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Trends in the Management of Isolated SLAP Tears in the United States
BACKGROUND: The management of superior labrum anterior and posterior (SLAP) tears remains controversial, with surgical treatment options including SLAP repair, debridement, and open or arthroscopic biceps tenodesis (BT), based on patient factors and the type of tear. HYPOTHESIS: We hypothesized that...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6431775/ https://www.ncbi.nlm.nih.gov/pubmed/30923727 http://dx.doi.org/10.1177/2325967119833997 |
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author | Cvetanovich, Gregory L. Gowd, Anirudh K. Agarwalla, Avinesh Forsythe, Brian Romeo, Anthony A. Verma, Nikhil N. |
author_facet | Cvetanovich, Gregory L. Gowd, Anirudh K. Agarwalla, Avinesh Forsythe, Brian Romeo, Anthony A. Verma, Nikhil N. |
author_sort | Cvetanovich, Gregory L. |
collection | PubMed |
description | BACKGROUND: The management of superior labrum anterior and posterior (SLAP) tears remains controversial, with surgical treatment options including SLAP repair, debridement, and open or arthroscopic biceps tenodesis (BT), based on patient factors and the type of tear. HYPOTHESIS: We hypothesized that SLAP repair has become less frequently performed over time, while BT is more frequently performed, particularly in patients ≥ 40 years. STUDY DESIGN: Descriptive epidemiology study. METHODS: A retrospective query was performed using the Humana insurance database from years 2007 to 2016. For the management of a SLAP tear diagnosis (International Classification of Diseases–Ninth Edition [ICD-9] code: 840.7), independent and exclusive cohorts were formed using Current Procedural Terminology (CPT) codes for debridement (29822, 29823), SLAP repair (29807), open or arthroscopic BT (29828, 23430), and SLAP repair combined with BT (29828 OR 23430 AND 29807). RESULTS: Of 46,650 diagnoses of a SLAP tear, there were 3347 patients who underwent operative management for an isolated SLAP tear from 2007 to 2016. There was a linear increase of SLAP tear diagnoses per year (r (2) = 0.800, P < .001) during this period. Overall, SLAP repair was performed in 1629 patients (48.7%), debridement was performed in 1076 patients (32.1%), BT was performed in 552 patients (16.5%), and combined SLAP repair and BT was performed in 90 patients (2.7%). There was a 69.3% decrease in isolated SLAP repair from 2007 to 2016 (r (2) = 0.882, P < .001). BT for the diagnosis of an isolated SLAP tear increased by 370.0% over the same period (r (2) = 0.800, P < .001). SLAP repair had an equivalent percentage of being performed in patients both older and younger than 40 years (P = .218). There was a 1500.0% increase in BT performed in patients older than 40 years during the study period. There were no statistical differences in the postoperative incidence of stiffness, surgical site infections, and reoperations between all surgical treatment groups (P > .05). CONCLUSION: An analysis of a large private-payer database revealed that surgical treatment of isolated SLAP tears in the United States has shifted from 2007 to 2016, with an increase in the frequency of BT and a decline in the frequency of SLAP repair, particularly in patients older than 40 years. |
format | Online Article Text |
id | pubmed-6431775 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-64317752019-03-28 Trends in the Management of Isolated SLAP Tears in the United States Cvetanovich, Gregory L. Gowd, Anirudh K. Agarwalla, Avinesh Forsythe, Brian Romeo, Anthony A. Verma, Nikhil N. Orthop J Sports Med Article BACKGROUND: The management of superior labrum anterior and posterior (SLAP) tears remains controversial, with surgical treatment options including SLAP repair, debridement, and open or arthroscopic biceps tenodesis (BT), based on patient factors and the type of tear. HYPOTHESIS: We hypothesized that SLAP repair has become less frequently performed over time, while BT is more frequently performed, particularly in patients ≥ 40 years. STUDY DESIGN: Descriptive epidemiology study. METHODS: A retrospective query was performed using the Humana insurance database from years 2007 to 2016. For the management of a SLAP tear diagnosis (International Classification of Diseases–Ninth Edition [ICD-9] code: 840.7), independent and exclusive cohorts were formed using Current Procedural Terminology (CPT) codes for debridement (29822, 29823), SLAP repair (29807), open or arthroscopic BT (29828, 23430), and SLAP repair combined with BT (29828 OR 23430 AND 29807). RESULTS: Of 46,650 diagnoses of a SLAP tear, there were 3347 patients who underwent operative management for an isolated SLAP tear from 2007 to 2016. There was a linear increase of SLAP tear diagnoses per year (r (2) = 0.800, P < .001) during this period. Overall, SLAP repair was performed in 1629 patients (48.7%), debridement was performed in 1076 patients (32.1%), BT was performed in 552 patients (16.5%), and combined SLAP repair and BT was performed in 90 patients (2.7%). There was a 69.3% decrease in isolated SLAP repair from 2007 to 2016 (r (2) = 0.882, P < .001). BT for the diagnosis of an isolated SLAP tear increased by 370.0% over the same period (r (2) = 0.800, P < .001). SLAP repair had an equivalent percentage of being performed in patients both older and younger than 40 years (P = .218). There was a 1500.0% increase in BT performed in patients older than 40 years during the study period. There were no statistical differences in the postoperative incidence of stiffness, surgical site infections, and reoperations between all surgical treatment groups (P > .05). CONCLUSION: An analysis of a large private-payer database revealed that surgical treatment of isolated SLAP tears in the United States has shifted from 2007 to 2016, with an increase in the frequency of BT and a decline in the frequency of SLAP repair, particularly in patients older than 40 years. SAGE Publications 2019-03-22 /pmc/articles/PMC6431775/ /pubmed/30923727 http://dx.doi.org/10.1177/2325967119833997 Text en © The Author(s) 2019 http://creativecommons.org/licenses/by-nc-nd/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Article Cvetanovich, Gregory L. Gowd, Anirudh K. Agarwalla, Avinesh Forsythe, Brian Romeo, Anthony A. Verma, Nikhil N. Trends in the Management of Isolated SLAP Tears in the United States |
title | Trends in the Management of Isolated SLAP Tears in the United States |
title_full | Trends in the Management of Isolated SLAP Tears in the United States |
title_fullStr | Trends in the Management of Isolated SLAP Tears in the United States |
title_full_unstemmed | Trends in the Management of Isolated SLAP Tears in the United States |
title_short | Trends in the Management of Isolated SLAP Tears in the United States |
title_sort | trends in the management of isolated slap tears in the united states |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6431775/ https://www.ncbi.nlm.nih.gov/pubmed/30923727 http://dx.doi.org/10.1177/2325967119833997 |
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