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Study finds rates, factors for failed repair of type II SLAP tears in young patients
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A recently presented study shows a high failure for arthroscopic repair of isolated SLAP II tears in young, active patients and links older patient age with an increased chance of failure.
“Successful outcomes after SLAP II repair in our patient population remained a challenge,” study author Matthew T. Provencher, MD, MC, USN, said. “We demonstrated a 38% overall failure rate. However, the revision surgery for a failed SLAP tear demonstrated a very good response with revision to biceps tenodesis. An age greater than 36 was our best predictor for failure, however, I think we need additional work to define who benefits from a SLAP II repair.”
He presented findings of a 4-year prospective analysis at the 2011 Annual Meeting of the American Orthopaedic Society for Sports Medicine.
Military cohort
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Image: Provencher MT |
For their study, Provencher and colleagues followed 215 military patients between 18 years and 50 years old who underwent surgical repair of an magnetic resonance arthrography and arthroscopically confirmed type II SLAP tear performed by two orthopedic surgeons. Patients were excluded from the study if they had distal clavicle procedures, tenotomy, rotator cuff repair, biceps tenodesis or labrum repairs performed outside the SLAP region.
Surgeons used a mean of 1.6 anchors and a vertical suturing construct during the repairs. Rehabilitation included 4 weeks of protected range of motion, followed by active motion at 4 weeks and strengthening exercises after 6 weeks. At 3 months to 4 months, patients were allowed return to play.
The investigators conducted a mean follow-up of 40.4 months for 179 patients (83.2% follow-up) with a mean age of 31.6 years. In addition to evaluating range of motion, Western Ontario Shoulder Instability (WOSI) index, Single Assessment Numeric Evaluation (SANE) and ASES shoulder scores, the investigators assessed patients’ overall return to military duty and investigated factors associated with failure of the primary repair.
Potential factors for failure
Using ASES scores (<75), return to full military duties and no need for revision procedures to mark successful cases, the investigators found that 66 patients (38.6%) had failures. Of these, 50 patients failures opted for corrective surgery including 42 patients who underwent biceps tenodesis, four patients who had biceps tenotomy and four patients who required debridement.
Age was a major factor in whether the repair was successful, Provencher noted. “The mean age in the failures was 39 years; successes was 29 years. We had no association with etiology, smoking history or their preoperative outcome scores,” he said.
In the successful initial procedures, the investigators found a statistical and clinical improvement across all outcome scores and range of motion.
“When we looked at the revision surgery outcomes, their scores improved from their postoperative SLAP II repair to their revision in all aspects in about the 80% range for all scores,” Provencher said. “In addition, the range of motion improved with flexion/abduction with the revision tenodesis and tenotomy surgery.”
Limitations for the study included having two surgeons perform the procedures and a strict failure criteria, Provencher noted in his presentation. – by Jeff Craven
Reference:
- Provencher MT, McCormick F, Dewing CB, Solomon DJ. Revision rates and outcomes of SLAP 2 repairs: A prospective analysis of 179 patients. Paper #18. Presented at the 2011 Annual Meeting of the American Orthopaedic Society for Sports Medicine. July 7-10. San Diego.
- CDR Matthew T. Provencher, MD, MC, USN, can be reached at the U.S. Naval Medical Center San Diego, Department of Orthopaedic Surgery, 34800 Bob Wilson Drive, San Diego, CA 92134; 619-532-8427; email: matthew.provencher@med.navy.mil.
- Disclosure: Provencher has no relevant financial disclosures.