High Rate of Satisfaction and Return to Play at 5-Year Follow-Up After Arthroscopic Superior-Labrum Anterior-Posterior Repairs

Establishing Clinical Significance for Patients Undergoing Arthroscopic Repair of Type II SLAP Lesions

Background

Type II superior labrum anterior to posterior (SLAP) lesions may be treated with either arthroscopic repair or biceps tenodesis. There are no previous reports of measures of clinically significant improvement after arthroscopic repair of SLAP lesions.

Purpose

To establish the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) for patients undergoing arthroscopic repair for type II SLAP lesions.

Study Design

Case series; Level of evidence, 4.

Methods

A total of 69 arthroscopic repair procedures for isolated type II SLAP lesions were performed in a military population. The mean age was 28.1 ± 4.7 years, 97.1% were male, and the mean follow-up was 99.5 ± 19.7 months. The MCID, PASS, and SCB were calculated for each patient-reported outcome measure, consisting of the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) for pain, using anchor- and distribution-based models. Factors associated with achieving a clinically relevant improvement were also determined.

Results

The MCID, PASS, and SCB for each measure were as follows: 7.7, 70, and 34 for the ASES score, respectively; 10.4, 80, and 45 for the SANE, respectively; and 1.0, 4, and 6 for the VAS pain, respectively. At least 85% of patients achieved the MCID for each measure; however, PASS rates were lower, with 50.7% for the SANE and 69.6% for both the ASES score and VAS pain. The ASES score had the highest percentage of patients achieving the SCB at 44.9%, followed by the SANE (26.1%) and VAS pain (10.1%). Greater forward flexion at final follow-up was associated with achieving the MCID and PASS for both the ASES score and SANE. Internal rotation stiffness at final follow-up was negatively associated with achieving the PASS for the VAS pain. Combat arms military occupational specialty was associated with a lesser likelihood of achieving the SCB for the ASES score.

Conclusion

Clinical metrics of improvement were defined for the ASES score, SANE, and VAS pain using the MCID, PASS, and SCB for patients undergoing arthroscopic repair of type II SLAP lesions. Better final range of motion was positively associated with achieving improvement, while high-intensity military duty was negatively associated.

Ill-defined Return-to-Sport Criteria and Inconsistent Unsuccessful Return Rates Caused by Various Reasons Not Necessarily Related to Treatment After Superior Labral Treatments: A Systematic Review

PURPOSE

To determine (1) which criteria are used to determine return to sport (RTS), (2) the number of patients who are unable to RTS after any superior labral pathophysiology treatment, and (3) which reasons are reported for not returning.

METHODS

A systematic review was performed across 5 databases, including studies that report rates for RTS after any treatment of superior labral pathophysiology. Study quality was assessed using the Methodological Index for Non-Randomized Studies criteria. Definitions for no return to sport (nRTS) were extracted as reported in the studies. The ranges of nRTS and no return to preinjury level (nRTPL) were summarized. Reasons for nRTS and nRTPL were categorized using a predefined coding scheme.

RESULTS

Among 45 studies with level of evidence ranging from II to IV, 1,857 patients were involved in sports, 78% (n = 1453) of whom underwent superior labral reattachment, 21% (n = 381) biceps tenodesis, and 9.4% (n = 175) nonoperative treatment. None of the studies provided criteria for RTS, and 2 studies provided criteria for return to preinjury level. The ranges of nRTS and nRTPL varied after superior labral reattachment (0-60%, n = 206; 0-89%, n = 424, respectively), biceps tenodesis (0-25%, n = 43; 3, 8%-48%, n = 78), and nonoperative treatment (11%-75%, n = 62; 18%-100%, n = 78). Reasons for nRTS and nRTPL were related to physical sensations (pain, feeling of instability, discomfort, weakness, lack of motion), psychological factors (fear of reinjury, lack of confidence), personal factors (lifestyle change, social reasons), and injury at another site.

CONCLUSIONS

Criteria for determining successful RTS and return to preinjury level after superior labral pathophysiology treatment were not reported by most studies. The nRTS and nRTPL rates varied greatly within and between treatments. The reasons for this unsuccessful return were diverse and related to physical sensations, psychological factors, personal factors, and injury unrelated to treatment.

LEVEL OF EVIDENCE

Level IV, Systematic review of Level II-IV studies.

A Single-Portal Arthroscopic Technique for Type II Slap Lesions in the Beach Chair Position

The options for surgical treatment of an anterior labrum lesion have become extensive. Arthroscopic treatments are widely used as an improved minimally invasive option with a quick recovery. Arthroscopic treatment of the anterior glenoid labrum generally requires the creation of two working portals. However, arthroscopic treatment through a single anterior portal is still successful. Our single-portal technique avoids interference between instruments inserted through the two working portals and minimizes postoperative scarring, pain, and reduction in range of motion. The purpose of this article was to describe our single-portal arthroscopy technique to repair the anterior glenoid labrum.