Isolated Type II Superior Labral Anterior Posterior Lesion: Age-Related Outcome of Arthroscopic Fixation
Authors: Brian R. Neri, Emily A. Vollmer and Ronald S. Kvitne
References: Am J Sports Med May 2009 vol. 37 no. 5 937-942
Background Superior labral anterior posterior tears have been described as symptomatic lesions in shoulders of patients of varying ages. It is unknown if age affects clinical outcome of arthroscopic fixation of type II superior labral anterior posterior repairs.
Hypothesis Clinical outcome of arthroscopic fixation of isolated type II superior labral anterior posterior tears differs between younger (<40 years) and older (≥40 years) patients.
Study Design Cohort study; Level of evidence, 3.
Methods Clinical results of arthroscopic fixation of isolated unstable type II superior labral anterior posterior repairs were compared between 25 patients younger than 40 years (group 1) and 25 patients aged 40 years or older (group 2). Patients with concomitant procedures, prior/subsequent shoulder surgeries, and use of non-suture anchor devices were excluded. Outcomes at a minimum 1-year follow-up were assessed using range of motion measurements and the American Shoulder and Elbow Surgeons questionnaire as compared with preoperative data. Ability and time to return to prior level of activity were assessed.
Results At a mean 3-year follow-up, there were statistically significant improvements in American Shoulder and Elbow Surgeons scores for both groups (P < .0001) but no significant difference between final American Shoulder and Elbow Surgeons scores (group 1, 91; group 2, 87; P > .198). Both groups demonstrated good or excellent results in >80% of patients. A traumatic mechanism of injury (P = .0346) and presence of osteoarthritis (P = .0401) were independent factors resulting in significantly lower postoperative scores. There were statistically significant differences in preoperative and postoperative range of motion for internal rotation (group 1, P = .0321) and forward elevation (group 2, P = .0003). Return to prior level of activity was similar between younger and older age groups: 80% versus 74%. Time to return to sport was prolonged for group 2 (11.0 months) compared with group 1 (8.45 months). Patients without osteoarthritis were significantly more likely to return to previous levels of activity than were those who had osteoarthritis (P = .0044).
Conclusion Good to excellent results and high return to prior level of activity can be expected for the majority of properly indicated patients who undergo isolated type II superior labral anterior posterior repairs, regardless of age. Subtle deficits in range of motion were experienced by both age groups; this did not seem to affect final outcomes. The presence of osteoarthritis was associated with lower American Shoulder and Elbow Surgeons scores and inability to return to prior level of activity. Time to return to activity was prolonged for the older group.