Is timing of superior labrum anterior to posterior (SLAP) repair important? A cohort study evaluating the effect of the duration of symptoms prior to surgery on the outcomes of patients who underwent type II SLAP repair


Background

An initial period of non-operative treatment is often advocated for superior labrum anterior to posterior (SLAP) lesions. However, while studies have shown non-operative treatment to significantly improve patient’s functional outcomes, many patients still require surgery after this period of non-operative treatment (15-51%). SLAP repair is a commonly advocated surgical treatment for SLAP tears which significantly improves patients shoulder function and pain. However, to our knowledge there has been no study that has analysed if the duration of time from symptom onset to surgery affects patient outcomes. The purpose of this current study therefore was to determine the benefit or not of having an early SLAP repair. We hypothesised that early SLAP repairs would be associated with improved functional outcomes.

Methods

Sixty-one consecutive arthroscopic superior labral repair cases performed by a single surgeon were retrospectively reviewed using prospectively collected patient-ranked outcomes and examiner-determined assessments pre-operatively, at 1 week, 6 weeks, 24 weeks and at a minimum of 2 years after surgery. Patients were allocated to an ‘early repair’ or ‘late repair’ group based on their time between symptom onset and surgery.

Results

Of the 61 patients, 22 patients (36%) had surgery within 6 months or sooner from symptom onset. Postoperatively, both groups had similar improvement up to 6 months, although ‘early repair’ patients had less range of external shoulder rotation at 6 weeks post-repair compared with ‘late repair’ patients (32 vs 45, p = 0.01). By >2 years after surgery ‘early repair’ patients had reduced level of pain and reduced difficulty with overhead activities (mild vs moderate, p =0.002), reported less shoulder stiffness (none vs a little, p = 0.001) and were more satisfied with their shoulders’ than ‘late repair’ patients (p = 0.04). ‘Early repair’ patients were able to return to a higher level of work earlier than ‘late repair’ patients (p = 0.01).

Conclusions

This study suggests that patients who undergo SLAP repair within 6 months or less of symptom onset have better long-term functional outcomes and an earlier return to a higher level of activity at work.