Sham surgery vs. labral repair or tenodesis in SLAP lesions
The use of surgical over conservative measures in rehabilitation is commonly thought of as the gold standard in treatment or perceived as essential for optimal recovery. Unfortunately, questions are often raised when sub-optimal outcomes are achieved, which in turn can raise questions regarding optimal care. The following study compared outcomes of those with SLAP lesions that were treated with labral repair, biceps tenodesis or sham surgery. Improvements from baseline were noticed among all groups, however the authors concluded no clinically significant difference existed between groups at long-term follow-up.
The current literature for SLAP lesion management reveals a call for stricter indications for surgical labral repair due to poor outcomes and high complication rates. The use of biceps tenodesis as an alternative surgical measure or the use of non-operative treatment have been proposed due to the suggestion of favorable outcomes. However, those have also been criticized over the fact that the body of knowledge on this topic is still in its infancy.
The current randomized, double blind sham-controlled trial, was used to determine the efficacy in current SLAP lesion management using outcomes over a 2-year period. The cohort consisted of individuals aged 18-60 with a history of shoulder pain >3 months, unresponsive to conservative interventions, as well as a positive MRI arthrography finding that confirmed a type II SLAP lesion.
The authors conclude that despite methodological challenges and further need for larger studies, clients should be educated on the conceivable complications of surgical management and the potential success of non-operative treatment.
> From: Schrøder et al., Br J Sports Med (2017) (Epub ahead of print). All rights reserved to BMJ Publishing Group Ltd. Click here for the online summary.