Novel arthroscopic fixation technique for SLAP lesions improves outcomes .
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(11):224 Knee Surg Sports Traumatol Arthrosc. 2012 Oct;20(10):1939-46. Epub 2011 Oct 18.28 patients with 29 shoulders undergoing arthroscopic repair for a type-II superior labrum anterior-posterior (SLAP) lesion were randomized to undergo a new fixation technique using double anchors or a conventional technique. The results after a one year follow-up suggest that the new fixation technique adequately restores the anatomical position of the SLAP lesion and provides improved short-term clinical and structural outcomes; including VAS pain and constant scores.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
1/4
Randomization
3/4
Outcome Measurements
2/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
Repair of SLAP lesions constitutes from 5% to 16% of all arthroscopic shoulder procedures in large practice settings. Controversy exists regarding many aspects of SLAP lesions, such as the mechanism of injury, and regarding which techniques are best to diagnose and repair the lesion. Although the functional outcomes of SLAP surgery range from good to excellent in most patients, it has been reported that up to 55% of patients are unable to return to their prior level of activity. A novel surgical technique has been developed to provide a more anatomical reconstruction of the superior labrum on the glenoid rim using a double anchor. This study aimed to determine whether this new technique improves clinical and structural outcomes when compared to a conventional technique for SLAP lesion repair.
Qual era a principal questão de investigação?
Does a novel technique for SLAP lesion repair improve clinical and structural outcomes compared to a conventional technique in patients undergoing arthroscopic repair for a SLAP lesion when assessed 12 months after surgery?
- The patients in both the new technique and conventional technique groups experienced significant improvements in the ASES score, CSS, score, and VAS pain score by the 12 months follow-up (p<0.001).
- The patients who underwent the new fixation technique experienced significantly better ASES scores (p=0.04), CSS scores (p=0.03), and VAS pain scores (p=0.03) than the patients who underwent the conventional fixation technique by the 12 month follow-up. The significant difference was maintained by the final follow-up (p=0.03, p=0.01, p=0.04, respectively).
- Forward flexion and external rotation (90 degree abduction) were significantly better among the patients who underwent the new fixation technique at the 6 month (p=0.03 and p=0.03, respectively) and 12 month (p=0.04 and p=0.04, respectively) follow-ups, but the difference was no longer significant by the final follow-up.
- Complete labrum-to-bone healing was identified in all patients that underwent MRI study except for 1 patient who underwent the conventional fixation technique. 1 patients from the conventional technique group experienced partial detachment of the repaired superior labrum from the glenoid.
De que é que me devo lembrar mais?
Patients who underwent the new fixation technique (anatomical double anchor repair) experienced significantly better Constant Scoring System scores, American Shoulder and Elbow Surgeons scores, visual analogue scale pain scores, and short-term range of motion scores than the patients who underwent the conventional fixation technique. The new fixation technique also resulted in complete labrum-to-bone healing.
Como é que isto afectará o tratamento dos meus doentes?
The use of this novel fixation technique for Type-II SLAP repair appears to significantly improve clinical and structural outcomes in patients with SLAP lesions when compared to the conventional fixation technique for Type-II SLAP repair. Further trials assessing long-term follow-ups and patient return to activities are need before superiority of one technique can be determined.
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