Management of Failed SLAP Repair. A Systematic Review
The management of failed SLAP repairs
Superior labral anterior-posterior (SLAP) tears are common shoulder injuries, especially in overhead athletes. However, outcomes of SLAP repair can be variable and failures occur.
Reasons for Failure
– The most common reason for failed SLAP repair is persistent mechanical symptoms that do not resolve with conservative treatment.
– Other causes include concomitant shoulder pathology, technical errors, hardware issues, and subsequent traumatic injuries.
– Patient factors like age over 40 years and tobacco use increase failure risk.
Evaluation of Failed Repair
– Thorough history, physical exam, and imaging are needed to identify causes of persistent pain and dysfunction after SLAP repair.
– Non-operative treatment is initially pursued but diagnostic arthroscopy may be required.
– No definitive guidelines exist for managing failed SLAP repairs. Treatment is tailored to the reason for failure and patient characteristics.
– Options include revision SLAP repair, biceps tenodesis or tenotomy, subacromial decompression, and hardware removal.
Outcomes of Revision Surgery
– All studies in this review reported improved functional outcomes after revision surgery compared to pre-operatively.
– A cohort study found higher return to activity rates with biceps tenodesis versus revision SLAP repair.
– Reported complication rates were low, around 1%, and no revision failures were noted but study quality was limited.
– This systematic review provides an overview of current evidence on outcomes of various techniques for failed SLAP repairs.
– Most studies were case series and comparative trials are lacking, precluding strong conclusions.
– Further high-quality randomized trials comparing management options are needed.
– Persistent post-operative pain is the most common reason for failed SLAP repair requiring revision surgery.
– Outcomes are generally good after revision but techniques must be individualized for each patient.
– Higher level evidence is still needed to guide treatment decisions for this difficult problem.
In summary, while some evidence exists, management of failed SLAP repairs remains challenging. Additional comparative research can help better define optimal surgical strategies and improve outcomes for these patients. Careful patient selection and identifying the reason for failure are critical to success.