Mollon Brent, Mahure Siddharth A, Ensor Kelsey L, Zuckerman Joseph D, Kwon Young W, Rokito Andrew S
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York, U.S.A.
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York, U.S.A..
Arthroscopy. 2016 Oct;32(10):1954-1962.e1. doi: 10.1016/j.arthro.2016.01.053. Epub 2016 Apr 12.
To quantify the incidence of and identify the risk factors for subsequent shoulder procedures after isolated SLAP repair.
New York's Statewide Planning and Research Cooperative System database was searched between 2003 and 2014 to identify individuals with the sole diagnosis of a SLAP lesion who underwent isolated arthroscopic SLAP repair. Patients were longitudinally followed up for a minimum of 3 years to analyze for subsequent ipsilateral shoulder procedures.
Between 2003 and 2014, 2,524 patients met our inclusion criteria. After 3 to 11 years of follow-up, 10.1% of patients (254 of 2,524) underwent repeat surgical intervention on the same shoulder as the initial SLAP repair. The mean time to repeat shoulder surgery was 2.3 ± 2.1 years. Subsequent procedures included subacromial decompression (35%), debridement (26.7%). repeat SLAP repair (19.7%), and biceps tenodesis or tenotomy (13.0%). After isolated SLAP repair, patients aged 20 years or younger were more likely to undergo arthroscopic Bankart repair (odds ratio [OR], 2.91; 95% confidence interval [CI], 1.36-6.21; P = .005), whereas age older than 30 years was an independent risk factor for subsequent acromioplasty (OR, 2.3; 95% CI, 1.4-3.7; P < .001) and distal clavicle resection (OR, 2.5; 95% CI, 1.1-5.5; P = .030). The need for a subsequent procedure was significantly associated with Workers' Compensation cases (OR, 2.4; 95% CI, 1.7-3.2; P < .001).
We identified a 10.1% incidence of subsequent surgery after isolated SLAP repair, often related to an additional diagnosis, suggesting that clinicians should consider other potential causes of shoulder pain when considering surgery for patients with SLAP lesions. In addition, the number of isolated SLAP repairs performed has decreased over time, and management of failed SLAP repair has shifted toward biceps tenodesis or tenotomy over revision SLAP repair in more recent years.
Level III, case-control study.
量化孤立性SLAP修复术后后续肩部手术的发生率，并确定其风险因素。
检索2003年至2014年纽约州全州规划与研究合作系统数据库，以确定仅诊断为SLAP损伤且接受孤立性关节镜下SLAP修复的个体。对患者进行至少3年的纵向随访，以分析后续同侧肩部手术情况。
2003年至2014年期间，2524例患者符合我们的纳入标准。经过3至11年的随访，10.1%的患者（2524例中的254例）在与初次SLAP修复相同的肩部接受了再次手术干预。再次肩部手术的平均时间为2.3±2.1年。后续手术包括肩峰下减压（35%）、清创术（26.7%）、再次SLAP修复（19.7%）以及肱二头肌固定术或肌腱切断术（13.0%）。孤立性SLAP修复术后，20岁及以下的患者更有可能接受关节镜下Bankart修复（优势比[OR]，2.91；95%置信区间[CI]，1.36 - 6.21；P = .005），而30岁以上是后续肩峰成形术（OR，2.3；95% CI，1.4 - 3.7；P < .001）和锁骨远端切除术（OR，2.5；95% CI，1.1 - 5.5；P = .030）的独立风险因素。后续手术的需求与工伤赔偿案件显著相关（OR，2.4；95% CI，1.7 - 3.2；P < .001）。
我们发现孤立性SLAP修复术后后续手术的发生率为10.1%，通常与其他诊断相关，这表明临床医生在考虑为SLAP损伤患者进行手术时应考虑肩部疼痛的其他潜在原因。此外，随着时间的推移，孤立性SLAP修复手术的数量有所减少，近年来，失败的SLAP修复的管理已从再次SLAP修复转向肱二头肌固定术或肌腱切断术。
III级，病例对照研究。
