Purpose
To use an expected-value decision analysis to determine the optimal treatment decision
between repair and biceps tenodesis (BT) for an isolated type II SLAP injury.
Methods
An expected-value decision analysis with sensitivity analysis was performed to systematically
quantify the clinical decision. To determine outcome probabilities, a decision tree
was constructed (repair vs BT) and a meta-analysis was conducted. To determine outcome
utilities, we evaluated 70 patients with a chief complaint of shoulder pain regarding
age, sex, Shoulder Activity Level, and visual analog scale score in terms of potential
outcome preferences. Statistical fold-back analysis was performed to determine the
optimal treatment. One-way sensitivity analysis determined the effect of changing
the reinjury rate on the expected value of BT.
Results
The overall expected value was 8.66 for BT versus 7.19 for SLAP repair. One-way sensitivity
analysis showed that BT was the superior choice if reinjury rates were expected to
be lower than 28%. Meta-analysis of 23 studies and 908 patients revealed that the
probability of a “well” outcome was significantly greater for BT (87.8%; 95% confidence
interval [CI], 74.9%-94.6%; I2 = 0.0%) than for SLAP repair (62.9%; 95% CI, 55.9%-69.3%; I2 = 65.9%; P = .0023). The rate of reinjury was 1.5% for BT (95% CI, 0.05%-33.8%; I2 = 0.0%) and 6.4% for repair (95% CI, 4.2%-9.6%; I2 = 24%), which was not statistically significantly different (P = .411). A total of 50 participants (mean age, 25.4 years [standard deviation, 8.9
years]; 76% male patients; 50% overhead athletes) met the inclusion criteria. Forty-six
percent of participants had a high Shoulder Activity Level score.
Conclusions
Decision analysis showed that BT is preferred over repair for an isolated type II
SLAP tear based on greater expected value of BT versus repair. Meta-analysis showed
more frequent favorable outcomes with BT. Surgeons can use this information to tailor
discussions with patients.
Level of Evidence
Level IV, meta-analysis of Level I-IV studies.
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Article Info
Publication History
Published online: June 02, 2022
Accepted:
May 13,
2022
Received:
December 13,
2021
Publication stage
In Press Journal Pre-ProofFootnotes
The authors report the following potential conflicts of interest or sources of funding: B.R.W. is a board or committee member of American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America; receives research support from Arthrex and Arthroscopy; is on the editorial or governing board of Arthroscopy; receives publishing royalties from Elsevier; receives financial support from Elsevier; is a paid consultant for FH Ortho; owns stock or stock options in Kaliber AI and Vivorte; is an unpaid consultant for Sparta Science; and is a paid presenter for Vericel, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2022 by the Arthroscopy Association of North America
