SHOULDER & ELBOW
A new technique of arthroscopic fixation using double anchors for SLAP lesions
This report has been verified
by one or more authors of the
original publication.
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)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
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
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
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.
主な研究課題は何ですか？
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?
重要な知見は？
- 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.
最も覚えておくべきことは？
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.
それが私の患者ケアにどのように影響するか？
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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