Abstract
Objectives:
When surgically managing superior labrum from anterior to posterior (SLAP) tears, there is no consensus on whether SLAP repair or biceps tenodesis yields superior long term outcomes. Additionally, no previous studies have specifically examined outcomes of these procedures in female patients, despite evidence of sex-based differences in recovery following orthopedic surgery. The purpose of this study was to retrospectively compare outcomes after SLAP repair and biceps tenodesis in females. Prior to the start of the study, it was predicted that outcomes between patients who undergo SLAP repair and biceps tenodesis as a treatment will not significantly differ.
Methods:
Female patients who underwent arthroscopic SLAP repair or biceps tenodesis for treatment of an SLAP lesion between 1/1/2014 and 9/1/2019 at a single institution were retrospectively reviewed.
Patients were queried using CPT codes for arthroscopic SLAP repair or biceps tenodesis: for those identified, electronic medical records were reviewed to confirm they met inclusion criteria. Exclusion criteria included: age less than 18 years old at the time of surgery, revision surgery, and concomitant rotator cuff repair at the time of surgery. Patients were contacted at a minimum of two-years post- surgery and asked to complete the standardized American Shoulder and Elbow Surgeons (ASES) score, single assessment numerical evaluation (SANE) survey, and visual analog scale (VAS) for pain. Patients were also given a custom survey assessing return to activity and level of activity following the operation. Patient demographics collected included age at time of surgery, BMI, laterality, and procedure type.
Differences in post-operative function between the procedures were assessed using T-tests or Mann- Whitney U tests for numerical data and Chi-Square testing for categorical data.
Results:
The study included 118 patients. 61 (51.7%) underwent arthroscopic SLAP repair, and 57 (48.3%) underwent open or arthroscopic biceps tenodesis. Comparing demographic data for SLAP repair versus biceps tenodesis groups, mean age was 35.2±8.93 years versus 45.5±10.2 years (p<0.001), mean BMI was 27.5 versus 29.2 (p=0.095), the rates of left shoulder repairs was 30 (50.8%) versus 14 (26.4%), and the rates of right shoulder repairs was 29 (49.2%) versus 39 (73.6%) (p=0.014). Concomitant pathologies were recorded in 68.9% of SLAP repairs and in 88.0% of biceps tenodesis (p=0.030). Concomitant procedures (including bursectomy, capsular release, and acromioplasty) were performed in 74.6% of SLAP repairs and in 92.0% of biceps tenodesis (p=0.033).
The two groups showed no differences in two-year ASES scores (81.5 in SLAP repair vs 83.3 in biceps tenodesis, p=0.461), SANE scores (75.6 in SLAP repair vs 79.7 in biceps tenodesis, p=0.344) and VAS scores (20.2 in SLAP repair vs 21.1 in biceps tenodesis, p=0.645). Furthermore, rates of participation in sports prior to surgery was similar (55.4% in SLAP repair vs 42.6% in biceps tenodesis , p=0.251); of those who reported participation prior to surgery, rates of return to participation in sport following surgery was also similar (77.4% in SLAP repair vs 78.3% in biceps tenodesis, p=1.000).
Conclusions:
This is the first study to evaluate the outcomes of SLAP repair and biceps tenodesis for SLAP lesions in female patients. Female patients who underwent surgical treatment of SLAP lesions with SLAP repair or biceps tenodesis show comparable minimum two-year results with respect to level of function, self-reported pain, and ability to return to sports after these procedures. The incidence of concomitant pathologies and concomitant procedures at the time of SLAP repair and biceps tenodesis differed between the two groups, possibly related to group age disparity. Further research is necessary to define precise treatment indications for this pathology in this specific patient population.