The Impact of Lateral Decubitus vs. Beach Chair Positioning on the Clinical Outcome of the Patients with Isolated SLAP Type II Repair: A Systematic Review and Meta-analysis



1 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

3 1 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran - 3 Rothman Orthopaedics Florida at Advent Health, Orlando, USA


Background: A superior labrum from anterior to posterior (SLAP) repairs can be performed in either beach chair (BC) or
lateral decubitus (LD). The purpose of this study was to perform a systematic review and meta-analysis to compare the
outcomes of surgical repair of type II SLAP injuries between the BC vs. LD positions. We hypothesized no statistically
significant differences in the functional, pain, and motion outcomes between the BC vs. LD positions after type II SLAP repair.
Methods: A comprehensive literature search was performed using MEDLINE, Scopus, Web of Science, Embase, and
Cochrane to identify studies reporting outcomes after type II SLAP repair. Outcome measures consisted of pain using
the visual analog score (VAS), range of motion (ROM), and functional scores, including the University of California at Los
Angeles Shoulder (UCLA) score, American Shoulder and Elbow Surgeons (ASES), and Constant score. The outcomes
were pooled and analyzed for eligibility and stratified into two subgroups for a random-effects model meta-analysis.
Results: Of the 8,016 identified studies through a database search, 13 papers (378 patients) were eligible for statistical
analysis in the BC and 10 articles (473 patients) were included in the LD group. The mean follow-up for BC and LD was
35 and 44 months, respectively. The SLAP repair in both positions demonstrated improvements in postoperative clinical
outcomes and ROM. Comparing the two positions, the LD group demonstrated significantly greater improvements in
VAS which contributed to better functional outcomes, while the BC group showed a significantly greater improvement in
abduction. No other differences were identified including ASES, UCLA, and Constant score as well as remaining ROM.
Conclusion: Based on the findings of this systematic review and meta-analysis, both the BC and LD positions provide
patients better outcomes following operative repair of type II SLAPs. While LD represented a better improvement in
functional outcome measures, the BC position demonstrated better abduction with no other significant differences
between both positions. An individualized approach to position selection concerning the patient’s complaint (pain vs.
motion) as well as the surgeon’s discretion is recommended.
Level of evidence: IV


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