scholarly journals Not All SLAPs Are Created Equal: A Comparison of Patients with Planned and Incidental SLAP Repair Procedures

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Mark C. Dougherty ◽  
J. Erik Kulenkamp ◽  
Haroutioun Boyajian ◽  
Jason L. Koh ◽  
Michael J. Lee ◽  
...  
Keyword(s):  
Tracking System ◽  
Progressive Increase ◽  
Descriptive Epidemiology ◽  
Epidemiology Study ◽  
Younger Patients ◽  
Slap Repair ◽  
Simultaneous Procedures ◽  
Year 2000 ◽  
Slap Tear ◽  
Anterior Posterior

Background. EpidemiologicalIt is very important for the corresponding author to have a linked ORCID (Open Researcher and Contributor ID) account on MTS. To register a linked ORCID account, please go to the Account Update page (http://mts.hindawi.com/update/) in our Manuscript Tracking System and after you have logged in click on the ORCID link at the top of the page. This link will take you to the ORCID website where you will be able to create an account for yourself. Once you have done so, your new ORCID will be saved in our Manuscript Tracking System automatically."?> studies have shown a progressive increase in the rate of superior labrum anterior-posterior (SLAP) repair surgery after the year 2000. However, it is not clear whether this is due to increased recognition of isolated SLAP tears or increased SLAP repair performed secondarily during arthroscopy for other purposes. Hypothesis/Purpose. We hypothesized that both isolated SLAP repair and secondary SLAP repair increased with time and that patient age influenced the pathway to SLAP diagnosis and surgery—such that younger patients were more likely to have isolated SLAP repair surgery after being diagnosed in clinic. Study Design. Descriptive epidemiology study. Methods. Data were obtained from the MarketScan database from 2003 to 2013. CPT and ICD-9 codes were used to identify SLAP surgery patients and concomitant procedures. The timing of SLAP diagnosis relative to surgery was used to determine whether the injury was recognized preoperatively. Results. 64,497 SLAP surgery patients were included. Preoperative SLAP diagnosis increased from 17.1% in 2003 to 44.6% in 2013. Patients diagnosed preoperatively were younger and had fewer concomitant procedures. Increasing age and concomitant rotator cuff tear (RCT) repair corresponded to lower odds of preoperative SLAP diagnosis. Discussion. Younger patients were more likely to have their SLAP tear diagnosed prior to surgery. Those diagnosed before surgery had fewer simultaneous procedures during their operations, suggesting that SLAP repair was more likely the primary operation. From 2003 to 2013, SLAP tears were increasingly recognized in the preoperative setting.

Biceps Tenodesis for Superior Labrum Anterior-Posterior Tear in the Overhead Athlete: A Systematic Review

2020 ◽  
pp. 036354652092117 ◽  
Author(s):  
Travis L. Frantz ◽  
Andrew G. Shacklett ◽  
Adam S. Martin ◽  
Jonathan D. Barlow ◽  
Grant L. Jones ◽  
...  
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Return To Sports ◽  
Biceps Tenodesis ◽  
Inclusion Criteria ◽  
Overhead Athletes ◽  
Overhead Athlete ◽  
Slap Repair ◽  
Slap Tear ◽  
Anterior Posterior

Background: Superior labrum anterior-posterior (SLAP) lesion is a common shoulder injury, particularly in overhead athletes. While surgical management has traditionally consisted of SLAP repair, high rates of revision and complications have led to alternative techniques, such as biceps tenodesis (BT). While BT is commonly reserved for older nonoverhead athletes, indications for its use have expanded in recent years. Purpose: To determine functional outcomes and return-to-sport rates among overhead athletes after BT for SLAP tear. Study Design: Systematic review. Methods: A systematic review was performed for any articles published before July 2019. The search phrase “labral tear” was used to capture maximum results, followed by keyword inclusion of “SLAP tear” and “biceps tenodesis.” Inclusion criteria included outcome studies of BT for isolated SLAP tear in athletes participating in any overhead sports, not limited to throwing alone. Abstracts and manuscripts were independently reviewed to determine eligibility. When clearly delineated, outcome variables from multiple studies were combined. Results: After full review, 8 articles met inclusion criteria (99 athletes; mean age, 19.8-47 years), with baseball and softball players the most common among them (n = 62). Type II SLAP tear was the most common diagnosis, and 0% to 44% of athletes had a failed previous SLAP repair before undergoing BT. Only 1 study included patients with concomitant rotator cuff repair. Open subpectoral BT was most commonly used, and complication rates ranged from 0% to 14%, with wound erythema, traumatic biceps tendon rupture, brachial plexus neurapraxia, and adhesive capsulitis being reported. Combined reported postoperative functional scores were as follows: American Shoulder and Elbow Surgeons, 81.7 to 97; 12-Item Short Form Health Survey physical, 50 to 54; visual analog scale for pain, 0.8-1.5; Kerlan Jobe Orthopaedic Clinic, 66 to 79; and satisfaction, 80% to 87%. The overall return-to-sports rate for overhead athletes was 70% (60 of 86). For studies that clearly delineated outcomes based on level of play/athlete, the combined return-to-sports rate was 69% (11 of 16) for recreational overhead athletes, 80% (4 of 5) for competitive/collegiate athletes, and 60% (18 of 30) for professionals. Conclusion: BT in the overhead athlete offers encouraging functional outcomes and return-to-sports rates, particularly in the recreational athlete. It can be successfully performed as an index operation rather than SLAP repair, as well as in a younger patient population. Careful consideration should be given to elite overhead athletes, particularly pitchers, who tend to experience poorer outcomes.

Risk Factors for Revision Surgery After Superior Labral Anterior-Posterior Repair: A National Perspective

2017 ◽  
Vol 45 (7) ◽  
pp. 1640-1644 ◽  
Author(s):  
Samuel A. Taylor ◽  
Ryan M. Degen ◽  
Alexander E. White ◽  
Moira M. McCarthy ◽  
Lawrence V. Gulotta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Revision Surgery ◽  
Significant Risk ◽  
Biceps Tenodesis ◽  
Time Of Surgery ◽  
Slap Repair ◽  
Long Head ◽  
Slap Tear ◽  
Anterior Posterior

Background: Data regarding risk factors for revision surgery after superior labral anterior-posterior (SLAP) repair are limited to institutional series. Purpose: To define risk factors for revision surgery after SLAP repair among patients in a large national database. Study Design: Case-control study; Level of evidence, 3. Methods: A national insurance database was queried for patients undergoing arthroscopic SLAP repair (Current Procedural Terminology [CPT] code 29807) for the diagnosis of a SLAP tear. Patients without a CPT modifier for laterality were excluded. Revision surgery was defined as (1) subsequent ipsilateral SLAP repair (CPT 29807), (2) ipsilateral arthroscopic debridement for the diagnosis of a SLAP tear (CPT 29822 or 29823, with diagnosis code 840.7), (3) subsequent ipsilateral arthroscopic biceps tenodesis (CPT 29828), (4) subsequent ipsilateral open biceps tenodesis (CPT 23430), and (5) subsequent biceps tenotomy (CPT 23405). Multivariable binomial logistic regression analysis was performed to identify risk factors for revision surgery after SLAP repair, including patient demographics/comorbidities, concomitant diagnoses, and concomitant procedures performed. Odds ratios (ORs), 95% CIs, and P values were calculated. The estimated financial impact of revision surgery was also calculated. Results: There were 4751 patients who met inclusion and exclusion criteria. Overall, 121 patients (2.5%) required revision surgery after SLAP repair. Regression analysis identified numerous risk factors for revision surgery, including age >40 years (OR, 1.5; 95% CI, 1.2-1.8; P = .045), female sex (OR, 1.5; 95% CI, 1.3-1.8; P = .010), obesity (OR, 1.8; 95% CI, 1.5-2.2; P = .001), smoking (OR, 2.0; 95% CI, 1.6-2.4; P < .0001), and diagnosis of biceps tendinitis (OR, 3.5; 95% CI, 3.0-4.2; P < .0001) or long head of the biceps tearing (OR, 5.1; 95% CI, 4.1-6.3; P < .0001) at or before the time of surgery. Concomitant rotator cuff repair and distal clavicle excision were not significant risk factors for revision surgery. The cost of revision surgery averaged almost $9000. Conclusion: Risk factors for revision surgery after SLAP repair include age >40 years, female sex, obesity, smoking, and diagnosis of biceps tendinitis or long head of the biceps tearing. The diagnosis of biceps tendinitis (OR, 3.5) or long head of the biceps tearing (OR, 5.1) at or before the time of surgery was an especially significant risk factor for revision surgery. The high cost of revision surgery highlights the importance of appropriate indications to avoid the need for subsequent procedures.

scholarly journals SLAP Tears

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542110007
Author(s):  
Steven B. Cohen ◽  
John R. Matthews
Keyword(s):  
Rotator Cuff ◽  
Shoulder Arthroscopy ◽  
Biceps Tendon ◽  
Full Range ◽  
Contralateral Side ◽  
Highly Active ◽  
Slap Repair ◽  
Biceps Tenotomy ◽  
Labral Tears ◽  
Anterior Posterior

Background: Superior labral tears are frequently encountered during shoulder arthroscopy. Outcomes following superior labral anterior-posterior (SLAP) repairs in young athletes have been well documented. Superior labral repairs in older patient population continue to remain controversial due to concerns of postoperative complications including persistent preoperative symptoms, pain, stiffness, and higher rates of revision surgery. Indications: We present a case of a highly active 38-year-old woman who failed 1½ years of nonoperative management of a type IIB SLAP tear with extension to the posterior labrum. Her symptoms continued to limit her hobbies and work. Technique: A knotless single-anchor SLAP repair was performed along with debridement of the posterior frayed labrum. No biceps tenotomy or tenodesis was performed after full evaluation of the tendon failed to demonstrate evidence of synovitis, tendinopathy, or tear. The patient also did not have any concomitant shoulder pathology, including a rotator cuff tear or chondral lesion. Results: At 6 months, the patient had regained full range of motion similar to the contralateral side. She had returned to her normal activities and sports, including tennis. Discussion/Conclusion: Successful outcomes following SLAP repairs in patients over 35 years can be achieved, but treatment should be individualized with particular attention to concomitant pathology involving the rotator cuff, chondral surface, or biceps tendon which may require tenodesis or tenotomy.

scholarly journals High Incidence of Hand Injuries From Blocking in Elite Taekwondo Despite the Use of Protective Gear: A 5-Year Descriptive Epidemiology Study

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097399
Author(s):  
Markus Geßlein ◽  
Johannes Rüther ◽  
Michael Millrose ◽  
Hermann Josef Bail ◽  
Robin Martin ◽  
...  
Keyword(s):  
Injury Risk ◽  
Injury Incidence ◽  
Dominant Hand ◽  
Wrist Injuries ◽  
Descriptive Epidemiology ◽  
Epidemiology Study ◽  
Time Loss ◽  
Data Set ◽  
Injury Site ◽  
Protective Gear

Background: Hand and wrist injuries are a common but underestimated issue in taekwondo. Detailed data on injury risk, patterns, and mechanism are missing. Purpose: To evaluate (1) the fight time exposure-adjusted injury incidence rate (IIR) and clinical incidence and (2) injury site, type, sport-specific mechanism, and time loss in taekwondo. Study Design: Descriptive epidemiology study. Methods: Athletes from a single national Olympic taekwondo training center were investigated prospectively for hand and wrist injuries during training and competition over 5 years. The Orchard Sports Injury Classification System Version 10 was used to classify injury type, and analysis of the anatomic injury site was performed. The mechanism of injury was classified as due to either striking or blocking techniques. Results: From a total of 107 athletes, 79 athletes (73.8%) with a total exposure time of 8495 hours were included in the final data set. During the study period, 75 injuries of the hand and wrist region were recorded despite the athletes using protective hand gear. The IIR was 13.9 (95% CI, 10.5-17.5) and was significantly higher during competition. The clinical incidence as an indicator for risk of injury was 60.7% (95% CI, 50.9-70.5). Finger rays were the most affected location (68%), and fractures (43%) and joint ligament injuries (35%) were the most common type of injury. Significantly more injuries were found on the dominant hand side ( P < .001). Comparison of injury mechanisms demonstrated significantly more injuries at the finger rays deriving from blocking techniques ( P = .0104). The mean time loss for all hand and wrist injuries was 15.7 ± 13.5 days (range, 3-45 days) and was highest for distal radial fractures, with a mean of 39.7 ± 4.8 days (range, 32-45 days). Conclusion: There was a significantly higher IIR for acute hand and wrist injuries in elite taekwondo athletes during competition, which resulted in considerable time loss, especially when fractures or dislocations occurred. Significantly more injuries to the finger rays were found during blocking despite the use of protective hand gear. Improvement of tactical skills and blocking techniques during training and improved protective gear appear to be essential for injury prevention.

scholarly journals Variability in Rehabilitation Protocols after Superior Labrum Anterior Posterior Surgical Repair

2021 ◽  
Vol 14 ◽  
pp. 243-248
Author(s):  
Christina Hermanns ◽  
Reed Coda ◽  
Sana Cheema ◽  
Matthew Vopat ◽  
Armin Tarakemeh ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Surgical Repair ◽  
Return To Sport ◽  
Return To Sports ◽  
Biceps Tenodesis ◽  
Slap Repair ◽  
Rehabilitation Protocols ◽  
Google Search ◽  
Improve Patient ◽  
Anterior Posterior

Introduction. Rehabilitation after a superior labral anterior posterior (SLAP) repair is an important aspect of patient outcomes, however, no standardized rehabilitation protocol has been defined. The purpose of this paper is to assess the variability of rehabilitation after SLAP repair to understand the need for standardization to improve patient outcomes. Methods. Protocols for SLAP repairs were collected through a search for Academic Orthopedic Programs and a general google search using the terms “[Program Name (if applicable)] SLAP Repair Rehab Protocol”. Protocols were compared by sling, range of motion (ROM), physical therapy, return to sport (RTS), return to throwing, and biceps engagement/ biceps tenodesis recommendations. Protocols for non-operative or generalized shoulders were excluded.  Results. Sixty protocols were included. A total of 61.7% (37/60) recommended a sling for four to six weeks and 90% (54/60) included a full ROM recommendation, but time was variable. There were different exercises recommended, but pendulum swings were recommended by 53% (32/60), submaximal isometrics by 55% (33/60), and scapular strengthening by 65% (39/60). Of the sixty protocols, 33% (20/60) recommended return to sports in 24 weeks and 38.3% (23/60) recommended allowing throwing in 16 weeks. Conclusion. There was variability in protocols for SLAP repair, especially time until full ROM, RTS, and biceps strengthening. Time in sling and scapular strengthening were the least variable. A lack of specificity within protocols in what return to throwing meant for functional ability made it difficult to compare protocols. Considering the large number of Orthopedic programs, a relatively small number had published protocols. Further studies are needed to evaluate a standardized post-operative rehabilitation for SLAP repairs to improve outcomes.

scholarly journals Epidemiology of Sport-Related Concussions in High School Athletes: National Athletic Treatment, Injury and Outcomes Network (NATION), 2011–2012 Through 2013–2014

2017 ◽  
Vol 52 (3) ◽  
pp. 175-185 ◽  
Author(s):  
Kathryn L. O'Connor ◽  
Melissa M. Baker ◽  
Sara L. Dalton ◽  
Thomas P. Dompier ◽  
Steven P. Broglio ◽  
...  
Keyword(s):  
High School ◽  
Outcome Measure ◽  
Sports Participation ◽  
Descriptive Epidemiology ◽  
Epidemiology Study ◽  
High School Athletes ◽  
High School Sports ◽  
School Sports ◽  
Exposure Data ◽  
Rate Ratios

Context:Sports participation is one of the leading causes of concussions among nearly 8 million US high school student-athletes.Objective:To describe the epidemiology of sport-related concussion (SRC) in 27 high school sports during the 2011–2012 through 2013–2014 academic years.Design:Descriptive epidemiology study.Setting:Aggregate injury and exposure data from 27 sports in 147 high schools in the National Athletic Treatment, Injury and Outcomes Network (NATION).Patients or Other Participants:Boy and girl high school athletes during the 2011–2012 through 2013–2014 academic years.Main Outcome Measure(s):Sport-related concussion counts, percentages, rates per 10 000 athlete-exposures (AEs), rate ratios (RRs), and injury proportion ratios (IPRs) were reported with 95% confidence intervals (CIs). Rate ratios and IPRs with 95% CIs not containing 1.0 were considered significant.Results:Overall, 2004 SRCs were reported among 27 high school sports, for a rate of 3.89 per 10 000 AEs. Football had the highest SRC rate (9.21/10 000 AEs), followed by boys' lacrosse (6.65/10 000 AEs) and girls' soccer (6.11/10 000 AEs). The SRC rate was higher in competition than in practice (RR = 3.30; 95% CI = 3.02, 3.60). Among sex-comparable sports, the SRC rate was higher in girls than in boys (RR = 1.56; 95% CI = 1.34, 1.81); however, the proportion of SRCs due to player-to-player contact was higher in boys than in girls (IPR = 1.48; 95% CI = 1.27, 1.73). Common symptoms reported among all athletes with SRCs were headache (94.7%), dizziness (74.8%), and difficulty concentrating (61.0%). Only 0.8% of players with SRCs returned to play within 24 hours. The majority of athletes with SRCs (65.8%) returned to play between 7 and 28 days. More players had symptoms resolve after 7 days (48.8%) than less than a week (40.7%).Conclusions:Our findings provide updated high school SRC incidence estimates and further evidence of sex differences in reported SRCs. Few athletes with SRCs returned to play within 24 hours or a week. Most injured players returned after 7 days, despite a smaller proportion having symptoms resolve within a week.

scholarly journals The diagnostic yield of the first episode of a periodic health evaluation: a descriptive epidemiology study

2012 ◽  
Vol 12 (1) ◽  
Author(s):  
Cindy A Kermott ◽  
Carol S Kuhle ◽  
Stephanie S Faubion ◽  
Ruth E Johnson ◽  
Donald D Hensrud ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
First Episode ◽  
Health Evaluation ◽  
Descriptive Epidemiology ◽  
Epidemiology Study ◽  
Periodic Health Evaluation

Descriptive Characteristics of Concussions in National Football League Games, 2010-2011 to 2013-2014

2017 ◽  
Vol 45 (4) ◽  
pp. 929-936 ◽  
Author(s):  
Michael D. Clark ◽  
Breton M. Asken ◽  
Stephen W. Marshall ◽  
Kevin M. Guskiewicz
Keyword(s):  
Incidence Rate ◽  
National Football League ◽  
Descriptive Statistics ◽  
Descriptive Epidemiology ◽  
Epidemiology Study ◽  
Head Impacts ◽  
Impact Location ◽  
Tests Of Association ◽  
Biomechanical Features ◽  
The Impact

Background: Despite a high reported incidence rate of concussion, little is known about the on-field characteristics of injurious head impacts in National Football League (NFL) games. Purpose: To characterize on-field features (location, player position, and time during game) and biomechanical features (anticipation status, closing distance, impact location and type) associated with concussions in NFL games over a 4-season period (2010-2011 to 2013-2014). Study Design: Descriptive epidemiology study. Methods: We analyzed video of a subset of reported, in-game concussions for the 2010-2011 to 2013-2014 seasons. These videos represented a sample of injuries that were diagnosed and reported on the same day and that could be clearly associated with an in-game collision as captured on video. We determined anticipation status, closing distance, impact location on the injured player’s helmet, and impact type (helmet-to-helmet, helmet-to-body, or helmet-to-ground). Associations between these variables were analyzed by use of descriptive statistics and tests of association. Results: A total of 871 diagnosed concussions were reported as occurring during NFL preseason, regular season, and postseason games for the 2010-2011, 2011-2012, 2012-2013, and 2013-2014 seasons. A total of 1324 games were played during this period, giving a concussion incidence rate of 0.658 per game (95% CI, 0.61-0.70). From the video-reviewed subset (n = 429; 49.3%), the majority of injurious impacts occurred with good anticipation (57.3%) and <10 yards of closing distance (59.0%). An association was found between anticipation status and play type ([Formula: see text] = 27.398, P < .001), largely because injuries occurring on pass plays were more likely to be poorly anticipated than injuries during run plays (43.0% vs 21.4%; [Formula: see text] = 14.78, P < .001). Kick returns had the greatest proportion of well-anticipated impacts (78%) and the greatest proportion of impacts with ≥10 yards of closing distance (80%). The type of impact was approximately equally divided between helmet-to-helmet, helmet-to-body, and helmet-to-ground types. The impact location was broadly distributed over the helmet of the injured player. Conclusion: In-game concussions in the NFL occurred through a diverse variety of mechanisms, surprisingly tended to be well-anticipated, and, also surprisingly, occurred with <10 yards of closing distance. The impacts causing concussion were broadly distributed over the helmet. More concussions occurred during the second half of game play, but we do not have evidence to explain this finding.

scholarly journals Epidemiology of Shoulder Injuries in Schoolboy Rugby Union in Ireland

2021 ◽  
Vol 9 (8) ◽  
pp. 232596712110234
Author(s):  
Therese M. Leahy ◽  
Ian C. Kenny ◽  
Mark J. Campbell ◽  
Giles D. Warrington ◽  
Roisin Cahalan ◽  
...  
Keyword(s):  
Incidence Rates ◽  
Rugby Union ◽  
Injury Incidence ◽  
Shoulder Injuries ◽  
Descriptive Epidemiology ◽  
Epidemiology Study ◽  
Time Loss ◽  
Potential Risk Factors ◽  
Rugby Players ◽  
And Training

Background: The shoulder has been reported as a frequent location of injury in adult professional and amateur rugby, with match injury incidence rates ranging from 1.8 to 3 per 1000 player-hours (h). An increased understanding of the incidence and mechanism of shoulder injuries in school rugby players is vital to establish effective injury preventive strategies and advise on appropriate rehabilitation. Purpose: To describe the incidence, nature, and severity of shoulder injuries in schoolboy rugby in Ireland. Study Design: Descriptive epidemiology study. Methods: Injury surveillance was carried out for Senior Cup teams across two seasons (N = 665 players aged 17-19 years) in Ireland from 2018 to 2020. Match and training injury data were recorded using an online system by trained nominated injury recorders. Match exposure was also recorded. Results: Shoulder match injury incidence was 12.2 per 1000 h (95% CI, 9.1-16.2), with a mean severity of 47 days’ time loss and an overall burden of 573 days per 1000 h. In total, 47 match and 5 training shoulder injuries were recorded. The most common injuries were shoulder dislocations/subluxations (34%), followed by acromioclavicular joint sprains (30%). Shoulder dislocations/subluxations represented the most burdensome injury (280 days per 1000 h). The tackle accounted for the majority (81%) of shoulder injuries. Forwards sustained a significantly higher incidence of shoulder injuries (8.3/1000 h) in comparison with backs (3.9/1000 h), with a rate ratio of 2.13 (95% CI, 1.15-3.94; P = .015). Conclusion: We found a notably higher injury incidence rate in schoolboy rugby as compared with the adult amateur and professional game. Shoulder injuries were responsible for more days lost than any other injury, and shoulder dislocations were the most severe. This is of particular concern so early in a player’s career and warrants further investigation into potential risk factors and mechanisms associated with shoulder injuries in school-age players.

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