By: 25 October 2011

Brian Forsythe, MD, et al
The Journal of Bone & Joint Surgery. June 2010. Vol. 92-A. No. 6. Pp. 1362-1369

Should a full-thickness of the rotator cuff be repaired at the same time a SLAP lesion is present, and what’s the best way to treat the SLAP lesion? Some studies have shown that surgical results vary depending on the age of the patients. For example, younger age groups (ages 18 to 40) tend to have poor outcomes when SLAP lesions are repaired at the same time as shoulder decompression is done.

Older adults don’t seem to respond well to surgery for SLAP tears. They get stiff after the recovery period and lose function. Some research has been done to see if a staged procedure might have better results.

In this study, surgeons compared two groups of middle aged adults after surgery for shoulder injuries. The first group had a torn rotator cuff but the labrum was undamaged. The second group had both a rotator cuff tear and a labral tear. Surgery for the group with damage to both the rotator cuff and the labrum was done as a concomitant procedure.

There were 34 patients in the concomitant procedure group and 28 in the rotator cuff repair one. All patients in both groups had minimal muscle atrophy and minimal fatty infiltration. Everyone had tried recovery with conservative care but without success.

One surgeon operated on all patients in both groups and the postoperative care was the same for both. A physical therapist supervised an intensive rehabilitation program for all 62 patients.

To measure the results and compare outcomes, everyone was tested before and after surgery. The specific tests involved shoulder range-of-motion and function. Information was gathered about patients in both groups and used to analyse differences based on sex, age, type of injury, type of tear, work status, and involvement in sports.

Everyone got better after surgery no matter which procedure they had done. Range-of-motion and function improved significantly in both groups. Almost everyone in both groups was able to return to work and return to sports previously enjoyed.

The authors concluded that it is both safe and effective to combine a SLAP repair with a rotator cuff repair in middle-aged adults. The fear that the shoulder will stiffen up too much isn’t a reality and there’s no need for a staged procedure either – the results for the concomitant surgical group were just as good. And the average age of patients in this study was 58 (older than has been reported in other studies).

There is also some evidence that the aggressive rehab program after surgery might account for the good results. It is possible that early motion is the key to preventing stiffness later. However, intense early range-of-motion programs come with the risk of re-tears. Future studies are needed to follow patients and perform postoperative imaging studies to see the effect of different types of rehab after surgery.