scholarly journals The Association between Radiologic Severity of Rotator Cuff Pathology and Supraspinatus Weakness on Biomechanical Assessment (229)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0033
Author(s):  
Stephen Gillinov ◽  
Nathan Varady ◽  
Paul Abraham ◽  
Michael Kucharik ◽  
Scott Martin
Keyword(s):  
Rotator Cuff ◽  
Full Range ◽  
Strength Testing ◽  
High Grade ◽  
Imaging Findings ◽  
Full Thickness ◽  
Absolute Strength ◽  
Shoulder Strength ◽  
The Mean ◽  
Isotonic Strength

Objectives: Many different magnetic resonance imaging (MRI)-based classifications are used to characterize rotator cuff supraspinatus pathology, ranging from mild tendinopathy to full-thickness tears. While MRIs are chiefly utilized to guide the need for and approach to operative management of supraspinatus pathology, the functional implications, if any, across the entire range of pathologies have not been defined. The purpose of this biomechanical study was to examine shoulder strength and function in patients presenting with presumptive supraspinatus pathology and to determine if these clinical parameters are correlated with radiologic severity. Methods: We prospectively enrolled 171 patients with suspected rotator cuff pathology disease and without apparent strength deficit on traditional rotator cuff physical examination (PE). Exclusion criteria were radiographically apparent glenohumeral OA, previously diagnosed rotator cuff tear of the affected shoulder, previously diagnosed adhesive capsulitis, prior ipsilateral shoulder surgery, injury to the ipsilateral hand or wrist, limited range of motion, and history or radiographic evidence of anterior or posterior shoulder dislocation. For both clinical (e.g. testing isotonic strength in patients with frank weakness yields unreliable strength measurements and provides little useful information) and ethical (e.g. to avoid causing pain to patients already experiencing significant shoulder pain) reasons, this study evaluating dynamic strength testing was strictly limited to patients with negative traditional, static PE tests. All patients underwent two bilateral shoulder strength tests using dynamometry; first, isometric strength was measured at 90 degrees of abduction and, second, isotonic strength was measured eccentrically from full abduction throughout the full range of motion until the arm was at the patient’s side. For both of these tests, the examiner placed the handheld dynamometer (Hoggan microFET® 3; Hoggan Scientific, LLC, Salt Lake City UT, USA) on the patient’s wrist, perpendicular to the arm, to measure the force applied along the arc. Absolute strength and symptomatic-to-asymptomatic arm (S/A) strength ratios were calculated. All patients were included in analyses of absolute strength measurements on strength testing; patients who had a history or clinical evidence of contralateral shoulder pathology were excluded from analyses of S/A strength ratios. Patients then underwent shoulder MRI, classifying supraspinatus findings into one of seven ordinal categories. The primary outcome was the relationship between the radiologic severity of supraspinatus pathology on MRI and the degree of rotator cuff strength deficit upon exam. Results were analyzed for both isotonic and isometric function. Results: The study cohort consisted of 171 patients (102 [59.6%] males, 69 [40.4%] females). The mean patient age (± 95% CI) was 52.0 ± 1.9 years. The mean symptom duration (± 95% CI) was 10.8 ± 2.9 months. MRI revealed: 26 (15.2%) instances of no supraspinatus pathology, 37 (21.6%) instances of tendinopathy, 17 (9.9%) instances of supraspinatus fraying, 39 (22.8%) partial thickness tears (PTTs), 13 (7.6%) high-grade PTTs, 12 (7.0%) focal full thickness tears (FTTs)/full-thickness perforations, and 27 (15.8%) FTTs. Isotonic strength : Increasing imaging severity was significantly associated with decreasing absolute strength during isotonic testing ( P=0.036, Table 1). Specifically, absolute strength measurements declined with increasingly severe imaging findings, from no tear [59.9 N], to tendinopathy [50.9 N], to fraying [48.2 N], to PTT [55.0 N], to high-grade PTT [48.9 N], to focal FTT/full thickness perforation [45.7 N], to FTT [44.2 N]. Similarly, increasing imaging severity was significantly associated with decreasing S/A strength ratios during isotonic testing ( P=0.022, Table 1). Isotonic S/A strength ratios declined with increasingly severe imaging findings, from no tear [91.9%], to tendinopathy [70.8%], to fraying [66.1%], to PTT [76.2%], to high-grade PTT [75.7%], to focal FTT/full thickness perforation [65.2%], to FTT [63.3%]. Isometric strength : In contrast to isotonic testing, increasing imaging severity was not significantly associated with decreased absolute strength measurements on isometric testing ( P=0.12, Table 2). Similar results were seen for isometric S/A ratio, as increasing imaging severity was not significantly associated with S/A strength ratio ( P=0.085, Table 2). Conclusions: Radiologic severity of supraspinatus pathology was correlated with dynamic clinical function across the full range of pathology, revealing the functional importance of these frequently-used classifications. The lower discriminatory ability of isometric measurements and higher strength measurements on isometric assessment may be related to a greater role of compensatory musculature in static testing. These biomechanical results support the need for future work investigating the utility of dynamic rotator cuff physical examination maneuvers.

scholarly journals Clinical and functional outcomes of a novel transosseous device to treat rotator cuff tears: A minimum 2-year follow-up

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901987517 ◽  
Author(s):  
Mehmet Arican ◽  
Yalçın Turhan ◽  
Zekeriya Okan Karaduman ◽  
Tacettin Ayanoğlu
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Functional Outcomes ◽  
Dash Score ◽  
Open Approach ◽  
Full Thickness ◽  
Gold Standard Method ◽  
Cuff Tear ◽  
The Mean

Purpose: Despite the improvements in the repair equipment techniques of rotator cuff, a gold standard method has not been defined yet and transosseous fixation through deltoid-splitting (mini-open) approach is still regarded as a good option. The primary purpose of this study is to present satisfactory clinical and functional outcomes with a novel transosseous device in full-thickness rotator cuff tear through deltoid-splitting. Materials and Methods: This retrospective study was performed on 70 consecutive patients who underwent surgery by a single surgeon from June 2014 to June 2016 for a full-thickness rotator cuff tear and was managed with a novel transosseous device. Total number of patients, mean age, percentage of male and female patients, mean duration of follow-up, percentage of involvement of the dominant extremity, affected shoulder, and tear size were recorded. Functional and clinical outcomes were assessed baseline and postoperatively at 3 and 6 months and final follow-up using Disabilities of the Arm, Shoulder and Hand (Q-DASH) and Constant-Murley scores. Results: A total of 70 (49 (70%) female, 21 (30%) male) patients whose mean age was 58.66 ± 9.19 (38–77) years were included. The mean surgery time was 35.33 ± 5.34 (28–55) min. The mean follow-up time was 28.31 ± 3.03 (24–36) months. According to the DeOrio and Cofield classification, 15 (21.43%) tears were small, 33 (47.14%) medium, 16 (22.86%) large, and 6 (8.57%) massive. By the final follow-up, the mean Constant-Murley score had significantly improved from 27.67 ± 7.46 (13–41) to 81.25 ± 3.77 (74–87; p = 0.0001) and the Q-DASH score had decreased from 82.34 ± 10.37 (65.91–100) to 10.28 ± 6.88 (0–23.45; p = 0.0001). There were no significant differences in the Constant-Murley or Q-DASH score at baseline–final follow-up between the small, medium, large, and massive tear groups ( p > 0.05). Conclusions: Treatment of full-thickness rotator cuff tear using this novel transosseous device significantly improved functional and clinical scores. However, further long-term prospective randomized multicenter trials involving comparative studies are necessary to confirm these findings.

The Differences of the Acromiohumeral Interval Between Supine and Upright Radiographs of the Shoulder

2021 ◽  
Author(s):  
Prakasit Sanguanjit ◽  
Adinun Apivatgaroon ◽  
Phanuwat Boonsun ◽  
Surasak Srimongkolpi ◽  
Bancha C้hernchujit
Keyword(s):  
Rotator Cuff ◽  
Diagnostic Test ◽  
Intraclass Correlation ◽  
Mean Difference ◽  
Rotator Cuff Tears ◽  
Diagnostic Study ◽  
Full Thickness ◽  
Cut Point ◽  
The Mean ◽  
Good Diagnostic Test

Abstract Background: Acromiohumeral interval (AHI) is a measurement method to determine the superior migration of the humeral head in patients with rotator cuff tears.Hypothesis/Purpose: The purpose of this study was to compare the AHI measurement in supine shoulder and upright shoulder radiographs, as well as magnetic resonance imaging (MRI), as well as to report the sensitivity, specificity, and accuracy in detecting full thickness rotator cuff tears.Study Design: Diagnostic study.Methods: From July 2020 to May 2021, evaluation of 86 shoulder radiographs in both supine & upright Grashey views compared with the MRI of the affected shoulder. Measurements of the AHI obtained from both radiographs and MRIs was determined by two independent orthopaedic surgeons. The intraclass correlation of the AHI measurement was tested. The difference between the AHI in each view was determined.Result: The 86 shoulders were divided into 3 groups that included; 1) non-full thickness tear (50%), 2) full thickness (FT) tear 3 cm (33.7%), and 3) FT tear > 3 cm (16.3%). The mean difference of AHI noted was significantly lower in the supine radiographs than with the upright (1.34-1.37 mm.). The mean difference of the AHI was significantly lower in the MRI than the upright (1.62-1.87 mm.). AHI obtained from the supine radiographs and MRI had no significant differences. The area under the curve (AUC) of the upright and supine AHI in the diagnosis of the FT tears were at 0.649 and 0.642 accuracy. Upright AHI 7.09 mm. had 27.9% sensitivity and 100% specificity in diagnosing FT tears with 64% accuracy (p<0.001). The upright AHI cut off value of 9.52 mm. had 60.5% sensitivity, 67.4% specificity, and 64% accuracy (p=0.01). The supine AHI 6.56 mm. had 32.6% sensitivity, 100.0% specificity, and 66.3% accuracy (p<0.01). Supine AHI cut off value of 7.42 mm. had 41.9% sensitivity, 86.0% specificity, and 64.0% accuracy (p=0.004). The inter- and intra-rater reliability of AHI measurement in 3 views were of substantial to almost perfect agreement (0.668-0.824).Conclusion: The AHI in supine radiographs were significantly lower than upright shoulder radiographs in all groups as divided by severity of the rotator cuff tear and was comparable with the MRI. For AHI ≤ 7 mm. in upright shoulder radiographs remains as a good diagnostic test of full thickness rotator cuff tears, while this value was not relevant for use as the cut point in the supine radiographs and MRI shoulders.Level of evidence: Level III; Diagnostic studyClinical Relevance: The AHI measurement in supine and upright radiographs are reliable and reproducible. The AHI ≤ 7 mm. in upright shoulder radiographs remains as a good diagnostic test of full thickness rotator cuff tears, while this value was not relevant for use as the cut point in the supine radiographs and MRI shoulders.

scholarly journals Shoulder-specific outcomes 1 year after nontraumatic full-thickness rotator cuff repair: a systematic literature review and meta-analysis

2017 ◽  
Vol 9 (4) ◽  
pp. 247-257 ◽  
Author(s):  
Navin Gurnani ◽  
Derek F. P. van Deurzen ◽  
Michel P. J. van den Bekerom
Keyword(s):  
Los Angeles ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Constant Score ◽  
Meta Analysis ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
The Mean ◽  
Cuff Repair ◽  
Mini Open

Background Nontraumatic full-thickness rotator cuff tears are commonly initially treated conservatively. If conservative treatment fails, rotator cuff repair is a viable subsequent option. The objective of the present meta-analysis is to evaluate the shoulder-specific outcomes one year after arthroscopic or mini-open rotator cuff repair of nontraumatic rotator cuff tears. Methods A literature search was conducted in PubMed and EMBASE within the period January 2000 to January 2017. All studies measuring the clinical outcome at 12 months after nontraumatic rotator cuff repair of full-thickness rotator cuff tears were listed. Results We included 16 randomized controlled trials that met our inclusion criteria with a total of 1.221 shoulders. At 12 months after rotator cuff repair, the mean Constant score had increased 29.5 points; the mean American Shoulder and Elbow Score score increased by 38.6 points; mean Simple Shoulder Test score was 5.6 points; mean University of California Los Angeles score improved by 13.0 points; and finally, mean Visual Analogue Scale score decreased by 4.1 points. Conclusions Based on this meta-analysis, significant improvements in the shoulder-specific indices are observed 12 months after nontraumatic arthroscopic or mini-open rotator cuff repair.

scholarly journals Clinical Methods to Assess and Profile Shoulder Strength in Competitive Surfers

2018 ◽  
Author(s):  
James Furness ◽  
Ben Schram ◽  
Tim Cottman-Fields ◽  
Brendan Solia
Keyword(s):  
Rotator Cuff ◽  
External Rotation ◽  
Testing Procedure ◽  
Strength Testing ◽  
Rater Reliability ◽  
Acute Injuries ◽  
Clinical Methods ◽  
Shoulder Strength ◽  
Shoulder Region ◽  
Current Procedure

The shoulder region has the highest incidence of acute injuries in the sport of surfing. Little is known about the strength profile at the shoulder in a surfing cohort. The primary aim of this study was to establish the reliability of a rotator cuff strength testing procedure for surfers with a secondary aim of providing a profile of internal (IR) and external rotation (ER) strength in a competitive surfing cohort. Shoulder IR and ER isometric strength was measured using a hand-held dynamometer in 13 competitive surfers. Intra-class coefficient values ranged from 0.97 to 0.98 for intra rater reliability and were lower for inter rater reliability ranging from 0.80 to 0.91. Normalised force (N/Kg) for IR strength was significantly greater than ER strength bilaterally (dominant, p= 0.007, non-dominant, p&lt;0.001). No significant differences (p&lt; 0.79) were found in IR strength (N/Kg) between the dominant and non-dominant arms. ER strength (N/Kg) was significantly weaker on the non-dominant arm compared with the dominant arm (p&lt;0.02). The non-dominant arm ER to IR ratio (0.82 &plusmn; 0.15) was significantly (p=0.025) lower than the dominant (0.88 &plusmn; 0.14) The current procedure is reliable with the same clinician, results indicate musculature asymmetry specific to the external rotators.

scholarly journals Prospective Randomized Trial Of Biologic Augmentation With Mesenchymal Stem Cells In Patientsundergoing Arthroscopic Rotator Cuff Repair

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0027 ◽  
Author(s):  
Brian J. Cole ◽  
Nikhil N. Verma ◽  
Adam Blair Yanke ◽  
Bernard R. Bach ◽  
Robert Stephen Otte ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Bone Marrow Aspirate ◽  
Statistical Significance ◽  
Control Group ◽  
Full Thickness ◽  
The Mean ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Objectives: To compare the clinical outcome of arthroscopic rotator cuff repair with and without augmentation with MSCs and to identify the incidence of persistent structural defects in the tendon following surgery Methods: Patients aged 18-70 undergoing repair of a full-thickness supraspinatus tear or partial thickness converted to full thickness tear determined by MRI were identified and prospectively enrolled. Exclusion criteria included involvement of the subscapularis tendon, revision surgery or irreparable tear. In the injection group, 60 cc of bone marrow aspirate was drawn from the iliac crest and processed to bone marrow aspirate concentrate (BMAC) using the Arthrex Angel System (Arthrex, Naples, FL). After completion of the rotator cuff repair, half of the BMAC was injected into the tendon at the junction of the bone and tendon while the other half was injected at the site of the footprint. The control group received a small 0.5 cm incision on the hip to maintain blinding. All patients underwent a shoulder exam pre-operatively as well as at 3 months, 6 months, 1 year and 2 years post-operatively. All patients completed the Standardized Shoulder Test (SST), ASES, Constant, SANE, and VR/SF-12 questionnaires preoperatively as well as 3 months, 6 months, 12 months, 18 months and 24 months postoperatively. Baseline questionnaire scores were subtracted from scores at each timepoint to find the improvement and unpaired T-tests were performed between the two groups. Additionally, all patients underwent an MRI at 12 months postoperatively to evaluate the rotator cuff. MRIs were read by a board-certified orthopaedic surgeon and graded using the Sugaya classification system. Results: 34 patients were randomized to the control group and 28 were randomized to the receive the injection. Average BMA MSC concentration (#/uL) was 2.63 compared to 14.95 for the BMAC MSC concentration. As a result, the BMAC was on average 5.68 times as concentrated with respect to MSC per ul when compared to the BMA. Patients received an average BMAC volume of 2.7 mL, equating to 50410.79 +/- 25375.45 mesenchymal stem cells. There were no differences across improvement in patient reported outcomes from baseline between the control group and the group randomized to receive the injection, except for the Standardized Shoulder Test at 6 months. The mean SST score at 12 months was 87.50 in the BMAC group compared with 85.32 in the control (p=0.18). The mean ASES score at 12 months was 87.38 in the BMAC group and 89.96 in the control group (0.67). Mean Sugaya score for the control group was 3.25±1.12 (range 2-5). Mean Sugaya score for the injection group was 2.60±0.91 (range 2-5). Sugaya scores showed statistical significance with Chi-squared test at 1 year postoperative MRI (p=0.0012), and approached statistical significance with independent t test (p=0.067). Conclusion: MSCs injected into the shoulder at the time of rotator cuff repair show improved tendon quality on post-operative MRI at 1-year post-op, based on the Sugaya scoring system, with the difference in mean Sugaya score approaching significance. Further investigation is needed into this new and evolving treatment; however, it shows promise for improving the rate of rotator cuff repair healing and overall functional outcome.

scholarly journals Clinical Outcomes and Repair Integrity after Arthroscopic Full-thickness Rotator Cuff Repair: Traditional Suture-bridge Versus Novel Modified Suture-bridge Technique

2021 ◽  
Author(s):  
Zengshuai Han ◽  
Wenru Ma ◽  
Dongfang Zhang ◽  
Yi Zhang ◽  
Chao Qi ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Scale Score ◽  
Full Thickness ◽  
Suture Bridge ◽  
The Mean ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair ◽  
Suture Bridge Technique

Abstract Background: This prospective study compared the clinical and radiologic outcomes of patients who underwent arthroscopic rotator cuff repairs by the traditional suture bridge technique and the modified suture bridge technique.Methods: From December 2018 to December 2019, 50 consecutive cases of full-thickness medium rotator cuff tear, 1 to 3 cm in the coronal plane, for which arthroscopic rotator cuff repair was performed, were included. The TSB technique was used in 24 consecutive shoulders; and the MSB technique, in 26 consecutive shoulders. Clinical outcomes at 3 months, 6 months and a minimum of 1 years (mean, 11.92±1.92months) were evaluated postoperatively using range of shoulder, the visual analog scale score; University of California Los Angeles Shoulder Scale score; Constant-Murley shoulder score and American Shoulder and Elbow Surgeons Subjective Shoulder Scale score. All patients underwent preoperative MRI and B-US to identify the rotator cuff tear, and postoperatively at final follow-up to evaluate tendon integrity. Results: At the final follow-up, the clinical outcomes improved in both groups. There were no significant differences in the results of the ROM between the two groups at 3 months, 6 months and the final follow-up. The average VAS score decreased from 6.12±0.95 to 1.04±0.45 in MSB Group and decreased from 6.29±0.91 to 1.33±0.48 at the final follow-up in TSB Group. The VAS score significantly differed between the two groups only at the final follow-up (P=0.03). The mean UCLA score increased from 12.23±3.47 to 30.96±2.54 in MSB Group and increased from 11.50±4.00 to 28.79±4.47 in TSB Group at the final follow-up; the mean Constant shoulder score increased from 40.54±5.61 to 92.08±7.21 in MSB Group and increased from 41.79±5.51 to 86.96±8.42 in TSB Group at the final follow-up. The average ASES score increased from 36.04±2.47 to 96.04±7.28 in MSB Group and increased from 35.04±3.10 to 91.50±7.33 in TSB Group at the final follow-up. The UCLA (P=0.044), Constant (P=0.025), ASES (P=0.033) score significantly differed between the two groups only at the final follow-up. At the final follow-up postoperatively, the MRI assessments showed no retear in MSB Group and two retears in TSB Group (8%)(Z=-1.538, P=0.124), B-US assessments showed no retear in MSB Group and one retear in TSB Group (4%)(Z=-1.169, P=0.242). No significant difference was found between the 2 groups regarding cuff integrity in accordance with MRI assessments and B-US assessmentsConclusion: For medium-sized RCTs, the patients who underwent MSB repair had shown better shoulder functional outcomes and a lower but not significant re-tear rate with those who underwent TSB repair. Therefore, the MSB repair technique can be considered an effective treatment for patients with medium-sized full-thickness RCTs.ClinicalTrials.gov Identifier: NCT04825249 Level of evidence: A prospective study, Level II.

Risk Factors for Tear Progression in Symptomatic Rotator Cuff Tears: A Prospective Study of 174 Shoulders

2017 ◽  
Vol 45 (11) ◽  
pp. 2524-2531 ◽  
Author(s):  
Nobuyuki Yamamoto ◽  
Mitsuyoshi Mineta ◽  
Jun Kawakami ◽  
Hirotaka Sano ◽  
Eiji Itoi
Keyword(s):  
Risk Factors ◽  
Rotator Cuff ◽  
Alcohol Drinking ◽  
Sports Participation ◽  
Rotator Cuff Tears ◽  
Hand Dominance ◽  
Full Thickness ◽  
Partial Thickness ◽  
The Mean ◽  
Tear Size

Background: The risk factors for tear progression in symptomatic rotator cuff tears have not been clarified yet. It is important for orthopaedic surgeons to know the natural course of tear progression when nonoperative management is to be chosen. Hypothesis: Tears in younger patients, high-activity patients, or heavy laborers would progress in size more than those in older patients, low-activity patients, or light laborers. Study Design: Case-control study; Level of evidence, 3. Methods: Two hundred twenty-five consecutive patients with symptomatic rotator cuff tears visited our institute between 2009 and 2015. Of these, 174 shoulders of 171 patients (mean age, 66.9 years) who underwent at least 2 magnetic resonance imaging (MRI) examinations were prospectively enrolled. The mean follow-up was 19 months. Tear progression was defined as positive when the tear size increased by ≥2 mm. The demographic factors that were analyzed by multivariate analysis included age, sex, hand dominance, smoking, alcohol drinking, hypercholesterolemia, sports participation, job type, tear size, and tear type (full or partial thickness). Results: Of the 174 shoulders, 82 shoulders (47%) showed tear progression. The mean (±SD) tear length and width in the progression group on final MRI were 23.1 ± 12.5 mm and 17.3 ± 9.6 mm, respectively; the tear size progressed by a mean 5.8 ± 5.6 mm in length and 3.1 ± 5.2 mm in width. The mean propagation speed was 3.8 mm/y in length and 2.0 mm/y in width. The size of full-thickness tears significantly increased compared with that of articular-sided partial-thickness tears ( P = .0215). The size of medium tears significantly increased compared with that of other tears ( P < .0001). According to the logistic regression analysis, smoking was significantly correlated with tear progression ( P = .026). Subgroup analyses showed that male sex, hand dominance, and trauma were correlated with tear progression. Age, alcohol drinking, hypercholesterolemia, sports participation, and job type did not show any correlation with tear progression. Conclusion: The tear size of symptomatic rotator cuff tears progressed in 47% of the shoulders during a mean of 19 months, and the speed of progression was 3.8 mm/y in length and 2.0 mm/y in width. The risk factors for tear progression were (1) a medium-sized tear, (2) a full-thickness tear, and (3) smoking.

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.

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