Type VIII Slap Repair: Patient-Reported Outcomes Of 34 Patients With Minimum 4-year Follow-up
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abstract
Objectives:
Type VIII superior labrum anterior posterior (SLAP) tears - described as SLAP
II injuries with posterior extension of the labral tear to the 6 o’clock
aspect of the glenoid - have been shown in short-term outcome work to be a
source of noted shoulder instability, pain, and reduced function/range of
motion in both throwing and non-throwing athletes. Limiting our evaluation
and effective treatment of these injuries in both the professional athlete
and weekend warrior is our lack of mid- and long-term post-operative
outcomes after surgical repair. It is hypothesized that Type VIII SLAP
repairs would fare poorly, particularly in the throwing cohort, at mid- to
long-term follow-up.
Methods:
With a minimum 4-year follow-up after Type VIII SLAP repair by a single
surgeon, return to sport, KJOC, ASES, stability, range of motion, and pain
were compared between throwers, contact, and non-contact athletes.
Results:
With an average follow-up of 6.2 years, 34 athletes (19 throwers, 5 contact
athletes, 10 non-contact athletes), with a mean age of 24.4 years were
evaluated. Significant (p < .0001) improvements were observed between
pre- and post-operative pain, range of motion, and ASES total and functional
scores in throwers and non-throwers. Stability improved but was not
significant (Table 1). There were no post-operative differences between
throwers and non-throwers (Table 2). Pre-operative ASES functional score was
significantly lower in contact athletes than in throwers and non-contact
athletes (p < .01), but post-operatively improved significantly with no
difference between groups (Table 3, 4). Overall, there was no difference in
return to sport between groups as 73.7% of throwers and 93.3% of
non-throwers returned (Table 4) and 62.5% of throwers and 57.9% of
non-throwers (p = .73) returned to the same level. Further, 89.5% of
throwers and 100% of non-throwers (p = .49) said that their surgery was
worthwhile.
Conclusion:
Given the paucity of literature, current surgical outcomes of athletes who
have undergone Type VIII SLAP repairs is limited, particularly in mid- and
long-term function and return to sport. The current findings suggest that
surgical repair of Type VIII SLAP lesions contributes to significant
improvements in pain, function, and shoulder range of motion that persists
>4 years after repair. However, stability changes after injury appear
more chronic in nature. Further, thrower and non-throwers appear to have
similar outcomes, which has not previously been seen in short term
studies.Table 1: Cohort Pain, Stability, and Functional OutcomesPre-OpPost-OpP-valueStability5.7 ± 3.64.5 ± 3.7.23Pain8.0 ± 1.51.3 ± 1.7*** < .0001ROM.76 ± .92.3 ± .5*** < .0001ASESFunctionalScore15.0 ± 4.027.6 ± 3.5*** < .0001ASES Total34.9 ± 12.190.1 ± 12.7*** < .0001Table 2: Thrower vs. Non-Thrower Post-Operative OutcomesThrowerNon-ThrowerP-valueStability3.7 ± 3.65.5 ± 3.7.15Pain1.3 ± 1.81.2 ± 1.6.83ROM2.3 ± .62.3 ± .5.70ASES Functional Score27.4 ± 4.027.9 ± 2.7.68ASES Total88.9 ± 14.091.6 ± 11.2.54Kerlan Jobe Score66.0 ± 28.375.0 ± 28.7.19Table 3: Thrower vs. Contact/Non-Contact Athletes – Patient Characteristics
and Pre-Operative Pain, Function, and Range of MotionThrowerContactNon-ContactP-valueAge at OR22.9 ± 8.221.4 ± 5.828.9 ± 12.6.21Age at Follow-Up29.1 ± 9.327.6 ± 5.934.9 ± 11.4.24Post-Op Follow-Up6.3 ± 1.96.2 ± 1.86.0 ± 2.0.95# Anchors4.6 ± 1.35.4 ± 1.35.5 ± .9.22Stability5.7 ± 3.54 ± 4.46.3 ± 4.0.67Pain7.9 ± 1.38.7 ± 1.28.0 ± 2.0.74ROM.5 ± .4.3 ±.61 ± .6.39ASES Functional Score14.8 ± 3.19.3 ± 5.517.7 ± 3.0** < .01ASES Total35.0 ± 9.923.8 ± 14.039.4 ± 14.5.18Table 4: Thrower vs. Contact/Non-Contact Athletes – Post-Operative Pain,
Function, and Range of MotionThrower (n=17)Contact (n=5)Non-Contact (n=10)P-valueStability3.7 ± 3.64.2 ± 4.16.3 ± 3.6.23Pain1.3 ±1.8.8 ± 1.81.4 ± 1.6.22ROM2.3 ± .62.6 ± .52.3 ± .5.47ASESFunctionalScore27.4 ± 4.027.6 ± 4.328 ± 1.8.90ASES Total88.9 ± 14.091.8 ± 16.091.5 ± 8.9.83
