SLAP lesions of the shoulder are rare injuries. Snyder reported that SLAP lesions made up 3% of shoulder cases in a large subspecialty surgical referral practice. It is the authors' impression that the percentage of young orthopedists cases that are SLAP lesion repairs is far higher and that complications with this increased rate of repair are not insignificant.
As a part of the certification process, Part II candidates submit a six-month case list to the American Board of Orthopaedic Surgery. In the present study, we searched the American Board of Orthopaedic Surgery Part II database to evaluate changes in treatment over time and to identify available outcomes and associated complications arthroscopic repair of SLAP lesions. The ABOS Part II database was searched for all SLAP lesions (ICD-9 codes 840.7) and SLAP repairs (CPT codes 29807) for the years 2003 through 2008. Utilization was analyzed by geographic region, and compared with regard to complications and outcomes as self-reported by candidates during the online application process. Incidence rates were also obtained based on applicant subspecialty declaration.
There were 4,975 SLAP repairs, representing 9.4% of all applicants shoulder cases. Mean follow-up was 8.9 weeks due to the time-limited case collection period. 78.4% were male and 21.6% of patients were female. The rate of repair increased over the study period to 10.1% by 2008. Mean age of male patients was 36.4 years (S.D.=13.0) with a maximum of 85 years of age. Mean age of female patients was 40.9 (S.D.=14.0), with a maximum of 88 years of age. Pain was reported as absent in only 26.3% of patients at follow-up, and function as normal in only 13.1%. 40.1% of applicants self-reported their patients to have an excellent result. The self-reported complication rate was 4.4%. Declared sports medicine specialists had a higher percentage of SLAP repairs than general orthopedists, 12.4% versus 9.2%.
The percentage of Part II Candidates cases that are SLAP repairs is three times the published incidence supported by the current literature for subspecialty referral practice. It might be anticipated that this rate should be even lower for general orthopedists. Especially worrisome is the rate of repair in middle-aged and elderly patients. This incidence of repair is associated with a significant rate of complications and poor outcomes. Focusing on educating young orthopedists to recognize pathologic SLAP lesions from incidental degeneration of the labrum may bring the rate of SLAP repair down to the incidence rates reflected in the literature, and hopefully decrease the complication rate and improve the outcome of arthroscopic SLAP repair.
© 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.