparisons between these 2 procedures in overhead athletes. PURPOSE The aim of this study was to compare the outcomes of SLAP repair versus biceps tenodesis, especially in overhead athletes with SLAP lesions. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS An electronic literature search was performed in Medline, Embase, Scopus, and the Cochrane Library. The studies were appraised using the Methodological Index for Non-randomized Studies (MINORS) tool. Studies that had a minimum follow-up of 2 years, included only patients with SLAP lesions without other major shoulder pathologies, and included only patients who engaged in overhead sports were included. The functional outcomes of the American Shoulder and Elbow Surgeons (ASES) score, rate of return to sport, rate of return to preinjury level of sport, and complication rate were subjected to meta-analysis. RESULTS A total of 332 articles were identified, and 13 were included in the systematic review. Even though the postoperative ASES scores were slightly higher in the biceps tenodesis group than in the SLAP repair group, no statistically significant differences were found between the groups (biceps tenodesis, 95% CI = 91.71-96.75, I2 = 0.00; SLAP repair, 95% CI = 85.47-94.46, I2 = 16.3; P = .085) The rate of return to sport and the return to preinjury level of sport were slightly higher in the biceps tenodesis group than in the SLAP repair group; however, in meta-analysis these factors did not reach statistical significance (return to sport: biceps tenodesis, 95% CI = 0.66-0.91, I2 = 0.00; SLAP repair, 95% CI = 0.68-0.93, I2 = 70.23; P = .94) (return to preinjury level of sport: biceps tenodesis, 95% CI = 0.61-0.89, I2 = 17.78; SLAP repair, 95% CI = 0.53-0.82, I2 = 58.07; P = .37). The biceps tenodesis group showed a lower complication rate compared with the SLAP repair group without statistical significance (biceps tenodesis, 95% CI = 0.013-0.145, I2 = 0.00; SLAP repair, 95% CI = 0.049-0.143, I2 = 0.00; P = .25). CONCLUSION The results of biceps tenodesis, compared with SLAP repair, were not inferior in the surgical treatment of overhead athletes with SLAP lesions with regard to the ASES score, rate of return to sport, rate of return to preinjury level of sport, and complication rate. Further high-level, randomized controlled studies are needed to confirm this result.
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Affiliation(s)
- Myung Ho Shin
- Department of Orthopaedic Surgery, Konkuk University, School of Medicine, Seoul, Republic of Korea
| | - Samuel Baek
- Department of Orthopaedic Surgery, Konkuk University, School of Medicine, Seoul, Republic of Korea
| | - Tae Min Kim
- Department of Orthopaedic Surgery, Konkuk University, School of Medicine, Seoul, Republic of Korea
| | - HyunTae Kim
- Department of Orthopaedic Surgery, Konkuk University, School of Medicine, Seoul, Republic of Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Konkuk University, School of Medicine, Seoul, Republic of Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University, School of Medicine, Seoul, Republic of Korea
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Jain A, Aniq H, Mistry A. SLAP Injury and the Superior Labrum. Semin Musculoskelet Radiol 2022; 26:577-584. [DOI: 10.1055/s-0042-1758840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AbstractInjuries around the superior labrum are a common cause of shoulder dysfunction and pain. The injuries sustained result mainly from repetitive microtrauma but can also occur following a fall on outstretched hand. Both athletic and general populations can be affected. Injuries to the superior labrum are called superior labrum anterior and posterior (SLAP) tears. Based on cross-sectional imaging findings, the literature defines four main SLAP tears (I–IV) and six extended types (V–X). An accurate description of imaging findings of the SLAP tear type, along with concomitant findings, aids clinicians in treatment planning. We also briefly discuss management options, postoperative appearance of superior labral repair, and the diagnosis of a retear.
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Affiliation(s)
- Abhishek Jain
- Liverpool University Hospitals, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Hifz Aniq
- Liverpool University Hospitals, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Alpesh Mistry
- Liverpool University Hospitals, Royal Liverpool University Hospital, Liverpool, United Kingdom
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30
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Biceps Tenodesis Combined With Arthroscopic Posterior Labral Repair for Type VIII SLAP Lesions in Active-Duty Military Patients Yields Excellent Return to Military Duty. Arthroscopy 2022; 38:2620-2627. [PMID: 35367303 DOI: 10.1016/j.arthro.2022.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To report short-term outcomes following biceps tenodesis combined with arthroscopic posterior labral repair of type VIII SLAP lesions in active-duty military patients. METHODS All consecutive patients from January 2012 through December 2018 who underwent biceps tenodesis combined with arthroscopic posterior labral repair of type VIII SLAP tears performed by the senior surgeon with complete outcome scores and minimum 2.5 years follow-up were identified. Exclusion criteria included concomitant glenoid microfracture, rotator cuff repair, or other capsulolabral repair. Outcome measures were completed by patients within 7 days before surgery and at latest follow-up. Biceps tenodesis performed was a mini-open, through a subpectoral approach, using a double-loaded 2.9mm suture-anchor. RESULTS Thirty-two patients met the inclusion criteria for the study. All patients were active-duty military at time of surgery. Average follow-up was 73.53 ± 22.37 months. Thirty-one patients achieved the minimal clinically important difference, 30 of 32 reached the substantial clinical benefit, and 31 of 32 met the patient acceptable symptomatic state, as defined for the American Shoulder and Elbow Surgeons Shoulder Score. Similarly, 30 of 32 patients reached the minimal clinically important difference, 29 of 32 achieved the substantial clinical benefit, and 32 of 32 met the patient acceptable symptomatic state for the Single Assessment Numeric Evaluation. There were no significant changes in forward flexion, external rotation, or internal rotation between pre- and postoperative measurements. Three patients reported postoperative complications and 1 patient progressed to further surgery. Thirty (93.75%) patients remained on active-duty military service and were able to return to preinjury levels of activity. CONCLUSIONS Active-duty military patients with type VIII SLAP tears had statistically and clinically significant increases in outcome scores, marked improvement in pain, and high rates of return to unrestricted active-duty following mini-open subpectoral biceps tenodesis combined with posterior labral repair. LEVEL OF EVIDENCE IV, retrospective case series.
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31
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Krespi R, Maman E, Factor S, Benshabat D, Dolkart O, Ashkenazi I, Beyth S, Chechik O. Combined Bankart and SLAP repair: patient-reported outcome measurements after a minimum 5-year follow-up. Arch Orthop Trauma Surg 2022; 143:2621-2626. [PMID: 36018369 DOI: 10.1007/s00402-022-04599-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anterior shoulder instability is typically characterized by detachment of the anteroinferior labrum (Bankart lesion). Some patients also sustain a superior labrum anterior-to-posterior (SLAP) injury. The purpose of this study was to compare the medium-term clinical results of isolated anterior Bankart repairs (ABR) with those of combined Bankart and SLAP repair (ABR + SLAP). METHODS Data on all patients treated surgically for recurrent anterior shoulder instability between 2006 and 2011 were retrospectively collected from medical charts. The minimum follow-up was 5 years. Patients were interviewed to assess patient-reported outcome measurements (PROM) as determined by the American Shoulder and Elbow Surgeons Score (ASES), the Subjective Shoulder Score (SSV), and the Disabilities of the Arm, Shoulder, and Hand Score (DASH), as well as their quality of life (QOL: SF12 questionnaire). Information on complications, re-operations, and recurrent instability was recorded and evaluated as well. RESULTS A total of 150 patients (88% males) with a mean age 23.7 years (range 15-40) were included. Forty-two patients following ABR + SLAP repair were compared to 108 patients following ABR alone, with a mean follow-up of 7.8 years (range 5-10.7). The rate of re-dislocation was similar in both groups (26% for ABR + SLAP vs 20% for ABR, p = .44). There were no significant differences in functional outcome between the ABR + SLAP and the ABR alone groups (SSV 86.7 vs 86.5, p = .93, ASES 89.6 vs 86.5, p = .11, and DASH 4.9 vs 7, p = .17), or in QOL outcome (SF12 physical 95.6 vs 93.3, p = .27, SF12 mental 84.4 vs 85.7, p = .63). CONCLUSION Surgical repair for anterior shoulder instability and a coexisting SLAP lesion yields clinical results as good as those of isolated ABR, as evidenced by similar PROM and re-dislocation rates after medium-term follow-up. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Raphael Krespi
- Orthopedic Division, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weitzman St., 6423906, Tel Aviv, Israel
| | - Eran Maman
- Orthopedic Division, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weitzman St., 6423906, Tel Aviv, Israel
| | - Shai Factor
- Orthopedic Division, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weitzman St., 6423906, Tel Aviv, Israel.
| | - Dvir Benshabat
- Orthopedic Division, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weitzman St., 6423906, Tel Aviv, Israel
| | - Oleg Dolkart
- Orthopedic Division, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weitzman St., 6423906, Tel Aviv, Israel
| | - Itay Ashkenazi
- Orthopedic Division, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weitzman St., 6423906, Tel Aviv, Israel
| | - Shaul Beyth
- Department of Orthopedic Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ofir Chechik
- Orthopedic Division, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weitzman St., 6423906, Tel Aviv, Israel
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Hong IS, Meade JD, Young BL, Yu Z, Trofa DP, Fleischli JE, Hamid N, Piasecki D, Saltzman BM. Trends in Repair vs. Biceps Tenodesis for Superior Labrum From Anterior to Posterior (SLAP) Tear: An Epidemiological Study. Cureus 2022; 14:e27096. [PMID: 36017300 PMCID: PMC9393044 DOI: 10.7759/cureus.27096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/05/2022] Open
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Funakoshi T, Furushima K, Takahashi T, Miyamoto A, Urata D, Yoshino K, Sugawara M. Anterior glenohumeral capsular ligament reconstruction with hamstring autograft for internal impingement with anterior instability of the shoulder in baseball players: preliminary surgical outcomes. J Shoulder Elbow Surg 2022; 31:1463-1473. [PMID: 35063639 DOI: 10.1016/j.jse.2021.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/08/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shoulder pain and dysfunction are common in baseball players, and although "internal impingement" is recognized as one of the most common pathologies of shoulder dysfunction, the optimal surgical treatment for internal impingement with anterior instability of the shoulder remains controversial. This study evaluated baseball players' preliminary outcomes following anterior glenohumeral capsular ligament reconstruction for internal impingement with anterior instability of the shoulder. METHODS Twelve baseball players (all male; mean age, 20.5 ± 2.2 years) with internal impingement and anterior instability managed via anterior glenohumeral capsular ligament reconstruction were examined. The mean follow-up period was 25.3 ± 4.6 months. Anterior glenohumeral capsular ligament reconstruction was performed with a knee hamstring autograft for balanced stability and laxity with two major targets: to prevent hyperangulation and translation in horizontal abduction and to mimic the individual arm cocking position at the final decision of tension. Preoperative and final follow-up evaluations were performed using Jobe's postoperative grading system; the Kerlan-Jobe Orthopaedic Clinic Overhead Athletes Shoulder and Elbow Score; Disabilities of the Arm, Shoulder and Hand sports module; plain radiographs; and magnetic resonance imaging. RESULTS Jobe's postoperative grading system score, the Kerlan-Jobe Orthopaedic Clinic Overhead Athletes Shoulder and Elbow Score, and the Disabilities of the Arm, Shoulder and Hand sports module score improved significantly from 20.4 ± 12.2, 28.4 ± 8.3, and 80.2 ± 11.1 points preoperatively to 88.8 ± 13.6, 80.8 ± 7.7, and 22.4 ± 18.7 points postoperatively, respectively (P < .001, .0025, <0.001, respectively). Both clinical and imaging evaluations revealed improved internal impingement with anterior instability after anterior glenohumeral capsular ligament reconstruction. The mean external rotation at abduction significantly decreased from 113° preoperatively to 104° postoperatively. At follow-up, 10 of the 12 athletes (83.3%) returned to their prior competitive level. Plain radiographs and magnetic resonance imaging revealed no obvious loosening of the graft or screws. CONCLUSIONS Anterior glenohumeral capsular ligament reconstruction resulted in preferable clinical outcomes for young baseball players who experienced pain during the throwing motion. Stabilization of the glenohumeral joint with autografting of the knee hamstring may thus represent a solution for internal impingement with anterior instability in overhead throwing athletes.
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Affiliation(s)
| | | | | | | | - Daigo Urata
- Keiyu Orthopaedic Hospital, Tatebayashi, Japan
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Primary Double-Pulley SLAP Repair in an Active-Duty Military Population With Type II SLAP Lesions Results in Improved Outcomes and Low Failure Rates at Minimum Six Years of Follow-up. Arthrosc Sports Med Rehabil 2022; 4:e1141-e1149. [PMID: 35747638 PMCID: PMC9210478 DOI: 10.1016/j.asmr.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/12/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To report mid-term outcomes of active-duty patients younger than the age of 35 years with shoulder type II SLAP lesions following our technique for double-pulley SLAP repair (DPSR). Methods All consecutive patients aged 18 to 35 years from January 2014 through December 2015 who underwent primary DPSR by the senior surgeon with complete outcome scores were identified. The clinical significance measures (patient acceptable symptomatic state [PASS], substantial clinical benefit [SCB], minimal clinically important difference [MCID]) have not yet been fully defined for type II SLAP repair procedures, so the values for biceps tenodesis were used as a stand-in. Patients were excluded if they were lost to follow-up of if they underwent a concomitant rotator cuff repair. Outcome measures were completed by patients within 1 week before surgery and at latest follow-up. Results Overall, 22 of 41 (53.7%) patients met the inclusion criteria for the study, and all were active-duty military at time of surgery. In total, 21 of 22 (95.5%) patients met the PASS, whereas 20 of 22 (90.9%) achieved SCB and 22 of 22 (100.0%) exceeded the MCID for their operative shoulder as determined by the American Shoulder and Elbow Surgeons score. In total, 19 of 22 (86.4%) patients met the PASS, whereas 22 of 22 (100.0%) achieved SCB and exceeded the MCID for their operative shoulder as determined by the Single Assessment Numeric Evaluation. In addition, 21 of 22 (95.5%) met the PASS, whereas 22 of 22 (100%) achieved SCB and exceeded the MCID for their operative shoulder as determined by the pain visual analog scale. Pre- and postoperative range of motion did not vary significantly. In total, 18 of 22 (81.8%) of patients remained on active duty and were able to return to preinjury work and recreation activity levels. In 2 patients (9.09%), the repair did not heal. Conclusions Mid-term outcomes in this population of young, active-duty patients undergoing DPSR for type II SLAP tears demonstrate a statistically and clinically significant improvement in patient-reported outcomes and an overall return to active-duty rate of 81.8%. Level of Evidence Level IV, therapeutic case series.
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Truong NM, Cevallos N, Lansdown DA, Ma CB, Feeley BT, Zhang AL. Biceps Tenodesis Demonstrates Lower Reoperation Rates Compared to SLAP Repair for Treatment of SLAP Tears in a Large Cross-Sectional Population. Arthroscopy 2022; 38:1802-1809.e2. [PMID: 34920004 DOI: 10.1016/j.arthro.2021.11.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/17/2021] [Accepted: 11/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To use a contemporary cross-sectional data set to evaluate trends in surgical treatment for superior labrum anterior and posterior (SLAP) tears and compare surgical outcomes with respect to 2-year revision surgery rates following index SLAP repair versus biceps tenodesis (BT). METHODS Patients diagnosed with a SLAP tear between 2010 and 2017 were queried using the Mariner PearlDiver database and stratified by demographic variables and surgical treatment with arthroscopic SLAP repair or arthroscopic/open BT. From 2015 to 2017, Current Procedural Terminology (CPT) and International Classification of Diseases 10th revision (ICD-10) codes were used to track ipsilateral subsequent reoperation within 2-years of index surgery. RESULTS Between 2010 to 2017, 16.6% of 377,463 patients diagnosed with a SLAP tear underwent surgery (62.3% SLAP repair vs 37.7% BT). 52.4% of BT procedures were arthroscopic (47.6% open). The frequency of SLAP repairs decreased from 74.0% to 46.2% (61%), while the frequency of BTs increased from 26.0% to 53.8% (202%) during the study period. Patients under age 50 were more likely to undergo SLAP repair, and those undergoing BT were more likely to be over 50 with higher CCI and comorbidity risk. 6.3% of 16,186 patients identified with ICD-10 coding required reoperation within 2-years postoperatively. SLAP repair demonstrated a higher revision rate (6.8%; 95% CI, 6.3-7.4%) than BT (5.7%; 95% CI, 5.2-6.2%; P =.0002), (open 5.8% vs arthroscopic BT 5.5%). Arthroscopic debridement, including biceps tenotomy, revision SLAP repair, and revision BT were the most common subsequent procedures. Patients aged 40 to 49 had the highest rate of revision surgery (7.8%). CONCLUSIONS The treatment trend for SLAP tears is changing, with SLAP repair becoming significantly less utilized and BT now becoming the preferred option, especially in patients over 50. Arthroscopic and open BT demonstrated slightly lower risk for reoperation than SLAP repair. LEVEL OF EVIDENCE IV, cross-sectional study.
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Affiliation(s)
- Nicole M Truong
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Nicolas Cevallos
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, U.S.A..
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Green CK, Scanaliato JP, Fares AB, Czajkowski H, Dunn JC, Parnes N. Midterm Outcomes After Arthroscopic Repair of Type VIII SLAP Lesions in Active Duty Military Patients Younger Than 35 Years. Orthop J Sports Med 2022; 10:23259671221095908. [PMID: 35601738 PMCID: PMC9118435 DOI: 10.1177/23259671221095908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background Superior labrum from anterior to posterior (SLAP) lesions represent a significant cause of shoulder pain and disability among active duty members of the US military. However, few data exist regarding the surgical management of type VIII SLAP lesions. Hypothesis We hypothesized that arthroscopic repair would decrease pain and increase function at the midterm follow-up and allow for a high rate of maintenance of active duty status. Study Design Case series; Level of evidence, 4. Methods Consecutive active duty military patients were identified from January 2011 through June 2015 who underwent arthroscopic repair of type VIII SLAP lesions performed by a single surgeon. Patients were excluded if they underwent glenoid microfracture, other capsulolabral repair, or rotator cuff repair. Outcome measures were completed by patients within 1 week before surgery and at latest follow-up: pain visual analog scale, Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons shoulder score, and Rowe instability score. Results A total of 30 patients met the inclusion criteria for the study. The mean ± SD follow-up was 96.60 ± 10.91 months. At final follow-up, the mean visual analog scale score improved from 8.17 ± 1.6 to 1.63 ± 1.90 (P < .0001), the Single Assessment Numeric Evaluation score from 41.65 ± 16.78 to 87.63 ± 13.02 (P < .0001), the American Shoulder and Elbow Surgeons score from 36.47 ± 10.26 to 88.07 ± 13.94 (P < .0001), and the Rowe score from 35.33 ± 6.56 to 90.00 ± 14.68 (P < .0001). Three patients reported postoperative complications, and 1 progressed to further surgery. Overall, 90% of patients remained on active duty military service and were able to return to preinjury levels of work and recreational activity. The failure rate, defined as persistent instability or activity-limiting pain, was 10%. Conclusion The results of this study demonstrated favorable outcomes for the majority of patients after arthroscopic repair of type VIII SLAP lesions at midterm follow-up, supporting repair as a viable treatment option for type VIII SLAP tears in this patient population.
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Affiliation(s)
- Clare K. Green
- School of Medicine, The George Washington University, Washington, DC, USA
| | - John P. Scanaliato
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Austin B. Fares
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Hunter Czajkowski
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York, USA
- Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
| | - John C. Dunn
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York, USA
- Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
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Almajed YA, Hall AC, Gillingwater TH, Alashkham A. Anatomical, functional and biomechanical review of the glenoid labrum. J Anat 2022; 240:761-771. [PMID: 34725812 PMCID: PMC8930820 DOI: 10.1111/joa.13582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/07/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022] Open
Abstract
The glenohumeral joint is the most mobile joint in the human skeleton, supported by both active and passive stabilisers. As one of the passive stabilisers, the glenoid labrum has increasingly been recognised to play an important role in stability of the glenohumeral joint, acting to maintain intraarticular pressure, centralise the humeral head and contribute to concavity-compression stability. Several studies have investigated the macro- and micro-anatomical features of the labrum as well as its biomechanical function. However, in order to better understand the role of the labrum and its mechanics, a comprehensive anatomical, functional and biomechanical review of these studies is needed. Therefore, this article reviews the current literature detailing anatomical descriptions of the glenoid labrum, with an emphasis on its function(s) and biomechanics, as well as its interaction with neighbouring structures. The intimate relationship between the labrum and the surrounding structures was found to be important in glenohumeral stability, which owes further investigation into the microanatomy of labrum to better understand this relationship.
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Affiliation(s)
- Yousef A. Almajed
- AnatomyEdinburgh Medical School: Biomedical SciencesUniversity of EdinburghEdinburghUnited Kingdom
- Basic SciencesPrince Sultan bin Abdulaziz College for Emergency Medical ServicesKing Saud UniversityRiyadhSaudi Arabia
| | - Andrew C. Hall
- Centre for Discovery Brain SciencesBiomedical SciencesUniversity of EdinburghEdinburghUnited Kingdom
| | - Thomas H. Gillingwater
- AnatomyEdinburgh Medical School: Biomedical SciencesUniversity of EdinburghEdinburghUnited Kingdom
- Centre for Discovery Brain SciencesBiomedical SciencesUniversity of EdinburghEdinburghUnited Kingdom
| | - Abduelmenem Alashkham
- AnatomyEdinburgh Medical School: Biomedical SciencesUniversity of EdinburghEdinburghUnited Kingdom
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Kibler WB, Grantham WJ, Pike JSM, Sciascia AD. Glenoid Labral Injuries Are More Common Posteriorly Than Superiorly and Are Combined Across Multiple Areas of the Glenoid. Arthrosc Sports Med Rehabil 2022; 4:e535-e544. [PMID: 35494307 PMCID: PMC9042739 DOI: 10.1016/j.asmr.2021.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose To categorize arthroscopically observed labral injuries to include location on the glenoid and frequency of the injuries in each location. Methods Patients undergoing arthroscopic labral surgery between January 2018 and June 2020 were reviewed. Inclusion criteria for labral injury were consistently applied and included history, clinical examination and imaging findings, and failure of rehabilitation. Exclusion criteria included arthritis, adhesive capsulitis, and previous surgery. Injury locations were categorized into superior, anterior, and/or posterior areas on the glenoid and as isolated in one area or combined in more than one area. Injury patterns also were evaluated. Interrater and intrarater agreement was assessed between 2 raters for injury location and tear pattern for 22 randomly assigned cases. Results In total, 167 cases met the inclusion criteria. Injuries were found in all areas. Combined injuries were found almost twice as often as isolated injuries (63.5% vs 37.5%). Isolated posterior injuries had the greatest frequency of all specific injury types (26.3%). Isolated superior injuries (SLAP 2-4) had a frequency of 7.2%. Tear patterns included peel back, separation/split, insubstance injury, peripheral rim flattening, and extension into the posterior inferior glenohumeral ligament. Interrater was excellent for all tear locations (intraclass correlation coefficient ≥0.85) whereas intrarater agreement was good to excellent (intraclass correlation coefficient ≥0.63). Conclusions Labral injuries that are associated with clinical symptoms can occur as isolated or combined types in the superior, anterior, and posterior glenoid areas and can display multiple injury patterns. Combined types of injuries are almost twice as common as those that are isolated in one area. Posterior injuries, isolated or combined, are frequent but superior injuries are less common Level of Evidence Level IV, therapeutic case series.
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Superior labral anterior and posterior (SLAP) lesions of the long bicep insertion on the glenoid: management in athletes. INTERNATIONAL ORTHOPAEDICS 2022; 46:1351-1360. [DOI: 10.1007/s00264-022-05385-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
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Abstract
» The thrower's shoulder has been a subject of great interest for many decades. Different theories have been proposed to clarify the pathophysiology, clinical presentation, and treatment options for this condition. In this review article, we summarize the relevant anatomy and pathophysiology and how these translate into signs, symptoms, and imaging findings. Also, a historical review of the treatment methodologies in the setting of an evolving concept is presented. » The initial event in the cascade is thickening and contracture of the posteroinferior capsule resulting from repetitive tensile forces during the deceleration phase of throwing. This is known as "the essential lesion" and is clinically perceived as glenohumeral internal rotation deficit (GIRD), and a Bennett lesion may be found on radiographs. » Change in the glenohumeral contact point leads to a series of adaptations that are beneficial for the mechanics of throwing, specifically in achieving the so-called "slot," which will maximize throwing performance. » The complexity of the throwing shoulder is the result of an interplay of the different elements described in the cascade, as well as other factors such as pectoralis minor tightness and scapular dyskinesis. However, it is still unclear which event is the tipping point that breaks the balance between these adaptations and triggers the shift from an asymptomatic shoulder to a painful disabled joint that can jeopardize the career of a throwing athlete. Consequences are rotator cuff impingement and tear, labral injury, and scapular dyskinesis, which are seen both clinically and radiographically. » A thorough understanding of the pathologic cascade is paramount for professionals who care for throwing athletes. The successful treatment of this condition depends on correct identification of the point in the cascade that is disturbed. The typical injuries described in the throwing shoulder rarely occur in isolation; thus, an overlap of symptoms and clinical findings is common. » The rationale for treatment is based on the pathophysiologic biomechanics and should involve stretching, scapular stabilization, and core and lower-body strengthening, as well as correction of throwing mechanics, integrating the entire kinetic chain. When nonoperative treatment is unsuccessful, surgical options should be tailored for the specific changes within the pathologic cascade that are causing a dysfunctional throwing shoulder.
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Affiliation(s)
- Giovanna Medina
- Jefferson Health 3B Orthopaedics, Philadelphia, Pennsylvania
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冯 思, 陈 俊, 张 健, 陈 世. [Research progress on the relationship between shoulder instability and superior labrum anterior posterior lesion]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:135-142. [PMID: 35172396 PMCID: PMC8863524 DOI: 10.7507/1002-1892.202108078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/25/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To summarize the relationship between shoulder instability and superior labrum anterior posterior (SLAP) lesion. METHODS The characteristics of shoulder instability and SLAP lesion were analyzed, and the relationship between them in pathogenesis, clinical symptoms, and biomechanics was discussed by referring to relevant domestic and foreign literature. RESULTS Shoulder instability and SLAP lesion can occur both spontaneously and respectively. SLAP lesion destroys the superior labrum integrity and the long head of biceps tendon (LHBT) insertion, causing excessive humeral head displacement against glenoid, and leading to shoulder instability. While chronic repetitive or acute high-energy traumatic shoulder instability can in turn aggravate SLAP lesion, resulting in expansion and increased degree of the original lesion. CONCLUSION SLAP lesion destroys mechanisms of shoulder stability, while shoulder instability causes tears of the upper labrum and the LHBT, showing a connection between shoulder instability and SLAP lesion. However, the existing evidence can only demonstrate that shoulder instability and SLAP lesion induce and promote the development of each other, instead of a necessary and sufficient condition. Therefore, the specific causal relationship between the two remains unknown and needs to be further studied.
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Affiliation(s)
- 思嘉 冯
- 复旦大学运动医学研究所（上海 200040）Sports Medicine Institute, Fudan University, Shanghai, 200040, P. R. China
- 复旦大学附属华山医院运动医学科（上海 200040）Department of Sports Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, 200040, P. R. China
| | - 俊 陈
- 复旦大学运动医学研究所（上海 200040）Sports Medicine Institute, Fudan University, Shanghai, 200040, P. R. China
- 复旦大学附属华山医院运动医学科（上海 200040）Department of Sports Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, 200040, P. R. China
| | - 健 张
- 复旦大学运动医学研究所（上海 200040）Sports Medicine Institute, Fudan University, Shanghai, 200040, P. R. China
- 复旦大学附属华山医院运动医学科（上海 200040）Department of Sports Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, 200040, P. R. China
| | - 世益 陈
- 复旦大学运动医学研究所（上海 200040）Sports Medicine Institute, Fudan University, Shanghai, 200040, P. R. China
- 复旦大学附属华山医院运动医学科（上海 200040）Department of Sports Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, 200040, P. R. China
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Rutgers C, Verweij LPE, Priester-Vink S, van Deurzen DFP, Maas M, van den Bekerom MPJ. Recurrence in traumatic anterior shoulder dislocations increases the prevalence of Hill-Sachs and Bankart lesions: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:2130-2140. [PMID: 34988633 PMCID: PMC9165262 DOI: 10.1007/s00167-021-06847-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The extent of shoulder instability and the indication for surgery may be determined by the prevalence or size of associated lesions. However, a varying prevalence is reported and the actual values are therefore unclear. In addition, it is unclear whether these lesions are present after the first dislocation and whether or not these lesions increase in size after recurrence. The aim of this systematic review was (1) to determine the prevalence of lesions associated with traumatic anterior shoulder dislocations, (2) to determine if the prevalence is higher following recurrent dislocations compared to first-time dislocations and (3) to determine if the prevalence is higher following complete dislocations compared to subluxations. METHODS PubMed, EMBASE, Cochrane and Web of Science were searched. Studies examining shoulders after traumatic anterior dislocations during arthroscopy or with MRI/MRA or CT published after 1999 were included. A total of 22 studies (1920 shoulders) were included. RESULTS The proportion of Hill-Sachs and Bankart lesions was higher in recurrent dislocations (85%; 66%) compared to first-time dislocations (71%; 59%) and this was statistically significant (P < 0.01; P = 0.05). No significant difference between recurrent and first-time dislocations was observed for SLAP lesions, rotator-cuff tears, bony Bankart lesions, HAGL lesions and ALPSA lesions. The proportion of Hill-Sachs lesions was significantly higher in complete dislocations (82%) compared to subluxations (54%; P < 0.01). CONCLUSION Higher proportions of Hill-Sachs and Bankart were observed in recurrent dislocations compared to first-time dislocations. No difference was observed for bony Bankart, HAGL, SLAP, rotator-cuff tear and ALPSA. Especially when a Hill-Sachs or Bankart is present after first-time dislocation, early surgical stabilization may need to be considered as other lesions may not be expected after recurrence and to limit lesion growth. However, results should be interpreted with caution due to substantial heterogeneity and large variance. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Cain Rutgers
- Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands.
| | - Lukas. P. E. Verweij
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | - Simone Priester-Vink
- Medical Library, Department of Research and Epidemiology, OLVG, Amsterdam, The Netherlands
| | - Derek F. P. van Deurzen
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | - Mario Maas
- Division of Musculoskeletal Radiology, Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
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Ongen G, Gokalp G, Nas OF. An assessment of SLAP type 5 lesions using proton density oblique sagittal imaging in magnetic resonance arthrography. Acta Radiol 2021; 64:195-200. [PMID: 34889113 DOI: 10.1177/02841851211064594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Bankart lesions accompany superior labrum anteroposterior (SLAP) lesions; these are called SLAP type 5. PURPOSE To compare SLAP type 5 lesions using routine magnetic resonance arthrography (MRA) and thin-slice oblique sagittal proton density (PDW) sequences and correlation operation results. MATERIAL AND METHODS In total, 181 patients were admitted with shoulder instability. The study was completed with 44 patients. The presence or absence of isolated Bankart and SLAP type 5 lesions in routine MRA and PDW oblique sagittal images were evaluated separately. Absence of rupture scored 0 points, suspected ruptures scored 1 point, and apparent ruptures scored 2 points. The two scores were compared with the shoulder arthroscopy findings. RESULTS According to the findings in the shoulder arthroscopy, 40 patients had Bankart lesions and 17 patients had accompanying SLAP type 5 lesions. To detect a Bankart lesion, there was no significant difference between routine MRA sequences and PDW oblique sagittal images (P = 0.061). Routine MRA sensitivity was 95%, specificity 25%, positive predictive value (PPV) 92%, negative predictive value (NPV) 33%, while for PDW oblique sagittal images, sensitivity was 75%, specificity 100%, PPV 100%, and NPV 28.5%. In 8/17 type 5 SLAP lesions, routine MRA detected sensitivity 47%, specificity 92.6%, PPV 80%, and NPV 73.5%; in 14/17 SLAP type 5 lesions, PDW oblique sagittal images detected sensitivity 82%, specificity 100%, PPV 100%, and NPV 90% (P = 0.015). CONCLUSION The PDW oblique sagittal images may play a significant role in assessing the anterior and superior extent of the tears.
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Affiliation(s)
- Gokhan Ongen
- Department of Radiology, Bursa Uludag University, School of Medicine, Bursa, Turkey
| | - Gokhan Gokalp
- Department of Radiology, Bursa Uludag University, School of Medicine, Bursa, Turkey
| | - Omer Fatih Nas
- Department of Radiology, Bursa Uludag University, School of Medicine, Bursa, Turkey
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Hodgetts C, Walker B. Epidemiology, common diagnoses, treatments and prognosis of shoulder pain: A narrative review. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Parnes N, Dunn JC, Czajkowski H, DeFranco MJ, Green CK, Scanaliato JP. Biceps Tenodesis as an Attractive Alternative to Superior Labral Anterior-Posterior (SLAP) Repair for Type II SLAP Lesions in Active-Duty Military Patients Younger Than 35 Years. Am J Sports Med 2021; 49:3945-3951. [PMID: 34672809 DOI: 10.1177/03635465211049373] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biceps tenodesis has been suggested as a superior surgical technique compared with isolated labral repair for superior labral anterior-posterior (SLAP) tears in patients older than 35 years. The superiority of this procedure in younger patients, however, is yet to be determined. PURPOSE To compare the outcomes of arthroscopic SLAP repair with those of arthroscopic-assisted subpectoral biceps tenodesis for type II SLAP tears in active-duty military patients younger than 35 years. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Preoperative and postoperative evaluations with a minimum 5-year follow-up including the visual analog scale (VAS), the Single Assessment Numeric Evaluation (SANE), and the American Shoulder and Elbow Surgeons (ASES) shoulder score were administered, and scores were compared between 2 groups of patients younger than 35 years. One group included 25 patients who underwent SLAP repair, and the second group included 23 patients who underwent arthroscopic-assisted subpectoral biceps tenodesis. RESULTS The preoperative patient age (P = .3639), forward flexion (P = .8214), external rotation (P = .5134), VAS pain score (P = .4487), SANE score (P = .6614), and ASES score (P = .6519) did not vary significantly between the 2 study groups. Both groups demonstrated statistically significant increases in function as measured by the ASES and SANE and decreases in pain as measured by the VAS at a minimum of 5 years postoperatively. Also at a minimum of 5 years postoperatively, patients in the tenodesis group had lower pain (1.3 vs 2.6, respectively; P = .0358) and higher SANE (84.0 vs 63.3, respectively; P = .0001) and ASES (85.7 vs 75.4, respectively; P = .0342) scores compared with those in the repair group. Failure rate was 20.0% in the repair group versus 0.0% in the tenodesis group (P = .0234). CONCLUSION Active-duty military patients younger than 35 years with type II SLAP tears had more predictable improvement in pain, better functional outcomes, and lower failure rates after biceps tenodesis compared with SLAP repair for type II SLAP tears. Overall, the results of this study indicate that arthroscopic- assisted subpectoral biceps tenodesis is superior to arthroscopic SLAP repair for the treatment of type II SLAP tears in military patients younger than 35 years.
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Affiliation(s)
- Nata Parnes
- Carthage Area Hospital, Carthage, New York, USA.,Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
| | - John C Dunn
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | | | | | - Clare K Green
- George Washington University School of Medicine, Washington, District of Columbia, USA
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Panico L, Roy T, Namdari S. Long Head of the Biceps Tendon Ruptures: Biomechanics, Clinical Ramifications, and Management. JBJS Rev 2021; 9:01874474-202110000-00007. [PMID: 34695033 DOI: 10.2106/jbjs.rvw.21.00092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Pathology of the long head of the biceps tendon is a common source of shoulder pain and often occurs in combination with other shoulder disorders. » Nonsurgical management, including rest and activity modification, use of nonsteroidal anti-inflammatory drugs, physical therapy, and corticosteroid injections, is usually the first line of treatment. » Patients with symptoms that are refractory to nonsurgical management are indicated for biceps tenotomy or various tenodesis procedures. » Although several studies have reported a higher incidence of "Popeye" deformity, muscle cramping, and pain in the bicipital groove postoperatively with tenotomy compared with tenodesis, there are no substantial differences in functional scores or patient satisfaction between the 2 techniques. » To date, both tenotomy and tenodesis have been shown to be effective options in the management of long head of the biceps tendinopathy, and there are advantages to each procedure.
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Affiliation(s)
- Leighann Panico
- Department of Orthopedic Surgery, UPMC Pinnacle, Harrisburg, Pennsylvania
| | - Trinava Roy
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey
| | - Surena Namdari
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
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Siebenlist S, Hinz M, Scheiderer B. Behandlung der SLAP-Verletzung des jungen Sportlers. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00488-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cavalcante MLC, Fernandes EG, Pinheiro Júnior JA, Jamacaru FVF, Coelho JVDV, Leite JAD. Análise de terminações nervosas no complexo labrum-bíceps superior usando imunohistoquímica de fluorescência e microscopia a laser confocal. Rev Bras Ortop 2021; 57:863-867. [PMID: 36226223 PMCID: PMC9550355 DOI: 10.1055/s-0040-1722579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/16/2020] [Indexed: 11/02/2022] Open
Abstract
Resumo
Objetivos As estruturas capsulo-ligamentares do ombro funcionam como estabilizadores estáticos, juntamente com os músculos do bíceps e do manguito rotador, aumentando a superfície de contato da cavidade glenoide. Terminações nervosas livres e mecanorreceptores foram identificados no ombro; no entanto, existem alguns estudos que descrevem a presença desses nervos na inserção do bíceps. Este estudo teve como objetivo descrever a morfologia e distribuição de terminações nervosas utilizando imunofluorescência com protein gene product 9.5 (PGP 9.5) e microscopia confocal.
Métodos Foram estudados seis complexos labrum-bíceps de seis cadáveres congelados frescos. Os espécimes foram cortados coronalmente e preparados pelo método de imunofluorescência. Tanto em hematoxilina e eosina (H&E) quanto em imunofluorescência, foi descrita a organização do tecido conjuntivo com fibras paralelas de colágeno.
Resultados No estudo de H&E, foram visualizadas estruturas vasculares e algumas estruturas nervosas, que foram identificadas pela presença alongada da célula nervosa. Todas as amostras analisadas com imunofluorescência e microscopia confocal demonstraram baixa ocorrência de morfotipos de corpúsculos sensoriais e terminações nervosas livres. Identificamos terminações nervosas livres localizadas no labrum, inserção bicipital e terminações nervosas esparsas ao longo do tendão. Terminais corpusculares com aspecto fusiforme, cuneiforme e oval foram identificados no tendão.
Conclusão Esses achados corroboram a hipótese de que a geração de dor nas lesões labrais superiores de anterior a posterior (SLAP, na sigla em inglês) deriva da parte mais proximal do cabo longo do bíceps e ainda mais do labrum superior. Estudos quantitativos futuros com um número maior de espécimes podem fornecer mais informações sobre esses sistemas sensoriais.
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Affiliation(s)
- Maria L. C. Cavalcante
- Departamento de Ortopedia, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, CE, Brasil
| | - Eduardo G. Fernandes
- Departamento de Ortopedia, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, CE, Brasil
| | - José A. Pinheiro Júnior
- Departamento de Ortopedia, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, CE, Brasil
| | | | - José Victor de V. Coelho
- Departamento de Ortopedia, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, CE, Brasil
| | - José Alberto Dias Leite
- Departamento de Ortopedia, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, CE, Brasil
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Hogan RE, Hurley ET, Kilkenny CJ, Moore TK, Rowe DN, Davey MS, Pauzenberger L, Mullett H. Type V superior labral anterior-posterior tears results in lower rates of return to play. Knee Surg Sports Traumatol Arthrosc 2021; 29:2364-2369. [PMID: 33386425 DOI: 10.1007/s00167-020-06388-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 11/24/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the rate of return to play (RTP) in patients who underwent Type V superior labrum anterior-posterior (SLAP) repair compared to patients who underwent isolated Bankart repair in the setting of traumatic anterior shoulder instability. METHODS A retrospective review of patients who underwent arthroscopic Bankart repair and SLAP repair by a single surgeon between 2012 and 2017 was performed. Additionally, these were pair-matched in a 1:2 ratio for age, sex, sport and level of pre-operative play, with those undergoing isolated arthroscopic Bankart repair alone as a control group. RTP, level of RTP and the timing of RTP were assessed. RESULTS The study included a total of 96 patients, with 32 in the study group and 64 in the control group, and a mean follow-up of 59 months. Overall, there was no significant difference in the overall rate of return to play (26/32 (81.3%) vs 56/64 (87.5%), n.s), but there was a significantly higher rate of RTP at the same/higher level in the control group (14/32 (43.6%) vs 43/64 (67.2%), p = 0.0463). There was no significant difference in timing of RTP between the groups (n.s). There was no significant difference in recurrent instability (6/32 (18.8%) vs 5/64 (7.8%), n.s) but there was a significant difference in revision rates (5/32 (15.6%) vs. 2/64 (3.1%), p = 0.0392) between the Type V SLAP repair group and the control group. CONCLUSION Following arthroscopic repair, patients with Type V SLAP tears had a similar overall rate of RTP when compared directly to a control group of patients who underwent arthroscopic Bankart repair alone. However, those who underwent Type V SLAP repair reported significantly lower rates of RTP at the same or higher level compared to the control group. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Richard E Hogan
- Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, IE, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eoghan T Hurley
- Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, IE, Ireland. .,Royal College of Surgeons in Ireland, Dublin, Ireland. .,National University of Ireland Galway, Galway, Ireland.
| | - Conor J Kilkenny
- Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, IE, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Thomas K Moore
- Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, IE, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David N Rowe
- Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, IE, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Martin S Davey
- Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, IE, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Leo Pauzenberger
- Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, IE, Ireland
| | - Hannan Mullett
- Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, IE, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
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Uzun E, Doğar F, Topak D, Güney A. Comparison of anterior single- and standard two-portal techniques in arthroscopic Bankart repair. Jt Dis Relat Surg 2021; 32:437-445. [PMID: 34145822 PMCID: PMC8343854 DOI: 10.52312/jdrs.2021.79712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/04/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives
This study aims to compare the outcomes of patients undergoing a single anterior portal or a standard two-portal arthroscopic procedure for Bankart repair. Patients and methods
Between January 2015 and March 2018, a total of 71 consecutive patients (53 males and 18 females; mean age: 33.3±10.3 years; range, 17 to 56 years) who underwent arthroscopic Bankart repair with a minimum two-year follow-up period were included. The patients were divided into two groups according to the arthroscopic technique used: single anterior portal group (Group 1, n=32) and standard two-portal group (Group 2, n=39). Demographic and surgical characteristics of the patients were recorded. Pre- and postoperative clinical and functional outcomes were evaluated using the external rotation degree, as well as Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES), University of California at Los Angeles (UCLA) Shoulder Rating Scale, Constant-Murley Score (CMS), Oxford Shoulder Instability Score (OSIS), and Rowe scores. The clinical and functional outcomes and revision rates were compared between the groups. Results
The mean follow-up was 32.0±7.4 months in Group 1 and 38.0±13.4 months in Group 2 (p=0.222). Good-to-excellent postoperative functional and clinical outcomes were achieved in both groups at the final follow-up, compared to baseline (p<0.001 for all). No significant difference was observed in the postoperative outcomes including daily sports activity, VAS, ASES, UCLA Shoulder Rating Scale, CMS, OSIS, and Rowe scores, and external rotation restriction degrees between the groups (p=0.270, p=0.190, p=0.313, p=0.248, p=0.125, p=0.203, p=0.318, p=0.083, respectively). The operative time in Group 1 was significantly lower than that in Group 2 (60.3±8.3 vs. 71.4±7.2, respectively; p=0.001). Four patients (5.6%) experienced recurrent dislocation with no significant difference between the groups (p=0.622). No significant complications occurred in the peri- or postoperative period. Fifty-eight (81.7%) patients returned to their preoperative sports activity level. The mean time to return to sports was 7.2±1.7 months. Conclusion
Good-to-excellent clinical and functional outcomes can be obtained after arthroscopic Bankart repair, regardless of the use of a single or two anterior working portals. However, the single-portal technique is associated with reduced the operative time, compared to two-portal technique.
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Affiliation(s)
| | - Fatih Doğar
- Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı, 46050 Kahramanmaraş, Türkiye.
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