Issue: July 2013
July 01, 2013
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Researchers find biceps tenodesis effective after failed repair of type 2 SLAP tears

Most patients had good to excellent outcome scores and improved motion after the revision.

Issue: July 2013
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CHICAGO — Researchers from the Naval Medical Center in San Diego found that biceps tenodesis was an effective procedure for revising type 2 SLAP tears that failed arthroscopic repair in active-duty military personnel.

“We demonstrate biceps tenodesis is a predictable, safe and effective surgical technique for failed SLAP syndrome, where we saw a significant improvement in outcomes, range of motion and return to active duty,” Frank McCormick, MD, from the Department of Sports Medicine at Rush University Medical Center, said during his presentation at the American Orthopaedic Society for Sports Medicine Specialty Day Meeting.

CDR Matthew T. Provencher and LCDR McCormick prospectively evaluated 42 patients at minimum 2-year follow-up who underwent an open subpectoral tenodesis following failed arthroscopic repair between 2004 and 2011. The surgeries were performed at a tertiary-care military hospital, and all patients had a comprehensive preoperative physical examination. Nearly all of the patients had rotator cuff interval synovitis, loose suture loops and lack of healing at the glenohumeral interface. “Subacromial decompression was performed in a minority of cases,” McCormick said. Patients had a mean age of 39 years at the time of surgery.

The investigators reported 81% of patients were able to return to pre-injury levels of activity and that no significant adverse complications occurred.

 

An arthroscopic picture from the posterior portal in a right shoulder in the lateral position demonstrates a failed SLAP repair. Most patients demonstrated loose sutures and rotator interval synovitis. However, the etiology of failure was often undetermined.

 

An arthroscopic picture from the posterior portal in a right shoulder in the lateral position demonstrates the arthroscopic biceps tenotomy at the bicep labral complex. An extensive debridement of the rotator interval was then performed.

Images: McCormick F 

The researchers used American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE) and Western Ontario Shoulder Instability Index (WOSI) scores to evaluate postoperative subjective and objective outcome measures.

“All three clinical outcomes saw clinically and statistically significant improvement of nearly 20 points for each outcome assessment,” McCormick said. “Moreover, the mean forward flexion also statistically improved within the surgical cohort.”

Specifically, the ASES score increased from 67 points preoperatively to 85 points postoperatively, while SANE scores increased from 64 points to 84 points preoperatively in the patients. WOSI scores also increased from 65 points to 81 points preoperatived and postoperatively, according to the abstract.

Regarding the limitations of his study, McCormick noted the lack of a control group, generalization in the patient cohort and fact that the cohort was not a “true throwing population.” – by Jeff Craven

Reference:
McCormick F. Paper #17. Presented at: American Orthopaedic Society for Sports Medicine Specialty Day Meeting; March 23, 2013; Chicago.
For more information:
Frank McCormick, MD, can be reached at the Department of Sports Medicine Rush University Medical Center, 1611 W. Harrison St., Chicago, Ill., 60612; email: drfrankmccormick@yahoo.com.
Disclosure: McCormick has no relevant financial disclosures.