No Advantages in Repairing a Type II Superior Labrum Anterior and Posterior (SLAP) Lesion When Associated with Rotator Cuff Repair in Patients over Age 50

Abstract

Background

Arthroscopic management has been recommended for some superior labrum anterior and posterior (SLAP) lesions, but no studies have focused on patients over 50 years of age with rotator cuff tear and a type II SLAP lesion.

Hypothesis

In patients over 50 years of age with an arthroscopically confirmed lesion of the rotator cuff and a type II SLAP lesion, there is no difference between (1) repair of both lesions and (2) repair of the rotator cuff tear without repair of the SLAP II lesion but with a tenotomy of the long head of the biceps.

Study Design

Randomized controlled clinical trial; Level of evidence, 1.

Methods

We recruited 63 patients. In 31 patients, we repaired the rotator cuff and the type II SLAP lesion (group 1). In the other 32 patients, we repaired the rotator cuff and tenotomized the long head of the biceps (group 2). Seven patients (2 in group 1 and 5 in group 2) were lost to final follow-up.

Results

At a minimum 2.9 years’ follow-up, statistically significant differences were seen with respect to the University of California, Los Angeles (UCLA) score and range of motion values. In group 1 (SLAP repair and rotator cuff repair), the UCLA showed a statistically significant improvement from a preoperative average rating of 10.4 (range, 6–14) to an average of 27.9 (range, 24–35) postoperatively (P < .001). In group 2 (biceps tenotomy and rotator cuff repair), the UCLA showed a statistically significant improvement from a preoperative average rating of 10.1 (range, 5–14) to an average of 32.1 (range, 30–35) postoperatively (P < .001) There was a statistically significant difference in total postoperative UCLA scores and range of motion when comparing the 2 groups postoperatively (P < .05).

Conclusions

There are no advantages in repairing a type II SLAP lesion when associated with a rotator cuff tear in patients over 50 years of age. The association of rotator cuff repair and biceps tenotomy provides better clinical outcome compared with repair of the type II SLAP lesion and the rotator cuff.

Keywords

rotator cuff tenotomy biceps tendon shoulder arthroscopy SLAP lesion

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References

Altchek

Warren

Wickiewicz

Ortiz

Arthroscopic labral debridement: A three-year follow-up study. Am J Sports Med. 1992;20:702–706.

American Academy of Orthopaedic Surgeons. Joint Motion: Method of Measuring and Recording. Chicago: American Academy of Orthopaedic Surgeons; 1965.

Baysal

Balyk

Otto

Luciak-Corea

Beaupre

Functional outcome and health-related quality of life after surgical repair of full-thickness rotator cuff tear using a mini-open technique. Am J Sports Med. 2005;33:1346–1355.

Burkhart

Morgan

SLAP lesions in the overhead athlete. Orthop Clin North Am. 2001;32:431–441.

Burkhart

Morgan

. The peel-back mechanism: Its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation. Arthroscopy. 1998;14:637–640.

Cofield

Parvizi

Hoffmeyer

Lanzer

Ilstrup

Rowland

. Surgical repair of chronic rotator cuff tears: A prospective long-term study. J Bone Joint Surg Am. 2001;83:71–77.

Ellman

Hanker

Bayer

Repair of the rotator cuff: End-result study of factors influencing reconstruction. J Bone Joint Surg Am. 1986;68:1136–1144.

Franceschi

Longo

Ruzzini

Papalia

Rizzello

Denaro

To detach the long head of the biceps tendon after tenodesis or not: Outcome analysis at the 4-year follow-up of two different techniques. Int Orthop. 2007;31:537–545.

Franceschi

Longo

Ruzzini

Rizzello

Denaro

Arthroscopic management of calcific tendinitis of the subscapularis tendon. Knee Surg Sports Traumatol Arthrosc. 2007 May 12:[Epub ahead of print].

10.

Franceschi

Ruzzini

Longo

. Equivalent clinical results of arthroscopic single-row and double-row suture anchor repair for rotator cuff tears: A randomized controlled trial. Am J Sports Med. 2007;35:1254–1260.

11.

Gartsman

. Arthroscopic rotator cuff repair. Clin Orthop Relat Res. 2001;390:95–106.

12.

Gartsman

Khan

Hammerman

. Arthroscopic repair of full-thickness tears of the rotator cuff. J Bone Joint Surg Am. 1998;80:832–840.

13.

Jost

Pfirrmann

Gerber

Clinical outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am. 2000;82:304–314.

14.

Kelly

Drakos

Fealy

Taylor

O'Brien

. Arthroscopic release of the long head of the biceps tendon: Functional outcome and clinical results. Am J Sports Med. 2005;33:208–213.

15.

Kempf

Gleyze

Bonnomet

. A multicenter study of 210 rotator cuff tears treated by arthroscopic acromioplasty. Arthroscopy. 1999;15:56–66.

16.

Kim

Queale

Cosgarea

McFarland

. Clinical features of the different types of SLAP lesions: An analysis of one hundred and thirty-nine cases: Superior labrum anterior posterior. J Bone Joint Surg Am. 2003;85:66–71.

17.

Morgan

Burkhart

Palmeri

Gillespie

Type II SLAP lesions: Three subtypes and their relationships to superior instability and rotator cuff tears. Arthroscopy. 1998;14:553–565.

18.

O'Brien

Allen

Coleman

Drakos

. The trans-rotator cuff approach to SLAP lesions: Technical aspects for repair and a clinical follow-up of 31 patients at a minimum of 2 years. Arthroscopy. 2002;18:372–377.

19.

Osbahr

Diamond

Speer

. The cosmetic appearance of the biceps muscle after long-head tenotomy versus tenodesis. Arthroscopy. 2002;18:483–487.

20.

Paxinos

Walton

Rutten

Muller

Murrell

. Arthroscopic stabilization of superior labral (SLAP) tears with biodegradable tack: Outcomes to 2 years. Arthroscopy. 2006;22:627–634.

21.

Rhee

Lee

Lim

. Unstable isolated SLAP lesion: Clinical presentation and outcome of arthroscopic fixation. Arthroscopy. 2005:21:1099.

22.

Snyder

Banas

Karzel

. An analysis of 140 injuries to the superior glenoid labrum. J Shoulder Elbow Surg. 1995;4:243–248.

23.

Voos

Pearle

Mattern

Cordasco

Allen

Warren

. Outcomes of combined arthroscopic rotator cuff and labral repair. Am J Sports Med. 2007;35:1174–1179.

24.

Walch

Boileau

Noel

Liotard

Dejour

Surgical treatment of painful shoulders caused by lesions of the rotator cuff and biceps, treatment as a function of lesions: Reflections on the Neer's concept [in French]. Rev Rhum Mal Osteoartic. 1991;58:247–257.