Summary

Both arthroscopic SLAP repair and combined arthroscopic-assisted subpectoral biceps tenodesis and anterior labral repair led to statistically and clinically significant increases in outcome scores, marked improvement in pain, and high rates of return to unrestricted- active duty in military patients with type V SLAP lesions

Abstract

Background

Superior labrum anterior posterior (SLAP) lesions and anterior instability are common causes of shoulder pain and dysfunction among active-duty members of the US military. However, little data has been published regarding the surgical management of type V SLAP lesions.

Purpose

To compare the outcomes of arthroscopic SLAP repair with those of combined arthroscopic-assisted subpectoral biceps tenodesis and anterior labral repair for type V SLAP tears in active-duty military patients younger than 35.

Study Design Cohort, Level III

Methods

All consecutive patients from January 2010 to December 2015 who underwent arthroscopic repair or combined biceps tenodesis and labral repair of a type V SLAP lesion with minimum 5 years follow up were identified. Outcome measures including the visual analog scale (VAS), the Single Assessment Numeric Evaluation (SANE), and the American Shoulder and Elbow Surgeons (ASES) shoulder score were administered pre- and post-operatively and scores were compared between groups.

Results

Eighty-four patients met inclusion criteria for the study. All patients were active-duty military at the time of surgery. Average follow-up was 102.59+/-20.98 months in the repair group and 94.50+/-27.11 months in the tenodesis group (p = 0.1281). There were no significant differences in preoperative range of motion or outcome scores between groups. Both groups experienced statistically significant improvements in outcome scores postoperatively (p<0.0001 for all), however, tenodesis patients reported significantly better VAS (2.52+/-2.36 vs 1.50+/-1.91, p = 0.0328), SANE (86.82+/-11.00 vs 93.43+/-8.81, p = 0.0034), and ASES (83.32+/-15.31 vs 89.90+/-13.31, p = 0.0394) scores. With regard to clinical significance, the number of patients who achieved the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) for the ASES and SANE did not differ significantly between groups. Thirty-four of patients in both cohorts returned to preinjury levels of work (77.27% vs 85.00%, p = 0.3677). Thirty-two (72.72%) repair patients and 33 (82.50%) of tenodesis patients returned to preinjury levels of sporting activity (p = 0.2850). There were no significant differences in the rates of medical discharge, failure of repair, or revision procedures between groups (p=0.2919, p=0.0624, p=0923).

Conclusion

Both arthroscopic SLAP repair and combined arthroscopic-assisted subpectoral biceps tenodesis and anterior labral repair led to statistically and clinically significant increases in outcome scores, marked improvement in pain, and high rates of return to unrestricted- active duty in military patients with type V SLAP lesions. The results of this study suggest that both procedures represent appropriate treatment options for the surgical management of this injury.