Surgical Treatment of Symptomatic Superior Labrum Anterior-Posterior Tears in Patients Older Than 40 Years

Erickson, John M.; Lavery, Kyle P.; Monica, James; Gatt, Charles J.; Dhawan, Aman

doi:10.1177/0363546514536874

Cited by 75 publications

(48 citation statements)

References 39 publications

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“…11,[14][15][16]18,19,21,23,30 There is conflicting evidence regarding the extent to which age-related degenerative and physiologic changes impact outcomes following surgical repair of other areas of the labrum. 24,31,32 Provencher et al 31 reported the relative risk of surgical failure following superior labrum anterior-posterior repair was 3.45 (95% confidence interval, 2.0-4.9) for patients older than 36 years. Another series describing arthroscopic repair of circumferential labral tears found no association between age and postoperative outcomes, complications, or revision rates.…”

Section: Discussionmentioning

confidence: 99%

“…11,23 Differences in mechanism of injury, tissue healing capacity, and other age-related changes may result in inferior outcomes for middle-aged adults undergoing labral repair compared with younger overhead athletes. 24,25 The purpose of this study was to evaluate the clinical results of arthroscopic repair of posterior labral tears in patients 35 years and older using validated functional outcome measures, as well as to report the incidence of complications and revision procedures. It was hypothesized that these patients would have worse outcomes than those previously reported in their younger counterparts.…”

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confidence: 99%

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Outcomes Following Arthroscopic Repair of Posterior Labral Tears in Patients Older Than 35 Years

Bateman¹,

Black²,

Lazarus³

et al. 2017

Orthopedics

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Although the results of arthroscopic management of posterior labral pathology in young athletes have been reported extensively in the literature, the clinical outcomes in older patients are unknown. This retrospective review included patients older than 35 years who underwent arthroscopic posterior labral repair. Functional outcome scores were collected, and subgroup analyses were performed to evaluate the impact of patient-specific factors. Forty-three patients met the inclusion criteria; average follow-up was 36.9 months (range, 24-54 months). Mean patient age at the time of surgery was 40.9 years (range, 35-57 years). Average outcome scores at final follow-up were Quick Disabilities of the Arm, Shoulder and Hand Scale (QuickDASH), 19±22; Simple Shoulder Test (SST), 9.9±3; Western Ontario Shoulder Instability Index (WOSI), 601±546; and Single Assessment Numeric Evaluation (SANE), 79.6%±23.4%. No significant differences in outcomes were observed in patients with preoperative symptomatic instability, active workers' compensation claims, or traumatic injury (P>.05). The presence of intraoperatively definable chondral damage (Outerbridge grade III or higher) was associated with significantly worse final functional outcomes (QuickDASH: 29 vs 11.9, P=.03; SST: 8.5 vs 10.9, P=.02; WOSI: 875 vs 407, P=.01; and SANE: 70.6% vs 86%, P=.05). One patient (2%) experienced a minor postoperative complication, and 3 patients (7%) required subsequent procedures: 2 total shoulder arthroplasties and 1 revision labral repair. The results of arthroscopic posterior labral repair in patients older than 35 years were variable and worse than those previously reported in younger patients. The presence of chondral damage at the time of the index procedure was a negative predictive factor. [Orthopedics. 2017; 40(2):e305-e311.].

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Outcomes Following Arthroscopic Repair of Posterior Labral Tears in Patients Older Than 35 Years

Bateman¹,

Black²,

Lazarus³

et al. 2017

Orthopedics

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“…1) Level 2*: (Gorantla et al, 2010) 2) Level 2*: (Erickson et al, 2015) Level 1: systematic review, level 2*: downgraded systematic review, level 2: randomized clinical trial (RCT) or inception cohort study, level 4: Case series or casecontrol study.…”

Section: Strength and Limitationsmentioning

confidence: 99%

Agreement between physical therapists and radiologists of stratifying patients with shoulder pain into new treatment related categories using ultrasound; an exploratory study

Graaf

Ottenheijm

Verhagen

et al. 2019

Musculoskeletal Science and Practice

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Study design: A systematic overview of the literature and an agreement study. Objectives: The aim of this study is to explore the inter-professional agreement of diagnostic musculoskeletal ultrasound (DMUS) between physical therapists (PT) and radiologists, using a new classification strategy based upon the therapeutic consequences in patients with shoulder pain. Background: DMUS is frequently used by PTs, although the agreement regarding traditional diagnostic labels between PTs and radiologists is only fair. Nevertheless, DMUS could be useful when used as a stratifying-tool. Methods: First, a systematic overview of current evidence was performed to assess which traditional diagnostic labels could be recoded into new treatment related categories (referral to secondary care, corticosteroid injections, physical therapy, watchful waiting). Next, kappa values were calculated for these categories between PTs and radiologists. Results: Only three categories were extracted, as none of the traditional diagnostic labels were classified into the 'corticosteroid injection' category. Overall, we found moderate agreement to stratify patients into treatment related categories and substantial agreement for the category 'referral to secondary care'. Both categories 'watchful waiting' and 'indication for physical therapy' showed moderate agreement between the two professions. Conclusion: Our results indicate that the agreement between radiologists and PTs is moderate to substantial when labelling is based on treatment consequences. DMUS might be able to help the PT to guide treatment, especially for the category 'referral to secondary care' as this showed the highest agreement. However, as this is just an explorative study, more research is needed, to validate and assess the consequences of this stratification classification for clinical care.

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“…Type II lesions are the most common to be approached surgically. Repair may be performed in patients younger than 40 years, but in older patients, successful healing and favorable outcomes with repair are less predictable, and biceps tenodesis or tenotomy is more typically performed-particularly if there is a coexisting rotator cuff tear (46).…”

Section: Labral Repairmentioning

confidence: 99%

Postoperative Shoulder Imaging: Rotator Cuff, Labrum, and Biceps Tendon

et al. 2016

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Imaging interpretation of the postoperative shoulder is a challenging and difficult task for both the radiologist and the orthopedic surgeon. The increasing number of shoulder rotator cuff, labrum, and biceps tendon repairs performed in the United States also makes this task a frequent occurrence. Whether treatment is surgical or conservative, imaging plays a crucial role in patient care. Many imaging findings can be used to predict prognosis and functional outcomes, ultimately affecting treatment. In addition, evolving surgical techniques alter the normal anatomy and imaging appearance of the shoulder such that accepted findings proved to be pathologic in the preoperative setting cannot be as readily described as pathologic after surgery. An understanding of common surgical procedures of the shoulder can aid in recognizing normal expected postoperative findings and discerning common complications. Although magnetic resonance (MR) imaging and MR arthrography are widely used, implementing a multimodality imaging approach for evaluation of the postoperative shoulder can provide additional imaging information that may be decisive and vital to diagnosis. The high spatial resolution of both computed tomography with arthrography and ultrasonography makes them additional modalities to consider, especially when dealing with metal artifact. To provide an accurate radiologic interpretation of high clinical value, radiologists should approach the postoperative shoulder comprehensively with knowledge of the anatomy, surgical techniques and complications, clinical outcomes, and imaging pitfalls. RSNA, 2016.

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Surgical Treatment of Symptomatic Superior Labrum Anterior-Posterior Tears in Patients Older Than 40 Years

Cited by 75 publications

References 39 publications

Outcomes Following Arthroscopic Repair of Posterior Labral Tears in Patients Older Than 35 Years

Outcomes Following Arthroscopic Repair of Posterior Labral Tears in Patients Older Than 35 Years

Agreement between physical therapists and radiologists of stratifying patients with shoulder pain into new treatment related categories using ultrasound; an exploratory study

Postoperative Shoulder Imaging: Rotator Cuff, Labrum, and Biceps Tendon

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