The trans-rotator cuff approach to SLAP lesions: Technical aspects for repair and a clinical follow-up of 31 patients at a minimum of 2 years

Purpose: To discuss a new technique for the surgical treatment of type II SLAP lesions as well as the evaluation of the technique's effectiveness with a minimum 2-year follow-up. Type of Study: Retrospective clinical follow-up study. Methods: We present a clinical follow-up of 31 patients who were treated arthroscopically for type II SLAP lesions using a trans-rotator cuff portal at an average follow-up time of 3.7 years. Patients were screened for concomitant procedures including rotator cuff repairs, shoulder stabilizations, thermal capsullographies, and previous surgeries. These patients were subsequently excluded from the study. Patients were given a standard physical examination of the upper extremity at our institution and they completed both the L'Isalata and American Shoulder and Elbow Surgeons questionnaires. Results: All 31 patients identified were available for follow-up at an average time of 3.7 years postoperatively (range, 2.0 to 7.4 years). The average L'Insalata score was 87.0 points (range, 46.1-100 points); the average ASES score was 87.2 points (range, 46.7-100 points). The average pain score was 1.5 (range, 0-5) and only 4 of the 31 patients complained of moderate pain with activity. Sixteen of the 31 patients returned to their preinjury level of sports; 11 of the 31 patients returned to limited activity and 2 patients were inactive at the time of follow-up. Overall satisfaction with the procedure averaged 3.79 points (range, 0-5 points): 22 patients rated overall satisfaction as good or excellent, 6 patients reported a fair outcome, and only 3 patients were unsatisfied with the results of the surgery. One patient who was unsatisfied with the procedure had reinjured his superior labrum and required a second operation. None of the 31 patients had symptoms suggestive of rotator cuff pathology. Of the 30 patients found to have a positive Active Compression test preoperatively, 26 of these patients now had a negative sign. Conclusions: The trans-rotator cuff approach allows for a more optimal placement of a biodegradable fixation device and/or suture anchors into the superior labrum. Furthermore, we believe that this approach does not compromise the function of the rotator cuff. The trans-rotator cuff technique is an effective and safe modality to address superior labral pathology.