Significant demographic and geographic differences exist in the reporting of superior labrum from anterior to posterior tear literature: a systematic review

Importance Superior labrum from anterior to posterior (SLAP) pathology can result in significant pain and functional limitation for a wide variety of patients. Although many different options have been described for the diagnosis and treatment of SLAP pathology, there is little high-quality evidence to support a given diagnosis/treatment method. Objective The aim of this study was to review the global demographics and trends of SLAP literature, diagnosis, management and consistency of reported outcomes Evidence review We performed a systematic search for studies addressing SLAP pathology published over the last 10 years. Extracted data included sample size, study location, intervention, outcome measures reported, sex distribution and level of evidence. Management was compared between geographic areas. Findings We identified 363 studies reporting on SLAP management over the past decade that met our inclusion and exclusion criteria. The majority of studies originated from North America (50.4%), followed by Asia (22.3%) and Europe (20.9%) with most studies describing results of operative intervention originating from the USA (58.5%). We found the majority of literature related to SLAP pathology was case series level data (44.0%) consisting of sample sizes of less than 40 patients (50.1%). The majority of studies presented clinical outcome scores with the ASES score being the most commonly reported (28.3%). The most common complications reported were pain (32.6%) and stiffness (30.4%) following surgical intervention. Conclusions Current literature related to the management of SLAP pathology demonstrates a predominance of North American studies with low levels of evidence consisting of small sample sizes and variably reported clinical outcome scores. Future research should focus on multicentre, randomised studies to clarify current controversies in the surgical versus non-operative management of SLAP pathology. Relevance Significant demographic and geographic differences exist in the diagnosis and treatment of SLAP. Level of evidence Level IV, systematic review of level I–IV studies.