Trends Related to the Treatment of Superior Labral Tears at a Single Institution

Document Type : RESEARCH PAPER

Authors

Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA

Abstract

Background: As preferred treatment options for superior labral tears continue to evolve, this study aims to describe
the recent longitudinal trends in the treatment of SLAP tears in a sub-specialized practice at a single institution. We
hypothesized that there was a trend toward biceps tenodesis over repair for Type II SLAP lesions.
Methods: A retrospective review was performed using an institutional billing database to identify all patients with a
SLAP tear who underwent surgical intervention between January 2002 and January 2016. Procedural codes associated
with the surgery were analyzed to determine type of treatment each patient received.
Results: Of the 6,055 patients who underwent surgery for a SLAP tear during the study period, 39.1% (2,370)
underwent labral repair, 15.4% (930) underwent tenodesis without repair, and 45.5% (2,755) underwent arthroscopy
without tenodesis or repair. Labral repair made up a significantly higher proportion of surgical interventions in 2002
(82.2%) compared to in 2015 (21.8%; p <0.001). Surgeon experience did not impact trends. Over the study period,
the mean age of patients receiving labral repair decreased from 40.4 years (range: 16.2 – 63.9) to 32.6 years (range:
14.0 – 64.7; p <0.001).
Conclusion: This study demonstrates that over the 14-year study period the rate of labral repairs for SLAP tears has
decreased significantly and that these repairs have been directed towards a younger patient population.
Level of evidence: III

Keywords


1. Kim TK, Queale WS, Cosgarea AJ, McFarland EG.
Clinical features of the different types of SLAP lesions:
an analysis of one hundred and thirty-nine cases. JBJS.
2003; 85(1):66-71.
2. Maffet MW, Gartsman GM, Moseley B. Superior
labrum-biceps tendon complex lesions of the
shoulder. The American journal of sports medicine.
1995; 23(1):93-8.
3. Snyder SJ, Karzel RP, Pizzo WD, Ferkel RD, Friedman
MJ. Arthroscopy classics. SLAP lesions of the shoulder.
Arthroscopy: the journal of arthroscopic & related
surgery: official publication of the Arthroscopy
Association of North America and the International
Arthroscopy Association. 2010; 26(8):1117-.
4. Snyder SJ, Banas MP, Karzel RP. An analysis of 140
injuries to the superior glenoid labrum. Journal of
Shoulder and Elbow Surgery. 1995; 4(4):243-8.
5. Andrews JR, Carson JR WG, Mcleod WD. Glenoid
labrum tears related to the long head of the biceps.
The American journal of sports medicine. 1985;
13(5):337-41.
6. Morgan CD, Burkhart SS, Palmeri M, Gillespie M.
Type II SLAP lesions: three subtypes and their
relationships to superior instability and rotator cuff
tears. Arthroscopy: The Journal of Arthroscopic &
Related Surgery. 1998; 14(6):553-65.
7. Brockmeier SF, Voos JE, Williams III RJ, Altchek DW,
Cordasco FA, Allen AA. Outcomes after arthroscopic
repair of type-II SLAP lesions. The Journal of Bone and
Joint Surgery. American volume. 2009; 91(7):1595.
8. Friel NA, Karas V, Slabaugh MA, Cole BJ. Outcomes of
type II superior labrum, anterior to posterior (SLAP)
repair: prospective evaluation at a minimum two-year
follow-up. Journal of shoulder and elbow surgery.
2010; 19(6):859-67. 
9. Fedoriw WW, Ramkumar P, McCulloch PC, Lintner
DM. Return to play after treatment of superior labral
tears in professional baseball players. The American
journal of sports medicine. 2014; 42(5):1155-60.
10. Erickson J, Lavery K, Monica J, Gatt C, Dhawan A.
Surgical treatment of symptomatic superior labrum
anterior-posterior tears in patients older than 40
years: a systematic review. The American Journal of
Sports Medicine. 2015; 43(5):1274-82.
11. Boileau P, Parratte S, Chuinard C, Roussanne Y, Shia
D, Bicknell R. Arthroscopic treatment of isolated type
II SLAP lesions: biceps tenodesis as an alternative to
reinsertion. The American journal of sports medicine.
2009; 37(5):929-36.
12. Denard PJ, Lädermann A, Parsley BK, Burkhart SS.
Arthroscopic biceps tenodesis compared with repair
of isolated type II SLAP lesions in patients older than
35 years. Orthopedics. 2014; 37(3):e292-7.
13. Ek ET, Shi LL, Tompson JD, Freehill MT, Warner JJ.
Surgical treatment of isolated type II superior labrum
anterior-posterior (SLAP) lesions: repair versus
biceps tenodesis. Journal of shoulder and elbow
surgery. 2014; 23(7):1059-65.
14. Hurley ET, Fat DL, Duigenan CM, Miller JC, Mullett
H, Moran CJ. Biceps tenodesis versus labral repair
for superior labrum anterior-to-posterior tears:
a systematic review and meta-analysis. Journal of
shoulder and elbow surgery. 2018; 27(10):1913-9.
15. Patterson BM, Creighton RA, Spang JT, Roberson
JR, Kamath GV. Surgical trends in the treatment of
superior labrum anterior and posterior lesions of the
shoulder: analysis of data from the American Board
of Orthopaedic Surgery Certification Examination
Database. The American journal of sports medicine.
2014; 42(8):1904-10.
16. Erickson BJ, Jain A, Cvetanovich GL, Nicholson GP,
Cole BJ, Romeo AA, et al. Biceps Tenodesis: An
Evolution of Treatment. Am J Orthop (Belle Mead NJ).
2017;46(4):E219–23.
17. Wang KK, Yalizis M, Hoy GA, Ek ET. Current trends in
the evaluation and treatment of SLAP lesions: analysis
of a survey of specialist shoulder surgeons. JSES Open
Access. 2018; 2(1):48-53.
18. Li M, Shaikh AB, Sun J, Shang P, Shang X. Effectiveness
of biceps tenodesis versus SLAP repair for surgical
treatment of isolated SLAP lesions: A systemic review
and meta-analysis. Journal of orthopaedic translation.
2019; 16:23-32.
19. Pogorzelski J, Horan MP, Hussain ZB, Vap A, Fritz EM,
Millett PJ. Subpectoral biceps tenodesis for treatment
of isolated type II SLAP lesions in a young and active
population. Arthroscopy: The Journal of Arthroscopic
& Related Surgery. 2018; 34(2):371-6.
20. Chalmers PN, Monson B, Frank RM, Mascarenhas R,
Nicholson GP, Bach BR, et al. Combined SLAP repair
and biceps tenodesis for superior labral anterior–
posterior tears. Knee Surgery, Sports Traumatology,
Arthroscopy. 2016; 24(12):3870-6.
21. Schrøder CP, Skare Ø, Reikerås O, Mowinckel P, Brox JI.
Sham surgery versus labral repair or biceps tenodesis
for type II SLAP lesions of the shoulder: a three-armed
randomised clinical trial. British journal of sports
medicine. 2017;51(24):1759-66.