Clin Orthop Surg.  2018 Sep;10(3):358-367. 10.4055/cios.2018.10.3.358.

Is Anatomical Healing Essential for Better Clinical Outcome in Type II SLAP Repair? Clinico-Radiological Outcome after Type II SLAP Repair

• Nashikkar
• Rhee SM
• Desai CV
• Oh JH

• KMID: 2418757
• DOI: http://doi.org/10.4055/cios.2018.10.3.358

Abstract

BACKGROUND
We hypothesized that anatomical healing in superior labrum anterior to posterior (SLAP) repair is associated with good clinical outcome. The purposes of this study were to assess the failure rate of anatomical healing after arthroscopic repair of SLAP lesions using computed tomography arthrography (CTA), investigate correlation of the rate with clinical outcomes, and identify prognostic factors for anatomical failure following SLAP repair.
METHODS
We retrospectively evaluated the outcome of 43 patients at a minimum follow-up of 1 year after arthroscopic surgery for SLAP lesions or SLAP lesions associated with Bankart lesions. Twenty-eight patients underwent isolated SLAP repair and 15 patients underwent Bankart repair with SLAP repair. The anatomical outcome was assessed using CTA at 1 year after surgery. Clinical outcomes including visual analogue scale for pain and satisfaction and Constant score were assessed at the final follow-up. We investigated clinical failure that was defined as stiffness, loss of maximum rotation, deterioration of pain, and/or need for revision of surgery.
RESULTS
Anatomical failure occurred in 32.6% of patients (14/43), whereas 16.3% of patients (7/43) had clinical failure. Clinicoradiological assessment revealed that clinical failure occurred only in 7.1% of patients (1/14) with unhealed SLAP lesions, whereas it occurred in 20.7% of patients (6/29) with healed SLAP lesions. Isolated SLAP repair resulted in a higher risk of anatomical failure (risk ratio, 7.0) than combined SLAP repair (p = 0.015). Nonoverhead activities were associated with higher risk of anatomical failure (risk ratio, 2.9; p = 0.041). Patients above 35 years of age had more risk of anatomical failure (risk ratio, 3.5; p = 0.010). Clinical outcomes significantly improved regardless of anatomical failure (p < 0.001) and were not significantly different between unhealed and healed repairs (all p > 0.05).
CONCLUSIONS
Since patients with unhealed SLAP lesions had less clinical failure than patients with healed SLAP lesions, anatomical healing does not seem essential for better clinical outcome of SLAP II repair, especially in patients with higher healing failure risk (isolated SLAP repair, nonoverhead activities, and above 35 years of age). Therefore, we believe the indications of SLAP repair should be narrowed to avoid overtreatment.

Keyword

Superior labrum from anterior to posterior injuries; Computed tomography; Healing; Prognostic factors

MeSH Terms

Arthrography
Arthroscopy
Follow-Up Studies
Humans
Medical Overuse
Retrospective Studies

Figure

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  Fig. 1 Flow diagram of patient inclusion and data analysis. SLAP: superior labrum anterior to posterior, CTA: Computed tomography arthrography, SD: standard deviation.

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  Fig. 2 Computed tomography arthrography (CTA) for superior labrum anterior to posterior (SLAP) repair evaluation. (A) An anatomically healed SLAP lesion after repair. (B) Anatomically unhealed SLAP lesion (arrows) after repair. Note the site of the dye leak between 10 and 12 o'clock positions. (C) CTA showing a healed lesion after repair that may be misinterpreted as an unhealed lesion (arrows). Note the site of leak beyond 12 o'clock.

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  Fig. 3 Superior labrum anterior to posterior (SLAP) repair. (A) Detection of a SLAP lesion (arrow). (B) SLAP repair.

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