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No gains seen in repairing SLAP lesions with rotator cuff tears in older patients
Rotator cuff repair alone may produce good outcomes, avoid postoperative shoulder stiffness.
LAS VEGAS — A study of patients older than 50 years with a rotator cuff tear and type II SLAP lesion shows significantly better function with rotator cuff repair and biceps tenotomy compared to cuff and lesion repair.
“We have demonstrated that we have no advantages in repairing the type II SLAP lesion when associated with a rotator cuff tear in patients over 50 years old,” Francesco Franceschi, MD, said during his presentation at the American Academy of Orthopaedic Surgeons 76th Annual Meeting, here.
“The association of rotator cuff repair and biceps tenotomy provides better clinical outcome when we compare it with the repair of the type II SLAP lesion and the rotator cuff. Rotator cuff repair alone is sufficient to determine a good postoperative outcome, allowing [us] to avoid postoperative stiffness of the shoulder,” he said.
Randomized, controlled trial
Franceschi and colleagues randomized 63 patients who were older than 50 years and had an arthroscopically confirmed rotator cuff tear and type II SLAP lesion into two treatment groups. Thirty-one patients in the first group underwent arthroscopic repair of both the rotator cuff tear and the type II SLAP lesion. Thirty-two patients in the second group had an arthroscopic repair of the rotator cuff tear only and a biceps tenotomy. The groups showed similar preoperative demographics.
At a follow-up of 5.2 years, the investigators found that both groups showed significant improvements from their preoperative range of motion and UCLA scores. The investigators also discovered that patients in the rotator cuff and type II SLAP repair group improved from an average preoperative UCLA score of 10.4 to an average score of 27.9 postoperatively.
UCLA scores for patients in the rotator cuff repair and biceps tenodesis group rose from an average of 10.1 preoperatively to an average of 32.1 postoperatively. However, a comparison of the groups revealed significantly better postoperative range of motion and UCLA scores in the rotator cuff repair and biceps tenodesis group.
The effect of tenotomy
Felix H. Savoie, III, MD, a co-moderator of the paper session, noted that the investigators examined the effect of tenotomy and not tenodesis of the biceps.
“You are already putting sutures in the rotator cuff. Why would you not consider tenodesis in the biceps since you are already there?” Savoie said.
“We didn’t perform that kind of operation because we like to treat only the SLAP, and we considered that the biceps tenotomy was sufficient in the shoulder,” Franceschi responded.
During the discussion session, an audience member also asked Franceschi how the investigators differentiated a SLAP lesion from a normal, age-related detachment of the labrum. Franceschi said he classified the shoulders using arthroscopy only and classified the lesions based upon his observations.
For more information:Reference:
- Francesco Franceschi, MD, can be reached at the Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Via Longoni 83, 00155 Rome, Italy; +39-06-22541-1161; e-mail: f.franceschi@unicampus.it. He has no direct financial interest in any products or companies mentioned in this article.
- Felix H. Savoie III, MD, can be reached at Tulane University School of Medicine, 1430 Tulane Ave., Room 2070, Department of Orthopaedics, New Orleans, LA 70112-2699, U.S.A.; +1-504-988-5770; e-mail: BuSavoie@aol.com. He is a member of the speakers’ bureau for Mitek.
- Franceschi F, Longo UG, Ruzzini L, et al. How to manage a patient over 50 with a Type II SLAP lesion and a rotator cuff tear. Paper #451. Presented at the American Academy of Orthopaedic Surgeons 76th Annual Meeting. Feb. 25-28, 2009. Las Vegas.