Concomitant arthroscopic SLAP and rotator cuff repair: surgical technique

The outcomes of combined arthroscopic repairs of a SLAP (superior labral anterior-posterior) lesion and a rotator cuff tear are not known. We compared the outcomes in a cohort of patients who had undergone concomitant arthroscopic repairs of a SLAP lesion and a rotator cuff tear with those in a cohort of patients with a stable biceps anchor who had undergone an isolated rotator cuff repair. We hypothesized that the results would be similar between the two cohorts with respect to the range of motion and preoperative and postoperative function.

Thirty-four patients (average age, 56.9 years) underwent an arthroscopic repair of an unstable SLAP lesion along with a concomitant arthroscopic rotator cuff repair. Twenty-eight patients (average age, 59.6 years) underwent an isolated arthroscopic rotator cuff repair. The average durations of follow-up for the two groups were 40.9 and 42.7 months, respectively. All patients in both groups had a symptomatic full-thickness rotator cuff tear for which initial conservative treatment had failed. Patients with advanced supraspinatus fatty infiltration or advanced muscle atrophy were excluded from the study. American Shoulder and Elbow Surgeons (ASES) and Constant scores were determined preoperatively and postoperatively, as were measurements of the ranges of forward flexion, abduction, external rotation, and internal rotation. Dynamometer strength testing was performed on all patients as an adjunct to qualitative assessments, and normalized Constant scores were calculated to perform sex and age-matched functional assessments.

In the group treated with concomitant repairs of a SLAP lesion and a rotator cuff tear, the average ASES score improved from 22.6 to 96.4 points and the average normalized Constant score improved from 55.1 to 101.0 points. In the group treated with an isolated arthroscopic rotator cuff repair, the average ASES score improved from 34.3 to 92.3 points and the average normalized Constant score improved from 60.7 to 95.8 points. The average preoperative ASES score in the group with the concomitant repairs was significantly worse than that in the group with the isolated rotator cuff repair (p = 0.027). This difference is also probably clinically relevant. There was no significant difference between the groups with regard to the preoperative normalized Constant scores, but postoperatively the normalized Constant score was significantly higher in the group with the concomitant repairs (p = 0.006). The active range of motion did not differ between the groups, preoperatively or postoperatively.

Controversy surrounds the treatment of a SLAP lesion with concomitant treatment of a full-thickness rotator cuff tear. This study suggests that, in middle-aged patients, the results of combined SLAP lesion and rotator cuff repair can be comparable with those achieved with rotator cuff repair alone.