Department of Orthopedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Am J Sports Med. 2020 Jun;48(7):1583-1589. doi: 10.1177/0363546520913538. Epub 2020 Apr 16.
Recent evidence has specified indications for performing superior labral anterior posterior (SLAP) repair and biceps tenodesis (BT) for the treatment of bicipital-labral lesions in the shoulder. Trends in performance of these procedures are expected to reflect the growing body of research regarding this topic.
To report practice trends for the surgical treatment of SLAP lesions utilizing the American Board of Orthopaedic Surgery (ABOS) database, particularly in older patients.
Cohort study; Level of evidence, 3.
The ABOS database was retrospectively queried between 2012 and 2017 by Current Procedural Terminology (CPT) codes for SLAP repair (29807), open BT (23430), and arthroscopic BT (29828). The patient population was excluded if any concomitant open shoulder procedure was performed. Trends over time were evaluated with respect to case volume, patient age, surgeon subspecialty, and whether a concomitant arthroscopic rotator cuff repair (RCR) was performed (CPT 29827).
A total of 9908 cases met inclusion/exclusion criteria: 4632 performed with RCR and 5276 performed without. The mean age of patients without RCR was 40.8 ± 13.8 years, while for those receiving RCR it was 55.0 ± 9.9 years ( < .001). In patients without RCR, there was a significant decline in rate of SLAP repairs performed over this period ( < .001). A significantly greater proportion of patients receiving open and arthroscopic BT were older than 35 years of age, compared with those receiving SLAP repair ( < .001). Within the RCR cohort, there was also a significant decline in concomitant SLAP repairs performed ( < .001) over the study period. With respect to BT, open BT was performed more frequently in the cohort without RCR (74.5%) than in the cohort with RCR (52.1%) ( < .001). Similarly, arthroscopic BT was performed more commonly in the cohort with RCR (47.9%) than in the cohort without RCR (25.5%) ( < .001).
The ABOS database revealed significantly reduced rates of SLAP repairs performed in recent times. Trends with age remained consistent over time, in that SLAP repairs were predominantly performed in younger patients. Open BT was performed more frequently overall, but with an increased proportion of arthroscopic BT occurring with RCR. Arthroscopic BT was performed much more frequently with RCR than without.
最近的证据明确了治疗肩部盂唇-二头肌复合体病变时进行肩盂上唇前后（SLAP）修复和肱二头肌长头腱固定术（BT）的适应证。这些手术方式的应用趋势预计将反映出针对该主题的研究不断增多。
利用美国骨科医师学会（ABOS）数据库报告 SLAP 病变手术治疗的实践趋势，特别是在老年患者中的应用趋势。
队列研究；证据等级，3 级。
通过美国骨科医师学会（ABOS）数据库，于 2012 年至 2017 年按现行操作术语（CPT）代码（29807 用于 SLAP 修复术、23430 用于开放 BT、29828 用于关节镜下 BT）查询 SLAP 修复术、开放 BT 和关节镜下 BT 的病例。如果同时进行了任何开放性肩部手术，则排除该患者。从病例量、患者年龄、外科医生亚专科和是否同时进行关节镜下肩袖修复术（CPT 29827）等方面评估随时间变化的趋势。
共纳入 9908 例符合纳入/排除标准的病例：其中 4632 例行 RCR，5276 例行非 RCR。非 RCR 组患者的平均年龄为 40.8±13.8 岁，而 RCR 组为 55.0±9.9 岁（<.001）。在非 RCR 组中，在此期间 SLAP 修复术的比例显著下降（<.001）。与接受 SLAP 修复术的患者相比，接受开放和关节镜下 BT 的患者中年龄超过 35 岁的比例显著更高（<.001）。在 RCR 组中，同期同时进行的 SLAP 修复术的比例也显著下降（<.001）。关于 BT，非 RCR 组中开放 BT 的实施比例（74.5%）明显高于 RCR 组（52.1%）（<.001）。同样，RCR 组中关节镜下 BT 的实施比例（47.9%）也明显高于非 RCR 组（25.5%）（<.001）。
ABOS 数据库显示，最近 SLAP 修复术的实施比例显著降低。随着时间的推移，年龄趋势保持一致，即 SLAP 修复术主要在年轻患者中进行。总的来说，开放 BT 更为常见，但随着 RCR 的应用，关节镜下 BT 的比例有所增加。与无 RCR 相比，RCR 时关节镜下 BT 的实施更为常见。
