Age, heavy lifting among factors that determine success of superior labrum repair

Issue: June 2010

Patients who are older than 40 years of age, engage in heavy lifting at work or use alcohol or tobacco are likely to see poorer results from superior labrum anterior to posterior (SLAP) repair, according to a recent study.

Patients with constant positive postoperative aggravating maneuvers – such as pain in the bicipital groove, O’Brien’s test, Speed’s test and Yergason’s test – are also likely to see poor results, according to Shane J. Nho, MD, at the American Orthopaedic Society for Sports Medicine’s 2010 Specialty Day.

“Clinical outcomes after SLAP repairs in the published literature have generally been good, however up to one-third of patients are still dissatisfied with their SLAP repair,” Nho said. “The purpose of this study was to report any prognostic factors that have a significant impact upon clinical outcomes following arthroscopic SLAP repair.”

Nho’s team retrospectively investigated patients who had an arthroscopic repair of type II SLAP lesions between 2004 and 2006 by contacting them and inviting them to return for a follow-up examination and questionnaire.

Completed questionnaires

All of the patients completed validated, shoulder-specific shoulder outcome scores at baseline and a minimum of 2 years after surgery. Statistical analysis was performed to determine associations between potential prognostic factors and failure of SLAP repair as defined by an American Shoulder and Elbow Society (ASES) score of less than 50 and revision surgery.

Nho said 54 patients met the study criteria with a mean follow-up of 3.4 years. These patients saw statistically significant improvements in mean ASES score as well as mean forward flexion.

Age associations

Nho said that significant associations were identified between ASES scores of less than 50 and age greater than 40 years, as well as correlations between ASES scores less than 50 and tobacco use, alcohol use, co-existing diabetes, high levels of lifting at work, pain in the bicipital groove and a positive O’Brien’s, Yergason’s or Speed’s test.

Furthermore, he added, patients under 20 years of age who engaged in throwing activity were found to make up a significant portion of the cases that needed revision surgery.

“Patient selection can be difficult,” Nho concluded. “Hopefully this study will be able to provide more guidance as to who will show a better clinical result after type II SLAP repair.” – by Robert Press

References:

Nho SJ, Frank RM, Reiff S, et al. Retrospective analysis of arthroscopic superior labrum anterior to posterior (SLAP) repair: Prognostic factors associated with failure. Paper 8790. Presented at the American Orthopaedic Society for Sports Medicine 2010 Specialty Day. March 13, 2010. New Orleans.

Shane J. Nho, MD, MS, can be reached at nhos@hss.edu

I think you have to be a little careful when you talk about this topic. We have to define our patient populations … I have to disagree with the concept that because someone is 40 years old, you do not fix a SLAP tear.

For a 40-year-old secretary, you probably do not need to fix the SLAP tear. For a 35-year-old professional pitcher, you probably do not need to. But for a recreational tennis player or a thrower who is 40, 45, 50 – with no other pathology – we have to be a little careful before saying we should not be fixing these people at all, because the results are actually very good.

– Thomas J. Gill, MD
Department of Orthopaedics
Massachusetts General Hospital Main Campus, Boston, Mass.