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Percutaneous SLAP Lesion Repair Technique Is an Effective Alternative to Portal of Wilmington

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Percutaneous SLAP Lesion Repair Technique Is an Effective Alternative to Portal of Wilmington Percutaneous SLAP Lesion Repair Technique Is an Effective Alternative to Portal of Wilmington HOME OF: Welcome, Guest Log in | Mobile | RSS Entire Site Meetings Home Blogs News Wire Multimedia Classified Marketplace Education Lab SHOULDER/ELBOW SEE ALSO ORTHOPEDICS November 2010;33(11):803. Scapular Percutaneous SLAP Lesion Repair Technique Osteochondromas Treated With Surgical Is an Effective Alternative to Portal of Excision Meetings & Courses Wilmington ORTHOPEDICS November Featured Meetings 2010 by Gregory J. Galano, MD; Christopher S. Ahmad, MD; Louis Bigliani, MD; William Levine, MD Contact Pressure and Submit a Comment Print E-mail Glenohumeral Translation Following Subacromial EFORT Abstract Decompression: How Topics Athletes with superior labral tear from anterior to posterior (SLAP) lesions place large demands on their Much Is Enough? Arthritis rotator cuff and often have partial articular-sided rotator cuff tears as part of an internal impingement ORTHOPEDICS November Arthroscopy 2010 process. A percutaneous technique that facilitates SLAP repair may decrease the rotator cuff morbidity Biologics associated with establishment of the standard Wilmington portal. The current study reports the clinical Subscapularis Function Business of Orthopedics outcome of patients with SLAP lesions treated with a percutaneous repair technique. Twenty-two patients Following the Latarjet Coracoid Transfer for Foot and Ankle with SLAP lesions underwent percutaneous repair. Mean patient age was 26.9 years. Standard posterior viewing and anterior working portals were used. Anchor placement and suture passing were performed Recurrent Anterior Hand/Upper Extremity with a 3-mm percutaneous and transtendinous approach to the superior labrum. Knot tying was performed Shoulder Instability Hip via the standard anterior working portal. Clinical outcomes were assessed with validated shoulder ORTHOPEDICS November 2010 Imaging evaluation instruments. Mean follow-up was 31.1 months (±6.6 months). Improvement of shoulder Infection evaluation scores from pre- to postoperative were as follows: American Shoulder and Elbow Surgeons Knee score improved from 49.5 to 83.6, visual analog scale improved from 5.4 to 1.5, and Simple Shoulder Multimedia Score improved from 6.4 to 11.0. All were significant improvements (P<.05). There was no significant Oncology difference in functional scores between Type II lesions versus combined lesions, or between patients with Osteoporosis or without a concurrent low-grade rotator cuff tear. Ninety percent of athletes were able to return to sport Pediatrics at pre-injury level of function. Percutaneously-assisted arthroscopic SLAP lesion repair may minimize Rehabilitation surgical morbidity to the rotator cuff and provides excellent results. Shoulder/Elbow Spine Superior labral tears extending anterior to posterior (SLAP tears) have gained much attention in shoulder HHR for Four-Part Fractures: Sports Medicine How to Get the Tuberosities to arthroscopy since their initial description by Andrews et al1 in 1985. The surgical treatment of these Trauma Heal (in the right place) lesions has evolved with the advances in arthroscopic techniques and instrumentation. Early studies by Matthew L. Ramsey, MD Exclusives reported debridement of these unstable lesions and demonstrated only short-term improvement with more Commentary deteriorating outcomes over time.2-4 Surgical repair is the more current treatment recommendation for Cover Stories unstable type II SLAP lesions. Multiple fixation methods have been used, including transosseous sutures, Cover Stories 4 Questions Interviews 2,5-13 staples, screws, bioabsorbable tacks, and suture anchors. The use of tacks has decreased Concern remains over From the Podium substantially as reports of synovial inflammation and severe joint destruction due to broken or prominent lack of solutions to 14,15 In the Journals implants have emerged. Therefore, the most recent recommendations are for surgical repair with worsening on-call 16-21 dilemma Personalities suture anchors. Despite advancements, reported outcomes of SLAP lesion repair have been variable especially with regard to athletes resuming their previous activity level. Reported outcomes of arthroscopic In what has been termed the ‘on- Round Table Discussions call dilemma,’ physicians are SLAP repair range from 63% to 100% good to excellent,2,5-13 but 9% to 55% are unable to return to their finding it more difficult — given a Surgical Techniques 3,7-10,12,13 potential lack of reimbursements, prior level of athletic activity. increasing practice costs, Bookstore increasing uncompensated care, http://www.orthosupersite.com/view.aspx?rid=76421[11/15/2010 2:40:31 PM] Percutaneous SLAP Lesion Repair Technique Is an Effective Alternative to Portal of Wilmington Story continues below↓ worsening paperwork and the Classified Marketplace medical liability climate — to ADVERTISEMENT provide proper on-call hours. Manuscript Submission Some regions are more troubled than others, but it has become Reprints obvious that a problem still exists and must be corrected. Subscribe more Follow us on Twitter Become a Fan on Facebook In addition to the standard anterior rotator interval and posterior arthroscopic portals, various options exist for instrumentation and repair of SLAP tears. These include a high anterolateral portal through the rotator interval, Neviaser’s portal, as well as various transrotator cuff portals. In 1998, Morgan et al22 described a posterolateral acromial portal used for suture anchor repair of posterosuperior component of these labral injuries, which they coined “Port of Wilmington.” For more anterosuperior labral work, an anterolateral acromial portal called an “accessory transrotator cuff portal” may be established. Both of these portals involve establishing a working cannula through the tendon of the supraspinatus.8,22-25 Recent attention has been drawn to the potential rotator cuff morbidity associated with this portal and some studies have reported inferior results when this portal is used.12,26 This may have an even greater impact on throwers and contact athletes who commonly develop SLAP lesions, have large demands on their rotator cuff, and require optimal rotator cuff function. Many of these overhead athletes fall under the spectrum of internal impingement as well, which often includes articular-sided rotator cuff pathology in combination with SLAP tears.27 For these reasons, a percutaneous technique of suture anchor insertion and suture passing to minimizing morbidity to the rotator cuff is important. This article reports the clinical outcomes for a cohort of patients treated with the percutaneous SLAP repair technique. The authors hypothesized that the results would be as good, if not better than those demonstrated with transrotator cuff portal SLAP repairs, with respect to validated shoulder measures as well as return to sports. Materials and Methods Institutional review board approval was obtained for this study. A retrospective hospital database review was performed to search for patients who underwent SLAP lesion repair by a single surgeon (C.S.A.) from the initiation of the technique. The study period was from January 2006 to January 2008. The technique was first used because a patient had concurrent SLAP and rotator cuff tears. The diagnosis of a SLAP lesion was made by a history of shoulder pain localized to the anterosuperior or posterosuperior aspects of the shoulder. All patients had physical examination findings suggesting a SLAP lesion including a positive active compression test,28 tenderness over the biceps in the bicipital groove, and apprehension-relocation testing for posterior-superior shoulder pain. Magnetic resonance imaging and/or magnetic resonance arthrography (MRA) were used to support the diagnosis and all SLAP lesions were confirmed at arthroscopy. Concomitant procedures, including anteroinferior and/or posteroinferior labral repair, or partial rotator cuff tear debridement. Patients were excluded from the study if they experienced a frank shoulder dislocation, were diagnosed with external impingement requiring subacromial decompression, or had a rotator cuff tear that required repair. Preoperatively, patients filled out American Shoulder and Elbow Surgeons (ASES) questionnaire, visual analog scale (VAS) of pain, and Simple Shoulder Test (SST). All patients were examined at last follow-up with the operating surgeon, and ASES, VAS, and SST data were again obtained with a questionnaire. Statistical significance between mean pre- and postoperative values was determined with Wilcoxon signed-rank test. By using this test, we avoided the assumption of a normal distribution of values. Subgroup comparison was performed using Mann-Whitney U test. A significant P value was regarded as anything less than .05, thereby corresponding to less than a 5% chance that the null hypothesis was rejected incorrectly. Surgical Technique http://www.orthosupersite.com/view.aspx?rid=76421[11/15/2010 2:40:31 PM] Percutaneous SLAP Lesion Repair Technique Is an Effective Alternative to Portal of Wilmington Anesthesia consisted of interscalene block and the patient was placed in a lateral decubitus position. Examination under anesthesia was performed and then 5 to 10 pounds of traction was applied to the operative arm. Standard posterior (viewing) and anterior (working) rotator interval portals were established. Diagnostic arthroscopy consisted of evaluation of all aspects of the labrum with visualization and probing (Figure
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