DOI QR코드

DOI QR Code

Arthroscopic Repair of Type II SLAP Lesion with Bioabsorbable Knotless Suture Anchor: Surgical Technique and Clinical Results

제 2형 SLAP병변에서 생체흡수성 봉합나사못을 이용한 관절경 봉함; 수술 술기와 임상 결과

  • Lee, Chae-Chil (Shoulder Service and Sports Medicine, Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Kim, Sung-Jae (Yonsei University) ;
  • Hwang, Chang-Ho (Shoulder Service and Sports Medicine, Department of Rehabilitation Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Seo, Dong-Kyo (Shoulder Service and Sports Medicine, Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Ko, Sang-Hun (Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine)
  • Published : 2007.06.15

Abstract

Purpose: The purpose of this study was to evaluate the results of bioabsorbable knotless suture anchoring for isolated type II SLAP. Materials and Methods: Fourteen patients with isolated type II SLAP underwent a surgical repair with bioabsorbable knotless anchor arthroscopically. Instability, rotator cuff tears or simple subacromial decompression were excluded. The UCLA and pain of VAS (Visual Analogue Scale), ADL (Activity of Daily Living, from the American Shoulder and Elbow Society) were evaluated and patients underwent a thorough shoulder examination at a minimum follow-up period of 2 years postoperatively. Results: At a mean of 27.1 months follow-up. The mean UCLA score improved from 14.4 pre-operatively to 31.2 on last follow-up. The mean VAS for pain was 4.9 and on last follow-up 1.0. The mean VAS for instability was 2.6 and on last follow-up 0.5. The mean ADL was 10.4 and on last follow-up 25.0. 12 patients reported their satisfaction as good to excellent and 10 of the 14 patients returned to their pre-injury level of activity (athletics) (P<0.05). Conclusion: Arthroscopic repair with bioabsorbable knotless suture anchors is an effective surgical technique for the treatment of an isolated unstable type II SLAP lesion. Overall satisfaction was only 85.7%. 1 patient had severe stiffness and 1 patient had shoulder pain.

목적: 이 연구는 제 2형 SLAP 병변에 대한 생체흡수성 knotless suture anchor의 결과를 평가하고자 하였다. 대상 및 방법: 단독으로 발생한 제2형 SLAP 병변을 가진 14예의 환자가 관절경 하 생체흡수성 knotless anchor를 이용하여 수술적 봉합을 시행받았다. UCLA 및 통증에 대한 VAS, ASD가 평가에 이용되었으며, 술 후 추시 최소 2년째 견관절 검사를 시행하였다. 결과: 평균 27.1 개월의 추시기간 동안 평균 UCLA 점수는 술 전 14.4에서 최종 추시에는 31.2로 향상되었다. 통증에 대한 평균 VAS 점수는 4.9에서 최종 추시에는 1.0이었다. 불안정성에 대한 평균 VAS 점수는 2.6에서 최종 추시에서는 0.5였다. 평균 ADL은 10.4에서 최종 추시에 25.0이었다. 12예의 환자가 우수, 우량의 만족도를 보였으나 14예 중 단 10예만이 수상 전 운동 범위로 돌아갔다(P<0.05). 결론: 생체흡수성 knotless suture anchor를 사용하는 관절경적 봉합술은 단독 제2형 SLAP 병변의 치료에 대해 효과적인 수술 술기이다. 전체 만족도는 단지 85.7%였으며, 게다가 1예에서는 심한 강직을, 1예에서는 활액막염으로 인한 장기간의 견관절 통증을 보였다.

Keywords

References

  1. Andrews JR, Carson WG, McLeod WD: Glenoid labrum tears related to the long head of the biceps. Am J Sports Med, 13: 338-341, 1985.
  2. Cohen DB, Coleman S, Drakos MC, Allen AA, O'Brien SJ, Altchek DW, Warren RF: Outcomes of isolated type II SLAP lesions treatend with arthroscopic fixation using a bioabsorbabe tack. Arthroscopy, 22: 136-142, 2006. https://doi.org/10.1016/j.arthro.2005.11.002
  3. DeJong LS, DeBerardino TM, Brooks DE, Judson K: In vivo comparison of a metal versus a biodegradable suture. Arthroscopy, 20: 511-516, 2005.
  4. Ellman H, Hanker G, Bayer M: Repair of the rotator cuff. J Bone Joint Surg Am, 68: 1136-1144, 1986.
  5. Garofalo R, Mocci A, Moretti B, Callari E, Giacomo G, Theumann N, Cikes A, Mouhsine E: Arthroscopic treatment of anterior shoulder instability using knotless suture anchors. Arthroscopy, 21: 1283-1289, 2005. https://doi.org/10.1016/j.arthro.2005.08.033
  6. Kartus J, Kartus C, Brownlow H, Burrow G, Perko M: Repair of type-2 SLAP lesions using Corkscrew anchors. A preliminary report of the clinical results. Knee Surg Sports Traumatol Arthrosc, 12: 229-234, 2004. https://doi.org/10.1007/s00167-003-0462-8
  7. Kartus J, Perko M: The disabled throwing shoulder: spectrum of pathology. Part II: evaluation and treatment of SLAP lesions in throwers. Arthroscopy, 20: 336, 2004.
  8. Maffet MW, Gartsman GM, Moseley B: Superior labrum-biceps tendon complex lesions of the shoulder. Am J Sports Med, 23: 93-98, 1995. https://doi.org/10.1177/036354659502300116
  9. Mihata T, McGarry MH, Tibone JE, Abe M, Lee TQ: Type II SLAP lesions: a new scoring system-the sulcus score. J Shoulder Elbow Surg, 14: 19-23, 2005. https://doi.org/10.1016/j.jse.2004.10.004
  10. Morgan CD, Burkhart SS, Palmeri M, et al: Type II SLAP lesions three subtypes and their relation to the superior instability and rotator cuff tears. Arthroscopy, 14: 553-565, 1998. https://doi.org/10.1016/S0749-8063(98)70049-0
  11. Nam EK, Snyder SJ: The diagnosis and treatment of superior labrum, anterior and posterior (SLAP) lesions. Am J Sports Med, 31: 798-810, 2003.
  12. Nord KD, Masterson JP, Mauck BM: Superior labrum anterior posterior (SLAP) repair using the Neviaser portal. Arthroscopy, 20: 129-33, 2004.
  13. Panossian VR, Mihata T, Tibone JE, Fitzpatrick MJ, McGarry MH, Lee TQ: Biomechanical analysis of isolated type II SLAP lesions and repair. J Shoulder Elbow Surg, 14: 529-534, 2005. https://doi.org/10.1016/j.jse.2004.11.002
  14. Research committee, American shoulder and elbow surgeons: Richard RR, An K, Bigliani LU, et al: A standardized method for the assessment of shoulder function. J shoulder Elbow Surg, 3: 347-352, 1994. https://doi.org/10.1016/S1058-2746(09)80019-0
  15. Rhee YG, Lee DH, Lim CT: Unstable isolated SLAP lesion: clinical presentation and outcome of arthroscopic fixation. Arthroscopy, 21: 1099, 2005.
  16. Snyder SJ, Karzel RP, Del Pizzo W, et al: SLAP lesions of the shoulder. Arthroscopy, 6: 274-279, 1990. https://doi.org/10.1016/0749-8063(90)90056-J
  17. Thal R: A Knotless suture anchor: Technique for use in arthroscopic Bankart repair. Arthroscopy, 17: 213-218, 2001. https://doi.org/10.1053/jars.2001.20666
  18. Thal R: Knotless suture anchor: Arthroscopic Bankart repair without tying knots. Clin Orthop Relat Res, 390: 43-51, 2001.
  19. Thal R: Knotless suture anchor: Design, function, and biomechanical testing. Am J Sports Med, 29: 646-649, 2001.
  20. Wilk KE, Reinold MM, Dugas JR, Arrigo CA, Moser MW, Andrews JR: Current concepts in the recognition and treatment of superior labral (SLAP) lesions. J Orthop Sports Phys Ther, 35: 273-291, 2005. https://doi.org/10.2519/jospt.2005.35.5.273
  21. Wolf BR, Selby RM, Dunn WR, MacGillivray JD: Lasso repair of SLAP or Bankart lesions: a new arthroscopic technique. Arthroscopy, 20: 125-128, 2004. https://doi.org/10.1016/j.arthro.2004.04.020
  22. Yian E, Wang C, Millett PJ, Warner JJP: Arthroscopic repair of SLAP lesions with a bioknotless suture anchor. Tehnical note. Arthroscopy, 20: 547-551, 2004. https://doi.org/10.1016/j.arthro.2004.01.036