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Archives of Orthopaedic and Trauma Surgery

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01-09-2018 | Arthroscopy and Sports Medicine

Outcome of arthroscopic SLAP repair using knot-tying-suture anchors compared with knotless-suture anchors in athletes

Authors: Y. Reinig, F. Welsch, R. Hoffmann, D. Müller, K. F. Schüttler, E. Zimmermann, Thomas Stein

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 9/2018

Abstract

Introduction

Arthroscopic repair is one option for the surgical treatment of type II superior labrum tears from anterior to posterior (SLAP) lesions in athletes’ shoulders.

Materials and methods

Sixty-one of 78 (78.2%) athletes were retrospectively examined after isolated arthroscopic SLAP repair (group 1/G1: 28x knot-tying anchors; group 2/G2: 33 knotless anchors; follow-up 24 months) and compared to two specific, separate matched volunteer athlete control groups (group 3/G3: 28 athletes matched to G1; group 4/G4: 33 athletes matched to G2). The assessment of G1–4 included numerical analogue scales (NASs: 1–15 scales) and the Athletic Shoulder Outcome Scoring System (ASOSS) score, and the Shoulder Sport Activity Score (SSAS). The preinjury status (FU-1), the status before surgery (FU0), and at follow-up (FU1) were assessed.

Results

High external rotation at abduction (hER) was significantly worse in G1 than G2 (FU1: G1, 86.6° ± 7.7° versus = vs G2, 91.1° ± 10.7°; p = 0.03). The ASOSS and SSAS revealed significant impairment in G1–2 compared to G3–4 (ASOSS FU1: 83.9 ± 19.9 G1 vs 94.6 ± 7.7 G3; p = 0.002 and 80.3 ± 17.7 G2 vs 91.8 ± 9.1 G4; p = 0.002; SSAS 5.9 ± 2.7 G1 vs 6.9 ± 1.8 G3; p = 0.02 and 6.3 ± 2.5 G2 vs 7.4 ± 1.4 G4; p = 0.06), with 17–20% loss on ASOSS and 23–25% deficits on SSAS. The NAS analysis detected for pain (4 ± 3.5 vs 3.2 ± 2.6), satisfaction (2 ± 0.8 vs 1.8 ± 0.9), reduction of function (4.6 ± 3.9 vs 3.9 ± 3.8) and proficiency (9.6 ± 4.7 vs 10.9 ± 3.9) similar impairments in G1–2 (p > 0.05) and better results in G3 and G4 (all p < 0.001).

Conclusions

After SLAP repair, athletes showed underestimated impairment of shoulder sport resumption and proficiency with high rates of shoulder sports cessation. The present data favor the knotless fixation technique, because this fixation technique allowed bilaterally equivalent ranges of motions. The uninjured shoulder athletes also showed functional deficits with significant shoulder sport impairments, which must be considered in outcome analysis and for the rehabilitation program.

Level of evidence

III, retrospective cohort study.

Andrews JR, Carson WG Jr, McLeod WD (1985) Glenoid labrum tears related to the long head of the biceps. Am J Sports Med 13(5):337–341PubMedCrossRef

Snyder SJ, Banas MP, Karzel RP (1995) An analysis of 140 injuries to the superior glenoid labrum. J Shoulder Elbow Surg 4(4):243–248PubMedCrossRef

Burkhart SS, Morgan CD, Kibler WB (2003) The disabled throwing shoulder: spectrum of pathology. Part II: evaluation and treatment of SLAP lesions in throwers. Arthroscopy 19(5):531–539PubMedCrossRef

Sayde WM, Cohen SB, Ciccotti MG, Dodson CC (2012) Return to play after type II superior labral anterior–posterior lesion repairs in athletes: a systematic review. Clin Orthop Relat Res 470(6):1595–1600. https://doi.org/10.1007/s11999-012-2295-6 PubMedPubMedCentralCrossRef

Zhang AL, Kreulen C, Ngo SS, Hame SL, Wang JC, Gamradt SC (2012) Demographic trends in arthroscopic SLAP repair in the United States. Am J Sports Med 40(5):1144–1147. https://doi.org/10.1177/0363546512436944 PubMedCrossRef

Ek ET, Shi LL, Tompson JD, Freehill MT, Warner JJ (2014) Surgical treatment of isolated type II superior labrum anterior–posterior (SLAP) lesions: repair versus biceps tenodesis. J Shoulder Elbow Surg 23(7):1059–1065. https://doi.org/10.1016/j.jse.2013.09.030 PubMedCrossRef

McCormick F, Bhatia S, Chalmers P, Gupta A, Verma N, Romeo AA (2014) The management of type II superior labral anterior to posterior injuries. Orthop Clin North Am 45(1):121–128. https://doi.org/10.1016/j.ocl.2013.08.008 PubMedCrossRef

Erickson J, Lavery K, Monica J, Gatt C, Dhawan A (2015) Surgical treatment of symptomatic superior labrum anterior–posterior tears in patients older than 40 years: a systematic review. Am J Sports Med 43(5):1274–1282. https://doi.org/10.1177/0363546514536874 PubMedCrossRef

Maier D, Jaeger M, Ogon P, Bornebusch L, Izadpanah K, Suedkamp NP (2013) Suture anchors or transglenoidal sutures for arthroscopic repair of isolated SLAP-2 lesions? A matched-pair comparison of functional outcome and return to sports. Arch Orthop Trauma Surg 133(2):227–235. https://doi.org/10.1007/s00402-012-1657-6 PubMedCrossRef

10.

Yang HJ, Yoon K, Jin H, Song HS (2016) Clinical outcome of arthroscopic SLAP repair: conventional vertical knot versus knotless horizontal mattress sutures. Knee Surg 24(2):464–469. https://doi.org/10.1007/s00167-014-3449-8 CrossRef

11.

Chalmers PN, Monson B, Frank RM, Mascarenhas R, Nicholson GP, Bach BR Jr, Verma NN, Cole BJ, Romeo AA (2016) Combined SLAP repair and biceps tenodesis for superior labral anterior–posterior tears. Knee Surg 24(12):3870–3876. https://doi.org/10.1007/s00167-015-3774-6 CrossRef

12.

Brockmeier SF, Voos JE, Williams RJ III, Altchek DW, Cordasco FA, Allen AA (2009) Outcomes after arthroscopic repair of type-II SLAP lesions. J Bone Joint Surg Am 91(7):1595–1603. https://doi.org/10.2106/JBJS.H.00205 PubMedPubMedCentralCrossRef

13.

Soldatis JJ, Moseley JB, Etminan M (1997) Shoulder symptoms in healthy athletes: a comparison of outcome scoring systems. J Shoulder Elbow Surg 6(3):265–271PubMedCrossRef

14.

Stein T, Buckup J, Efe T, von Eisenhart-Rothe R, Hoffmann R, Zimmermann E, Welsch F (2015) Structural and clinical integrity of the rotator cuff in athletes after arthroscopic Bankart repair using the three-portal technique. Arch Orthop Trauma Surg 135(3):369–382. https://doi.org/10.1007/s00402-015-2158-1 PubMedCrossRef

15.

Vangsness CT Jr, Jorgenson SS, Watson T, Johnson DL (1994) The origin of the long head of the biceps from the scapula and glenoid labrum. An anatomical study of 100 shoulders. J Bone Joint Surg Br 76(6):951–954PubMedCrossRef

16.

Chokshi BV, Kubiak EN, Jazrawi LM, Ticker JB, Zheng N, Kummer FJ, Rokito AS (2006) The effect of arthroscopic suture passing instruments on rotator cuff damage and repair strength. Bull Hosp Jt Dis 63(3–4):123–125PubMed

17.

Allain J, Goutallier D, Glorion C (1998) Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder. J Bone Joint Surg Am 80(6):841–852PubMedCrossRef

18.

Tibone JE, Bradley J (1993) Evaluation of treatment outcomes for the athletes shoulder. The shoulder: a balance of mobility and stability. The American Academy of Othropaedic Surgeons, Rosemont

19.

Zeichen J, Meller R, Siegel A, Gehrke A, Hecker H, Krettek C (2004) Is the shoulder sport activity after shoulder injuries quantifiable? Implementation of a new Shoulder Sport Activity Score. German Congress for Orthopaedics and Traumatology, Berlin,

20.

Barber FA, Dockery WD, Cowden CH III (2013) The degradation outcome of biocomposite suture anchors made from poly l-lactide-co-glycolide and beta-tricalcium phosphate. Arthroscopy 29(11):1834–1839. https://doi.org/10.1016/j.arthro.2013.08.004 PubMedCrossRef

21.

Walch G (1987) Walch-Duplay rating sheet for anterior instability of the shoulder. Paper presented at the SESEC/ESSE, Paris

22.

Schroder CP, Skare O, Reikeras O, Mowinckel P, Brox JI (2017) Sham surgery versus labral repair or biceps tenodesis for type II SLAP lesions of the shoulder: a three-armed randomised clinical trial. Br J Sports Med. https://doi.org/10.1136/bjsports-2016-097098 PubMedCentralCrossRefPubMed

23.

Slenker NR, Lawson K, Ciccotti MG, Dodson CC, Cohen SB (2012) Biceps tenotomy versus tenodesis: clinical outcomes. Arthroscopy 28(4):576–582. https://doi.org/10.1016/j.arthro.2011.10.017 PubMedCrossRef

24.

Frost A, Zafar MS, Maffulli N (2009) Tenotomy versus tenodesis in the management of pathologic lesions of the tendon of the long head of the biceps brachii. Am J Sports Med 37(4):828–833. https://doi.org/10.1177/0363546508322179 PubMedCrossRef

25.

McCulloch PC, Andrews WJ, Alexander J, Brekke A, Duwani S, Noble P (2013) The effect on external rotation of an anchor placed anterior to the biceps in type 2 SLAP repairs in a cadaveric throwing model. Arthroscopy 29(1):18–24. https://doi.org/10.1016/j.arthro.2012.06.021 PubMedCrossRef

26.

Gorantla K, Gill C, Wright RW (2010) The outcome of type II SLAP repair: a systematic review. Arthroscopy 26(4):537–545. https://doi.org/10.1016/j.arthro.2009.08.017 PubMedCrossRef

27.

Boileau P, Parratte S, Chuinard C, Roussanne Y, Shia D, Bicknell R (2009) Arthroscopic treatment of isolated type II SLAP lesions: biceps tenodesis as an alternative to reinsertion. Am J Sports Med 37(5):929–936. https://doi.org/10.1177/0363546508330127 PubMedCrossRef

28.

O’Brien SJ, Allen AA, Coleman SH, Drakos MC (2002) 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 18(4):372–377PubMedCrossRef

29.

Morgan CD, Burkhart SS, Palmeri M, Gillespie M (1998) Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears. Arthroscopy 14(6):553–565PubMedCrossRef

30.

Yung PS, Fong DT, Kong MF, Lo CK, Fung KY, Ho EP, Chan DK, Chan KM (2008) Arthroscopic repair of isolated type II superior labrum anterior–posterior lesion. Knee Surg Sports Traumatol Arthrosc 16(12):1151–1157. https://doi.org/10.1007/s00167-008-0629-4 PubMedCrossRef

31.

Thorsness R, Alland JA, McCulloch CB, Romeo A (2016) Return to play after shoulder surgery in throwers. Clin Sports Med 35(4):563–575. https://doi.org/10.1016/j.csm.2016.05.003 PubMedCrossRef

32.

Fedoriw WW, Ramkumar P, McCulloch PC, Lintner DM (2014) Return to play after treatment of superior labral tears in professional baseball players. Am J Sports Med 42(5):1155–1160. https://doi.org/10.1177/0363546514528096 PubMedCrossRef

33.

Kim SH, Ha KI, Kim SH, Choi HJ (2002) Results of arthroscopic treatment of superior labral lesions. J Bone Joint Surg Am 84-A(6):981–985PubMedCrossRef

34.

Cohen DB, Coleman S, Drakos MC, Allen AA, O’Brien SJ, Altchek DW, Warren RF (2006) Outcomes of isolated type II SLAP lesions treated with arthroscopic fixation using a bioabsorbable tack. Arthroscopy 22(2):136–142. https://doi.org/10.1016/j.arthro.2005.11.002 PubMedCrossRef

35.

Coleman SH, Cohen DB, Drakos MC, Allen AA, Williams RJ, O’Brien SJ, Altchek DW, Warren RF (2007) Arthroscopic repair of type II superior labral anterior posterior lesions with and without acromioplasty: a clinical analysis of 50 patients. Am J Sports Med 35(5):749–753. https://doi.org/10.1177/0363546506296735 PubMedCrossRef

36.

Neuman BJ, Boisvert CB, Reiter B, Lawson K, Ciccotti MG, Cohen SB (2011) Results of arthroscopic repair of type II superior labral anterior posterior lesions in overhead athletes: assessment of return to preinjury playing level and satisfaction. Am J Sports Med 39(9):1883–1888. https://doi.org/10.1177/0363546511412317 PubMedCrossRef

37.

Yoneda M, Hirooka A, Saito S, Yamamoto T, Ochi T, Shino K (1991) Arthroscopic stapling for detached superior glenoid labrum. J Bone Joint Surg Br 73(5):746–750PubMedCrossRef

38.

Brockmeier SF, Voos JE, Williams RJ III, Altchek DW, Cordasco FA, Allen AA, Sports M, Shoulder S (2009) Hospital for special surgery. Outcomes after arthroscopic repair of type-II SLAP lesions. J Bone Joint Surg Am 91(7):1595–1603. https://doi.org/10.2106/JBJS.H.00205 PubMedPubMedCentralCrossRef

39.

Ide J, Maeda S, Takagi K (2005) Sports activity after arthroscopic superior labral repair using suture anchors in overhead-throwing athletes. Am J Sports Med 33(4):507–514. https://doi.org/10.1177/0363546504269255 PubMedCrossRef

40.

Baltaci G, Johnson R, Kohl H III (2001) Shoulder range of motion characteristics in collegiate baseball players. J Sports Med Phys Fit 41(2):236–242

41.

Bigliani LU, Codd TP, Connor PM, Levine WN, Littlefield MA, Hershon SJ (1997) Shoulder motion and laxity in the professional baseball player. Am J Sports Med 25(5):609–613PubMedCrossRef

42.

Stein T, Linke RD, Buckup J, Efe T, von Eisenhart-Rothe R, Hoffmann R, Jager A, Welsch F (2011) Shoulder sport-specific impairments after arthroscopic Bankart repair: a prospective longitudinal assessment. Am J Sports Med 39(11):2404–2414. https://doi.org/10.1177/0363546511417407 PubMedCrossRef

43.

Ide J, Maeda S, Takagi K (2004) Arthroscopic Bankart repair using suture anchors in athletes: patient selection and postoperative sports activity. Am J Sports Med 32(8):1899–1905PubMedCrossRef

44.

Lephart SM, Henry TJ (1995) Functional rehabilitation for the upper and lower extremity. Orthop Clin North Am 26(3):579–592PubMed

45.

Myers JB, Lephart SM (2000) The role of the sensorimotor system in the athletic shoulder. J Athl Train 35(3):351–363PubMedPubMedCentral

46.

Myers JB, Lephart SM (2002) Sensorimotor deficits contributing to glenohumeral instability. Clin Orthop Relat Res 400:98–104CrossRef

47.

Myers JB, Wassinger CA, Lephart SM (2006) Sensorimotor contribution to shoulder stability: effect of injury and rehabilitation. Man Ther 11(3):197–201PubMedCrossRef

48.

Swanik CB, Lephart SM, Rubash HE (2004) Proprioception, kinesthesia, and balance after total knee arthroplasty with cruciate-retaining and posterior stabilized prostheses. J Bone Joint Surg Am 86-A(2):328–334PubMedCrossRef

49.

Warner JJ, Lephart S, Fu FH (1996) Role of proprioception in pathoetiology of shoulder instability. Clin Orthop Relat Res 330:35–39

50.

Matsen FA, Lippit SB, Sidles JA, Harryman DT (1994) Practical evaluation and management of the shoulder. Saunders, Philadelphia

51.

Oh JH, Jo KH, Kim WS, Gong HS, Han SG, Kim YH (2009) Comparative evaluation of the measurement properties of various shoulder outcome instruments. Am J Sports Med 37(6):1161–1168. https://doi.org/10.1177/0363546508330135 PubMedCrossRef

52.

Placzek JD, Lukens SC, Badalanmenti S, Roubal PJ, Freeman DC, Walleman KM, Parrot A, Wiater JM (2004) Shoulder outcome measures: a comparison of 6 functional tests. Am J Sports Med 32(5):1270–1277. https://doi.org/10.1177/0363546503262193 PubMedCrossRef

53.

Burkhart SS, Morgan CD, Kibler WB (2003) The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. Arthroscopy 19(4):404–420. https://doi.org/10.1053/jars.2003.50128 PubMedCrossRef

54.

Burkhart SS, Morgan CD (1998) The peel-back mechanism: its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation. Arthroscopy 14(6):637–640PubMedCrossRef

55.

Walch G, Liotard JP, Boileau P, Noel E (1993) Postero-superior glenoid impingement. Another impingement of the shoulder. J Radiol 74(1):47–50PubMed

56.

Jobe CM (1995) Posterior superior glenoid impingement: expanded spectrum. Arthroscopy 11(5):530–536PubMedCrossRef

57.

Kibler WB (1998) The role of the scapula in athletic shoulder function. Am J Sports Med 26(2):325–337PubMedCrossRef

58.

Kibler WB, McMullen J (2003) Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg 11(2):142–151PubMedCrossRef

59.

Merolla G, De Santis E, Campi F, Paladini P, Porcellini G (2010) Supraspinatus and infraspinatus weakness in overhead athletes with scapular dyskinesis: strength assessment before and after restoration of scapular musculature balance. Musculoskelet Surg 94(3):119–125. https://doi.org/10.1007/s12306-010-0082-7 PubMedCrossRef

60.

Lajtai G, Pfirrmann CW, Aitzetmuller G, Pirkl C, Gerber C, Jost B (2009) The shoulders of professional beach volleyball players: high prevalence of infraspinatus muscle atrophy. Am J Sports Med 37(7):1375–1383. https://doi.org/10.1177/0363546509333850 PubMedCrossRef

61.

Lippitt S, Matsen F (1993) Mechanisms of glenohumeral joint stability. Clin Orthop Relat Res (291):20–28

62.

FA M (1994) Stability in “Practical evaluation and management of the shoulder”. Saunders

63.

Yildiz F, Bilsel K, Pulatkan A, Uzer G, Aralasmak A, Atay M (2017) Reliability of magnetic resonance imaging versus arthroscopy for the diagnosis and classification of superior glenoid labrum anterior to posterior lesions. Arch Orthop Trauma Surg 137(2):241–247. https://doi.org/10.1007/s00402-016-2605-7 PubMedCrossRef

Title: Outcome of arthroscopic SLAP repair using knot-tying-suture anchors compared with knotless-suture anchors in athletes
Authors: Y. Reinig
F. Welsch
R. Hoffmann
D. Müller
K. F. Schüttler
E. Zimmermann
Thomas Stein
Publication date: 01-09-2018
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 9/2018
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-018-2951-8

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Springer Medicine

Outcome of arthroscopic SLAP repair using knot-tying-suture anchors compared with knotless-suture anchors in athletes

Abstract

Introduction

Materials and methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Level of evidence

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