SLAP lesions, An Opinion Piece.

SLAP lesions were first classified by Snyder in 1990. Results of treatment have been controversial without clear consensus. All have agreed that prospective studies would be useful. We conducted such a study between 2008 to 2114 that randomized treatment between sham surgery, biceps tenodesis and labral repair. No significant differences in results between the groups were found. Crossover between groups was only possible from the sham surgery group and this may introduce some degree of bias. However, the six month outcomes between all three groups before any crossover were statistically identical. Our results also do not favor biceps tenodesis versus SLAP repair when surgery is performed. Based on these results we have narrowed our indications for SLAP lesion surgery. We still treat some SLAP lesions surgically and individualize our treatment in each such cases. Most SLAP lesion patients, however, are ultimately treated non-operatively.

Paralabral cysts of the shoulder treated with isolated labral repair: effect on pain and radiologic findings.

BACKGROUND: Paralabral cysts emanating from posterosuperior labral tears may compress the suprascapular nerve and induce neuropathy. This study prospectively assessed patients with labral tears and symptomatic paralabral cysts treated with isolated labral repair. Pain relief, time to cyst resolution, reversibility of muscular edema, atrophy, fatty infiltration, and bone erosion were evaluated. METHODS: Forty-seven patients with symptomatic posterosuperior paralabral cysts were treated with isolated labral repair. Magnetic resonance imaging (MRI) was repeated 6 and 12 weeks postoperatively or until cyst resolution. In a subgroup of 15 patients, MRI was performed the day before the operation, the first postoperative day, and at 2 weeks. RESULTS: Median cyst size was 6.8 cm3 (range, 2.1-88.9; standard deviation [SD], 18.3 cm3). Preoperatively, 20 patients (43%) presented clinical muscle atrophy and radiologic edema on MRI, 8 had fatty infiltration, and 3 presented bony scapular erosion caused by cyst compression. Median time to cyst resolution and regression of muscular edema was 11 weeks (range, 3-20; SD, 8.8 weeks) and 14 weeks (range, 3-52; SD 10.6 weeks), respectively. Preoperative fatty infiltration grade I and II of the supraspinatus and infraspinatus muscles was reduced in two patients. Bony erosions remodeled after cyst resolution. Mean pain ratings (1-10 scale) improved from 7.7 (SD, 1.8) to 1.3 (SD, 1.3; 95% confidence interval of difference, 5.5-6.8; P < .001). CONCLUSION: Labral repair leads to significant pain relief with cyst resolution within 2 to 3 months in most patients. Secondary muscle pathology (ie, edema, atrophy and fatty infiltration) may be partially or completely reversed. Bony erosion caused by cyst compression may be remodeled after cyst resolution.

Shoulder instability surgery in Norway: the first report from a multicenter register, with 1-year follow-up.

BACKGROUND AND PURPOSE: In January 2008, we established the Norwegian Register for Shoulder Instability Surgery. We report on the establishment, the baseline data, and the results at 1-year follow-up. METHODS: Primary and revision shoulder stabilization is reported by the surgeon on a 1-page paper form containing the patient's history of shoulder injury, clinical findings, and perioperative findings. The WOSI questionnaire for self-assessment of shoulder function is completed at baseline and at follow-up after 1, 2, and 5 years. To evaluate the completeness of registration, we compared our data with those in the Norwegian Patient Registry (NPR). RESULTS: The NPR reported 39 hospitals performing shoulder stabilizations. 20 of these started to report to our register during 2009, and 464 procedures (404 primary, 59 revisions) were included up to December 31, 2009, which represented 54% of the procedures reported to NPR. Of the 404 primary procedures, 83% were operations due to anterior instability, 10% were operations due to posterior instability, and 7% were operations due to multidirectional instability. Arthroscopic soft tissue techniques were used in 88% of the patients treated for primary anterior instability and open coracoid transfer was used in 10% of such patients. At 1-year follow-up of 213 patients, we found a statistically significantly improved WOSI score in all types of instability. 10% of the patients treated with arthroscopic anterior labral repair and 16% treated with arthroscopic posterior labral repair reported recurrent instability. No statistically significant difference in functional improvement or rate of recurrence was found between these groups. INTERPRETATION: The functional results are in accordance with those in previous studies. However, the incidence of recurrent instability 1 year after arthroscopic labral repair is higher than expected.

Treatment of labral tears with associated spinoglenoid cysts without cyst decompression.

BACKGROUND: The treatment of symptomatic spinoglenoid cysts has varied from observation, needle aspiration, and open excision to arthroscopic decompression. The purpose of the present study was to prospectively assess whether labral repair alone would lead to cyst resolution and pain relief. METHODS: Forty-two patients with a posterosuperior labral tear and a ganglion cyst at the spinoglenoid notch were treated with arthroscopic débridement of the glenoid rim and labral repair, either with a resorbable tack or a suture anchor. Patients ranged in age from twenty-three to sixty-eight years. Seven patients had clinical and/or radiographic evidence of atrophy of the infraspinatus muscle; one had atrophy of both the infraspinatus and the teres minor muscles, while two had atrophy of the teres minor muscle. All patients had postoperative magnetic resonance imaging performed twice, at an average of fifteen months and again at an average of forty-three months postoperatively. The clinical outcome, including the Rowe score, was assessed for all patients at a median of forty-three months postoperatively. RESULTS: In thirty-seven (88%) of the forty-two patients, the cysts had resolved completely. In five patients, a cyst was still present but with a clear reduction in size. These five patients had remission of pain and were satisfied with the shoulder function. Three patients with preoperative muscular atrophy without fatty infiltration regained normal appearing muscle, while the seven with preoperative fatty changes continued to demonstrate those changes postoperatively. The median Rowe score improved from 61.5 points preoperatively to 98.0 points at the time of follow-up. Thirty-one patients assessed the result of treatment as excellent; nine, as good; and two, as fair. CONCLUSIONS: Most spinoglenoid cysts resolve, and patient satisfaction can be expected to be high after labral fixation without cyst decompression.