Poor outcomes after SLAP repair: descriptive analysis and prognosis.

PURPOSE

In the first part of this study, we analyzed a subset of patients to determine what factors may have been present in those with poor outcomes after SLAP repair. In part 2, we evaluated clinical outcomes of these patients after further treatment.

METHODS

We completed a retrospective medical record review of consecutive patients presenting between 2000 and 2007 with pain, stiffness, and/or mechanical symptoms after a SLAP repair. To evaluate for similarities among this cohort, data collection included demographics, age at initial SLAP repair, history of trauma, medical history, nonoperative and operative treatments, and physical examination. Outcome measures included patient satisfaction and the Simple Shoulder Test questionnaire. Subsequent treatment was then reviewed, investigating whether patients received physical therapy, cortisone injection, and/or revision surgery in an attempt to improve satisfaction. Outcome measures again included patient satisfaction and the Simple Shoulder Test questionnaire.

RESULTS

We found 40 shoulders in 39 patients who met inclusion criteria. The mean age at the time of initial SLAP repair was 43 years. Of the patients, 30 (75%) presented with pain and decreased range of motion, 9 (22.5%) presented with pain but full range of motion, and 1 (2.5%) presented with pain and mechanical symptoms but full range of motion. The mean Simple Shoulder Test score upon presentation after SLAP repair was 3.04 out of 12 (SD, 2.18; range, 0 to 7). We included 34 shoulders in the analysis of treatment outcome. Of these, 29% (10 of 34) were satisfied after conservative treatment, 62% (13 of 21) were satisfied after revision surgery, and 68% (23 of 34) were satisfied overall after either type of further treatment. The mean Simple Shoulder Test score after further treatment was 8.73 out of 12 (SD, 3.45; range, 0 to 12).

CONCLUSIONS

In this study 71% of patients (mean patient age, 43 years) with a poor outcome after SLAP repair were dissatisfied with conservative treatment. Therefore, once a patient has a poor outcome after SLAP repair, there is a high chance of conservative treatment failing. Although patients have better outcomes with operative intervention, 32% will continue to have a suboptimal result.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.