Isolated Type II SLAP Tears Undergo Reoperation More Frequently
Key findings
- This retrospective study analyzed 539 adults who had primary arthroscopic superior labrum anterior and posterior (SLAP) type II repair
- The two overlapping outcomes were unplanned reoperation (any subsequent surgery on the ipsilateral shoulder) and SLAP repair failure (revision SLAP repair or biceps tenodesis/tenotomy)
- Among the entire patient cohort, the rate of reoperation was 12% and the failure rate was 8%
- Isolated SLAP repair was an independent risk factor for unplanned reoperation; smoking and use of knotless sutures were independent predictors of SLAP repair failure
- After isolated SLAP repair, the reoperation rate was 16%; obesity and smoking significantly increased the risk of reoperation
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Orthopedic surgeons don't agree about the causes of failure of primary superior labrum anterior and posterior (SLAP) repair, mostly because there have been few comprehensive studies of the issue.
Recently, Matthew W. DeFazio, MD, researcher, Sezai Özkan, MD, PhD, research fellow and Neal C. Chen, MD, chief of the Hand and Arm Center; and Eric R. Wagner, MD, MSc, former clinical fellow and Jon J.P. Warner, MD, chief of the Shoulder Service; all in the Department of Orthopaedics at Massachusetts General Hospital, studied risk factors for revision of SLAP repair using a large retrospective cohort. One of the most clinically relevant findings, reported in Knee Surgery, Sports Traumatology, Arthroscopy, was that isolated SLAP repair was independently associated with unplanned reoperation.
Study Methods
The researchers examined data on 539 adults who had arthroscopic SLAP type II repair at Mass General or an affiliated hospital between 2005 and 2016. Of this cohort, 52% underwent at least one other concomitant procedure, not including subacromial decompression or joint debridement (rotator cuff repair, 62%; distal clavicle excision, 41%; or other).
The outcomes were defined as:
- Unplanned reoperation: any ipsilateral shoulder surgery after the primary SLAP repair
- SLAP repair failure was defined as revision SLAP repair or a biceps tenodesis/tenotomy procedure
Unplanned Reoperation
- Incidence: 12% of patients underwent unplanned reoperation
- In multivariable analysis, concomitant procedure at index surgery was independently associated with unplanned reoperation (OR, 0.57; P = 0.046)
Repair Failure
- Incidence: 8% of patients underwent revision SLAP repair or revision to bicep tenodesis
- In multivariable analysis smoking (OR, 3.1; P=0.004) and use of knotless sutures were independently associated with repair failure (OR, 3.4; P=0.007)
Isolated SLAP Repair
- 16% of patients who had an isolated SLAP repair underwent reoperation
- In this subgroup, obesity (P=0.02) and smoking (P=0.03) were associated with unplanned reoperation or SLAP failure repair
Counseling Patients
All patients undergoing primary type II SLAP repair should be aware of the potential for reoperation. It is also important to consider modifiable risk factors including smoking and obesity when discussing surgical options.
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