Trans-rotator cuff portal is safe for arthroscopic superior labral anterior and posterior lesion repair: clinical and radiological analysis of 58 SLAP lesions.
BACKGROUND
There are numerous accessory portals for the arthroscopic repair of superior labral anterior and posterior lesions. Many surgeons are reluctant to make a portal through the cuff because of concern about iatrogenic injury to the cuff.


OBJECTIVE
An arthroscopic superior labral anterior and posterior lesion repair procedure using the trans-rotator cuff portal may yield favorable clinical and radiological outcomes, and cuffs may heal properly.


METHODS
Case series; Level of evidence, 4.


METHODS
Fifty-eight consecutive patients undergoing superior labral anterior and posterior lesion repair using the trans-rotator cuff portal, who had available both functional and radiological outcomes after 1 year of the operation, were enrolled. We evaluated the structural outcomes for the labrum and cuff using computed tomographic arthrography and measured various clinical outcomes (the supraspinatus power, visual analog scale for pain and satisfaction, American Shoulder and Elbow Surgeons shoulder evaluation form, University of California-Los Angeles shoulder score, Constant score, and Simple Shoulder Test) at the final visit.


RESULTS
All functional outcomes were improved significantly (P < .001). On computed tomographic arthrography, labral healing to the bony glenoid was achieved in all patients. Subacromial leakage of contrast media was observed in 3 patients (5.2%) through the muscular portion without any retraction or gap of the tendon. Two of 3 had preoperative cuff pathologic changes, and they were older than 45 years of age. Partial articular cuff tears were observed in 6 patients (10.3%), and 4 had the lesion preoperatively. There were no statistical differences in functional scores according to the presence of preoperative lesion, postoperative leakage, or partial cuff tear.


CONCLUSIONS
The data demonstrate favorable outcomes for arthroscopic superior labral anterior and posterior lesion repair using the trans-rotator cuff portal. We suggest that the trans-rotator cuff portal is an efficient and safe portal for superior labral anterior and posterior lesion repair, although there are some valid concerns of damaging the cuff in patients with a superior labral anterior and posterior lesion with concurrent cuff disorders, as well as in older patients.
Oh
Joo Han
JH
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
Kim
Sae Hoon
SH
Lee
Ho Kyoo
HK
Jo
Ki Hyun
KH
Bae
Kee Jeong
KJ
D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D017006:Rotator Cuff / Q000601:surgery*; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D020069:Shoulder Pain / Q000601:surgery*; D055815:Young Adult