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[Is the patient age a negative predictive factor in the reconstruction of SLAP lesions?]
L J Lehmann1, M Moursy, C Lederer
1Orthopädisch-Unfallchirurgisches Zentrum, Medizinische Fakultät Mannheim der Universität Heidelberg, Universitätsmedizin Mannheim. lars.lehmann@umm.de
Background:
The treatment strategy of SLAP (superior labrum anterior posterior) lesions is generally a matter of controversy, particularly in patients over 40 years of age. Various factors, such as the increasing number of associated injuries in older age, play a role in the decision-making process. There currently is no empirical evidence for the greater efficacy of treatment planning for SLAP repair as compared to tenodesis/tenotomy. The aim of this study was to analyse, as part of a cohort comparison, the results after SLAP repair in patients under and over 40 years of age.
Methods:
We followed 45 patients after surgical treatment of a SLAP lesion, with a mean follow-up of 60 months (5 years), clinically using the Constant score (CS), the Rowe score, and the "subjective shoulder value" (SSV). Of these, 18 patients in group 1 (age at surgery<40 years, mean age at surgery 29 years, range: 21-39 years) and 27 patients in group 2 (age≥40 years at surgery, mean age at surgery 50 years, range: 40-60 years).
Results:
A mean CS of 89% (min 16%-max 105%) resulted. The Rowe score averaged 90 points (min. 35 points-max 100 points), while the SSV averaged 90% (min 20%-max 100%). In comparing the two groups, neither displayed a significant difference in the CS (p=0.198) (group 1: min 58%-max 105%, median 92%, group 2: min 16%-max 105%, median 89%) nor in the Rowe score (p=0.5) (group 1: min 55-max 100 points, median 85 points, group 2: min 35-max 100 points, median 92.5 points). The SSV also showed no significant difference in level (p=0.068) between the two groups (group 1: min 60%-max 100%, median 95%, group 2: min 20%-max 100%, median 90%), although the SSV in group 1 had a better correlation with the CS than in group 2.
Discussion:
The patient's age seems to have less influence on the outcome after reconstruction of SLAP than previously thought. Even at age≥40 years results show that the reconstruction results of the complex SLAP are comparable with the known literature data, and that it is good clinical practice. Impact on the long-term outcome seems to be particularly dependent on the number and severity of associated injuries, not the patient's age.
