There is little doubt that arthroscopic surgeries of the knee, elbow, and ankle have helped return athletes and active individuals back to sports, exercise, and work faster than in previous decades. Surgeons can completely visualize the joint through two or three small incisions. We can treat problems with a camera and small instruments. Arthroscopy has revolutionized the field of sports medicine.
These advances might even be truer for the shoulder. In the past, rotator cuff tears were mostly repaired through large, open incisions placed on the side of the shoulder. Now they are usually performed arthroscopically. Likewise, arthroscopic repairs of superior labral tears (SLAP tears) have become standard.
Study: SLAP repairs rising sharply
A study in May 2012 issue of The American Journal of Sports Medicine reflects this trend. Alan L. Zhang et al looked at insurance data collected for over 11 million patients from 2004 to 2009. They found a remarkable 105% increase in SLAP repairs performed across the United States between 2004 and 2009.
The 20-29 year and 40-49 year age groups had the highest incidence of SLAP repairs. Males comprised approximately 75% of those surgical patients. Interestingly, SLAP repairs were performed more often in the West and the South compared to the Midwest and Northeast.
Explanations for this increase?
In my opinion, there are several explanations for this trend. It is possible that the injury is more common. More people play sports, including the overhead sports that can cause SLAP tears, than ever. Plus, the baby boomers are staying active as they get older.
But I think if there is an increase in the diagnosis of SLAP tears, it reflects our better diagnostic abilities. There has been more attention given to labral tears in the media with these injuries occurring among famous athletes. There also seems to be more research devoted the injury. We could now be more suspicious of these tears when we examine active patients with shoulder pain. Possibly the suspicion leads us to order more MRIs and MR arthrograms, which reveal the injuries.
Are younger surgeons more comfortable with arthroscopic repair?
There is likely an even more important change, though. Newer generations of sports medicine surgeons, myself included, trained in the era of arthroscopic surgeries. We possibly feel much more comfortable performing labral repairs than prior generations of orthopaedic surgeons. A recent study showed that candidates applying for the American Board of Orthopaedic Surgery were performing the SLAP repairs at rates three times higher than expected.
Surgeons less comfortable with SLAP repairs might choose to leave a labral tear alone or simply to debride it when encountered during surgery for another problem. Surgeons comfortable with suture management and anchor placement through arthroscopic portals might be inclined to repair SLAP tears when we encounter them.
This study and the trend of increasing arthroscopic SLAP repairs are enlightening, but they raise some questions. Does the trend coincide with increased popularity in sports medicine as a field and subspecialty of orthopaedic surgery? As most graduating orthopaedic surgery residents and fellows become familiar with arthroscopic surgery, will the numbers plateau? Will patient outcome scores and activity levels increase? Time and much more data should answer these questions.
Sports medicine surgeons, physical therapists, and athletic trainers, I want to know what you think! Are you seeing more SLAP tears in your practice? If so, what accounts for the change? Have any of you reading had surgery for a SLAP tear? Share your experiences here!