title: Predictive factors associated with failure of nonoperative treatment of superior labrum anterior-posterior tears.
abstract: BACKGROUND
  Uncertainty remains in the natural course of superior labrum anterior-posterior (SLAP) tears treated conservatively with rehabilitation and activity modification. Our purpose was to evaluate clinical outcomes after nonoperative treatment of type II SLAP tear in young active patients and to identify factors related to negative outcomes.
  
  
  METHODS
  We retrospectively reviewed 63 patients who initially underwent nonoperative treatment for isolated type II SLAP tear. Assessments were made at baseline and at 6 months, and telephone survey was used to evaluate the final outcome. All included patients underwent a consistent nonoperative treatment protocol, and patient-specific data on the outcome were assessed. Failure was defined as abandonment of nonoperative management for surgery at any time points, <20-point improvement in American Shoulder and Elbow Surgeons score at final follow-up, or inability to return to activities.
  
  
  RESULTS
  At the average follow-up of 21 months, pain relief and function improved significantly (American Shoulder and Elbow Surgeons score, 54.2-86.4; Visual Analog Scale score, 4.6-1.7; P < .05) in 45 patients (71.4%) with successful nonoperative treatment. Eighteen patients (28.5%) were either dissatisfied with treatment or had arthroscopic surgery and were considered a failure group. Multivariate analysis showed that failure of nonoperative treatment is strongly linked with history of trauma, positive compression-rotation test result, and participation in overhead activities (P < .05).
  
  
  CONCLUSIONS
  An initial trial of nonoperative management may be considered in young active patients with isolated SLAP tear. Patients with history of trauma, mechanical symptoms, and demand for overhead activities are less likely to succeed.
authors.affiliation: Department of Orthopedic Surgery, Inje University, Seoul Paik Hospital, Seoul, Republic of Korea. Electronic address: orthopodjang@gmail.com.
authors.forename: Suk-Hwan
authors.initials: SH
authors.lastname: Jang
authors.affiliation: Department of Orthopedic Surgery, Inje University, Seoul Paik Hospital, Seoul, Republic of Korea.
authors.forename: Jeong-Gook
authors.initials: JG
authors.lastname: Seo
authors.affiliation: Department of Orthopedic Surgery, Inje University, Seoul Paik Hospital, Seoul, Republic of Korea.
authors.forename: Ho-Su
authors.initials: HS
authors.lastname: Jang
authors.affiliation: Sports Medical Center, Inje University, Seoul Paik Hospital, Seoul, Republic of Korea.
authors.forename: Jae-Eun
authors.initials: JE
authors.lastname: Jung
authors.affiliation: Department of Orthopedic Surgery, Konkuk University Hospital, Seoul, Republic of Korea.
authors.forename: Jin-Goo
authors.initials: JG
authors.lastname: Kim
mesh_terms: D000328:Adult; D001182:Arthroscopy; D002358:Cartilage, Articular / Q000293:injuries*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D012189:Retrospective Studies; D012307:Risk Factors; D012421:Rupture / Q000150:complications / Q000534:rehabilitation / Q000601:surgery; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000503:physiopathology; D020069:Shoulder Pain / Q000209:etiology / Q000534:rehabilitation* / Q000601:surgery; D017211:Treatment Failure
keywords: Shoulder; nonoperative treatment; overhead activity; physical test; predictive factors; superior labrum anterior-posterior (SLAP) tear