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Only 24% of failed SLAP repair patients satisfied with nonoperative care
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WASHINGTON — A new study indicates that few patients who failed prior superior labrum anterior-posterior repair respond to subsequent conservative treatment alone.
Laurie Katz, MD, and colleagues retrospectively reviewed 34 patients presenting to their institution who were dissatisfied after a previous superior labrum anterior-posterior (SLAP) repair. At the institution, all of the patients underwent physical therapy and 65% also received intra-articular cortisone injections.
The investigators discovered that 24% of the patients were satisfied with conservative treatment alone. Of the patients who were dissatisfied after receiving conservative care and underwent a subsequent surgical revision, 61% reported their satisfaction level as great to excellent.
In addition, the investigators found an overall patient satisfaction rate of 65% after either conservative or surgical treatment.
"Patients who have a poor outcome after SLAP repair have a low response rate to conservative treatment alone," Katz said during her presentation at the 27th Annual Meeting of the Arthroscopy Association of North America, here. "Therefore, you must look for signs of missed pathology and if they have a low threshold for [operative treatment] if they are not making progress with conservative measures.
"In this study, outcome was improved with revision surgery. And, regardless of conservative or operative intervention, 35% of these patients still had a suboptimal outcome," she said.
The investigation included patients with a mean age of 42 years. All had undergone an initial Type II slap repair and presented at the investigators' institution at an average of 9 months following the initial repair. The most common patient complaint at the time of presentation was pain with stiffness.
"[You] have to remember that SLAP repair is not an innocuous procedure," Katz said. "Part 1 of the study was presented at last year's [AANA] meeting, and we recommend that you take caution when evaluating SLAP lesions in patients over 40 years old. You have to consider that there may be incidental findings due to normal aging, so make sure that you look for other causes of their disability."
For more information:
- Katz L, Curtis A, Miller S, et al. Outcomes of failed SLAP repair. Paper #SS14. Presented at the 27th Annual Meeting of the Arthroscopy Association of North America. April 24-27, 2008. Washington.