Nonoperative Treatment of Superior Labrum Anterior Posterior Tears Improvements in Pain, Function, and Quality of Life
Sara L. Edwards, MD*, Jessica A. Lee†, John-Erik Bell, MD‡, Jonathan D. Packer, MD†, Christopher S. Ahmad, MD†, William N. Levine, MD†, Louis U. Bigliani, MD† and Theodore A. Blaine, MD§? +
Author Affiliations *Northwestern University, Chicago, Illinois †Columbia University, Center for Shoulder, Elbow and Sports Medicine, New York, New York ‡Dartmouth-Hitchcock Medical Center, Orthopaedic Surgery, Lebanon, New Hampshire ?Brown University, Rhode Island Shoulder and Elbow Service, Providence, Rhode Island §Theodore A. Blaine, MD, 2 Dudley Street, Suite 200, Providence, RI 02905 (e-mail: tblaine@universityorthopedics.com).
Presented at the 33rd annual meeting of the AOSSM, Calgary, Alberta, Canada, July 2007, where it won the Aircast Award for Best Paper.
American Journal of Sports Medicine, vol. 38 no. 7, 1456-1461
Conclusion: Using validated, patient-derived outcome instruments, the present study shows that successful nonoperative treatment of superior labral tears results in improved pain relief and functional outcomes compared with pretreatment assessments. Although 20 patients (51%) in this group elected surgery and may be considered nonoperative treatment failures, those patients with successful nonoperative treatment had significant improvements in pain, function, and quality of life. Return to sports was comparable with patients with successful surgical treatment, although return to overhead sports at the same level was difficult to achieve (66%). Based on these findings, a trial of nonoperative treatment may be considered in patients with the diagnosis of isolated superior labral tear. In overhead athletes and in those patients where pain relief and functional improvement is not achieved, surgical treatment should be considered.
Full text: http://ajs.sagepub.com/content/38/7/1456.short?rss=1&ssource=mfc
firstly we cant take a level 4 evidence without any control group as guide line..to me this study sounds very much like biased single surgeon observation..wht bt u folks?
the way i understand it, there seems to be no debate about couple of things
1)the fact that type 1 and 3 can be managed conservatively / just debridment). but type 2 definitely will need stabilization.
2) the prognosis of a type 2 SLAP shoulder in a high demand person (over head athlete) is not great if he plans to go back to high level sports..but its much better definitely in stabilized shoulder than a conservative shoulder
The Outcome of Type II SLAP Repair: A Systematic Review ;Kalyan Gorantla, Corey Gill,, Pages 537-545 (April 2010) journal of arthroscopy ; its a nice analysis that shows there are no level one evidenced studies for SLAP repair. but in all other levels type 2 SLAP repair has good outcome in non -high performing overhead athletes
Outcomes After Arthroscopic Repair of Type-II SLAP Lesions,Stephen F. Brockmeier; The Journal of Bone and Joint Surgery (A). 2009;91:1595-1603- again shows favorable results of type 2 SLAP repair
i find both these studies better balanced than the one quoted above..
and from whatever i have seen personally, another major indication for scopy in SLAP is an associated sphenoglenoid cyst..all three cases i have seen had great results..also something to look out for in the MRI which has SLAP