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The Impact of Superior Labral Anterior to Posterior Lesions on Functional Status in Shoulder Instability: A Multicenter Cohort Study.

Gaudelli C, Hébert-Davies J, Balg F, Pelet S, Djahangiri A, Godbout V, Rouleau DM - Orthop J Sports Med (2014)

Bottom Line: These patients were compared with a group of patients who simply had a Bankart lesion (SLAP-).At baseline, SLAP+ subjects had inferior QuickDASH scores compared with SLAP- subjects (37.8 vs 29.0) as well as poorer pain subscores on both the WOSI and QuickDASH.At 1-year follow-up, however, there were no significant differences in any of the outcome measures.

View Article: PubMed Central - PubMed

Affiliation: Université de Montréal and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.

ABSTRACT

Background: Type IV superior labral anterior to posterior (SLAP) lesions, which are superior labral detachments associated with Bankart tears, are reported to occur in up to 25% of recurrent shoulder instability patients. However, the clinical implications of this finding are debatable.

Purpose: To determine whether there are any functional differences between anterior instability patients with and without type IV SLAP lesions at the time of presentation and at short-term follow-up after surgical intervention.

Study design: Cohort study; Level of evidence, 2.

Methods: A prospective, multicenter database was established to follow the clinical evolution of patients with shoulder instability. Patients were diagnosed as having a type IV SLAP lesion at the time of arthroscopic Bankart surgery (SLAP+). These patients were compared with a group of patients who simply had a Bankart lesion (SLAP-). The 2 groups had their functional outcomes (Western Ontario Shoulder Instability Index [WOSI]; Disability of the Arm, Shoulder, and Hand [QuickDASH]; and Walch-Duplay) compared prior to surgery and 1 year postoperatively.

Results: A total of 103 subjects were included in the study; of these, 56 (43 men, 13 women) completed 1-year follow-up. Twenty-three subjects had a type IV SLAP tear, and most had this repaired along with their Bankart lesion. At baseline, SLAP+ subjects had inferior QuickDASH scores compared with SLAP- subjects (37.8 vs 29.0) as well as poorer pain subscores on both the WOSI and QuickDASH. At 1-year follow-up, however, there were no significant differences in any of the outcome measures.

Conclusion: A type IV SLAP lesion can be expected in 22% of patients with recurrent shoulder instability. This finding implies that at baseline, the patient will have slightly worse functional scores related to pain. However, following surgical management of the labral pathology, these patients will have equivalent functional outcomes at short-term follow-up.

Clinical relevance: With surgical management of the superior and anteroinferior labrum, patients with type IV SLAP lesions will do as well as those with only Bankart tears. Thus, the presence of SLAP lesions should not alter the decision to provide surgical management and should not change the prognosis for a specific patient.

No MeSH data available.


Related in: MedlinePlus

Representation of a type IV superior labral anterior to posterior (SLAP) lesion. There is a superior labral detachment in addition to the anteroinferior Bankart lesion.
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fig1-2325967114554195: Representation of a type IV superior labral anterior to posterior (SLAP) lesion. There is a superior labral detachment in addition to the anteroinferior Bankart lesion.

Mentions: Superior labral anterior to posterior (SLAP) tears were first classified by Snyder et al14 into 4 categories. However, this initial description did not encompass all possible permutations. Maffet et al12 added to this classification and defined the type IV lesion, that is, a detachment of the superior labrum associated with a Bankart lesion (Figure 1). They found this lesion in 2% of subjects in their series, which consisted of patients presenting to their center for either diagnostic or therapeutic arthroscopy. It has been reported to occur in up to 25% of patients with symptomatic, recurrent shoulder instability.4 Thus, a type IV SLAP lesion is not uncommon in patients presenting for surgical management of shoulder instability.


The Impact of Superior Labral Anterior to Posterior Lesions on Functional Status in Shoulder Instability: A Multicenter Cohort Study.

Gaudelli C, Hébert-Davies J, Balg F, Pelet S, Djahangiri A, Godbout V, Rouleau DM - Orthop J Sports Med (2014)

Representation of a type IV superior labral anterior to posterior (SLAP) lesion. There is a superior labral detachment in addition to the anteroinferior Bankart lesion.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4555552&req=5

fig1-2325967114554195: Representation of a type IV superior labral anterior to posterior (SLAP) lesion. There is a superior labral detachment in addition to the anteroinferior Bankart lesion.
Mentions: Superior labral anterior to posterior (SLAP) tears were first classified by Snyder et al14 into 4 categories. However, this initial description did not encompass all possible permutations. Maffet et al12 added to this classification and defined the type IV lesion, that is, a detachment of the superior labrum associated with a Bankart lesion (Figure 1). They found this lesion in 2% of subjects in their series, which consisted of patients presenting to their center for either diagnostic or therapeutic arthroscopy. It has been reported to occur in up to 25% of patients with symptomatic, recurrent shoulder instability.4 Thus, a type IV SLAP lesion is not uncommon in patients presenting for surgical management of shoulder instability.

Bottom Line: These patients were compared with a group of patients who simply had a Bankart lesion (SLAP-).At baseline, SLAP+ subjects had inferior QuickDASH scores compared with SLAP- subjects (37.8 vs 29.0) as well as poorer pain subscores on both the WOSI and QuickDASH.At 1-year follow-up, however, there were no significant differences in any of the outcome measures.

View Article: PubMed Central - PubMed

Affiliation: Université de Montréal and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.

ABSTRACT

Background: Type IV superior labral anterior to posterior (SLAP) lesions, which are superior labral detachments associated with Bankart tears, are reported to occur in up to 25% of recurrent shoulder instability patients. However, the clinical implications of this finding are debatable.

Purpose: To determine whether there are any functional differences between anterior instability patients with and without type IV SLAP lesions at the time of presentation and at short-term follow-up after surgical intervention.

Study design: Cohort study; Level of evidence, 2.

Methods: A prospective, multicenter database was established to follow the clinical evolution of patients with shoulder instability. Patients were diagnosed as having a type IV SLAP lesion at the time of arthroscopic Bankart surgery (SLAP+). These patients were compared with a group of patients who simply had a Bankart lesion (SLAP-). The 2 groups had their functional outcomes (Western Ontario Shoulder Instability Index [WOSI]; Disability of the Arm, Shoulder, and Hand [QuickDASH]; and Walch-Duplay) compared prior to surgery and 1 year postoperatively.

Results: A total of 103 subjects were included in the study; of these, 56 (43 men, 13 women) completed 1-year follow-up. Twenty-three subjects had a type IV SLAP tear, and most had this repaired along with their Bankart lesion. At baseline, SLAP+ subjects had inferior QuickDASH scores compared with SLAP- subjects (37.8 vs 29.0) as well as poorer pain subscores on both the WOSI and QuickDASH. At 1-year follow-up, however, there were no significant differences in any of the outcome measures.

Conclusion: A type IV SLAP lesion can be expected in 22% of patients with recurrent shoulder instability. This finding implies that at baseline, the patient will have slightly worse functional scores related to pain. However, following surgical management of the labral pathology, these patients will have equivalent functional outcomes at short-term follow-up.

Clinical relevance: With surgical management of the superior and anteroinferior labrum, patients with type IV SLAP lesions will do as well as those with only Bankart tears. Thus, the presence of SLAP lesions should not alter the decision to provide surgical management and should not change the prognosis for a specific patient.

No MeSH data available.


Related in: MedlinePlus