Hahn Alexander K, Holmberg Kyle, Hammarstedt Jon E, Philp Frances, DeMeo Patrick, Lai Vince J, Kindya Michael Christopher, Paci James Michael, Farrow Lutul D, Vardiabasis Nicolas, Nye Darin, Frey Steven, Moutzouros Vasilios, Purnell Gregory J, Wang Patrick, Vaccariello Michael, Schweizer Scott K, Phillips Dennis J, Frank Darren A, Akhavan Sam
Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA.
Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
Orthop J Sports Med. 2023 Nov 10;11(11):23259671231204851. doi: 10.1177/23259671231204851. eCollection 2023 Nov.
Superior labral anterior and posterior (SLAP) tears are a common finding in overhead athletes. The original classification system produced by Snyder in 1990 contained 4 types of SLAP tears and was later expanded to 10 types. The classification has been challenging because of inconsistencies between surgeons making diagnoses and treatments based on the diagnosis. Furthermore, patient factors-such as age and sports played-affect the treatment algorithms, even across similarly classified SLAP tears.
To (1) assess the interobserver and intraobserver reliability of the Snyder and expanded SLAP (ESLAP) classification systems and (2) determine the consistency of treatment for a given SLAP tear depending on different clinical scenarios.
Cohort study (diagnosis); Level of evidence, 3.
A total of 20 arthroscopic surgical videos and magnetic resonance imaging scans of patients with SLAP tears were sent to 20 orthopaedic sports medicine surgeons at various stages of training. Surgeons were asked to identify the type of SLAP tear using the Snyder and ESLAP classifications. Surgeons were then asked to determine the treatment for a SLAP tear using 4 clinical scenarios: (1) in the throwing arm of an 18-year-old pitcher; (2) in the dominant arm of an 18-year-old overhead athlete; (3) a 35-year-old overhead athlete; (4) or a 50-year-old overhead athlete. Responses were recorded, and the cases were shuffled and sent back 6 weeks after the initial responses. Results were then analyzed using the Fleiss kappa coefficient (κ) to determine interobserver and intraobserver degrees of agreement.
There was moderate intraobserver reliability in both the Snyder and ESLAP classifications (κ = 0.52) and fair interobserver reliability for both classification systems (Snyder, κ = 0.31; ESLAP, κ = 0.30; < .0001) among all surgeons. Additionally, there was only fair agreement (κ = 0.30; < .0001) for the treatment modalities chosen by the reviewers for each case.
This study demonstrated that SLAP tears remain a challenging problem for orthopaedic surgeons in diagnostics and treatment plans. Therefore, care should be taken in the preoperative discussion with the patient to consider all the possible treatment options because this may affect the postoperative recovery period and patient expectations.
上盂唇前后向（SLAP）损伤在从事过顶运动的运动员中很常见。1990年斯奈德提出的原始分类系统包含4种类型的SLAP损伤，后来扩展到10种类型。由于外科医生在诊断以及基于诊断进行治疗时存在不一致性，该分类一直具有挑战性。此外，患者因素，如年龄和从事的运动，即使是在分类相似的SLAP损伤中，也会影响治疗方案。
（1）评估斯奈德和扩展的SLAP（ESLAP）分类系统的观察者间和观察者内可靠性；（2）根据不同临床情况确定给定SLAP损伤治疗的一致性。
队列研究（诊断）；证据等级，3级。
将20例SLAP损伤患者的关节镜手术视频和磁共振成像扫描资料分发给20名处于不同培训阶段的骨科运动医学外科医生。要求外科医生使用斯奈德和ESLAP分类法确定SLAP损伤的类型。然后要求外科医生针对4种临床情况确定SLAP损伤的治疗方案：（1）一名18岁投手的投掷手臂；（2）一名18岁过顶运动运动员的优势手臂；（3）一名35岁的过顶运动运动员；（4）或一名50岁的过顶运动运动员。记录回答情况，并在初次回答6周后将病例打乱后发回。然后使用Fleiss卡方系数（κ）分析结果，以确定观察者间和观察者内的一致程度。
在所有外科医生中，斯奈德和ESLAP分类的观察者内可靠性中等（κ = 0.52），两种分类系统的观察者间可靠性一般（斯奈德，κ = 0.31；ESLAP，κ = 0.30；P <.0001）。此外，对于每位评审员为每个病例选择的治疗方式，一致性也仅为一般（κ = 0.30；P <.0001）。
本研究表明，SLAP损伤在诊断和治疗方案方面对骨科外科医生来说仍然是一个具有挑战性的问题。因此，在与患者进行术前讨论时应谨慎考虑所有可能的治疗选择，因为这可能会影响术后恢复期和患者的期望。
