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Presenter: Surgeons should preserve native anatomy in labral tears

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PHILADELPHIA — Before performing surgery on a suspected labral tear, orthopedists need to identify the true labral pathology through imaging, physical examination and rehabilitation, according to a presentation at the Advances in Throwing: Latest on Injury Treatment and Performance Optimization Symposium.

According to Andrew F. Kuntz, MD, director of the shoulder study group at Penn Medicine in Philadelphia, orthopedists should identify whether a patient has a superior labral tear from anterior to posterior (SLAP), “which is typically described by the thrower as a sudden loss of velocity or a dead arm sensation.” A SLAP event will be associated with a large increase in pain, the development of mechanical symptoms and less effective rehabilitation, he noted.

Andrew F. Kuntz

Although the MRI report can help with diagnosis, orthopedists should also perform a physical examination during which the kinetic chain is addressed.

“If you do not want to address the kinetic chain, not only are you more likely to end up in surgery for a lesion that maybe does not need to be fixed, but you are also more likely to have a patient back in the operating room or having recurrent symptoms after surgery,” Kuntz said.

Prior to any surgery, these patients should do shoulder rehabilitation exercises and take anti-inflammatory medications, according to Kuntz.

Research shows that rehabilitation leads to decreased pain, improved function and improvements in quality of life. However, if the patient still fails after a nonoperative approach, surgery may then be needed to restore the normal anatomy, he said.

“The [return-to-sport] outcomes have been reported anywhere from 30% up to the high 80%, but I think if you go down this path of rehabbing your patients and trying only to repair true labral pathology, then you can expect your patients to have this higher level of return to sport,” Kuntz said. – by Casey Tingle

Reference:

Kuntz AF. Biceps tendon: To kill or not to kill? Presented at: Advances in Throwing: Latest on Injury Treatment and Performance Optimization Symposium; Jan. 27, 2018; Philadelphia.

Disclosure: Kuntz reports he receives research support from Integra LifeSciences and is a paid consultant for Orthofix.