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Sham surgery versus labral repair or biceps tenodesis for type II SLAP lesions of the shoulder: a three-armed randomised clinical trial
  1. Cecilie Piene Schrøder1,
  2. Øystein Skare1,
  3. Olav Reikerås2,3,
  4. Petter Mowinckel2,
  5. Jens Ivar Brox2,3
  1. 1 Orthopedic Department, Lovisenberg Diaconal Hospital, Oslo, Norway
  2. 2 Oslo University Hospital, Oslo, Norway
  3. 3 University of Oslo, Oslo, Norway
  1. Correspondence to Dr Cecilie Piene Schrøder, Orthopedic Department, Lovisenberg Diaconal Hospital, Lovisenberggt 17, 0440 Oslo, Norway; cecilie.schroder{at}lds.no

Abstract

Background Labral repair and biceps tenodesis are routine operations for superior labrum anterior posterior (SLAP) lesion of the shoulder, but evidence of their efficacy is lacking. We evaluated the effect of labral repair, biceps tenodesis and sham surgery on SLAP lesions.

Methods A double-blind, sham-controlled trial was conducted with 118 surgical candidates (mean age 40 years), with patient history, clinical symptoms and MRI arthrography indicating an isolated type II SLAP lesion. Patients were randomly assigned to either labral repair (n=40), biceps tenodesis (n=39) or sham surgery (n=39) if arthroscopy revealed an isolated SLAP II lesion. Primary outcomes at 6 and 24 months were clinical Rowe score ranging from 0 to 100 (best possible) and Western Ontario Shoulder Instability Index (WOSI) ranging from 0 (best possible) to 2100. Secondary outcomes were Oxford Instability Shoulder Score, change in main symptoms, EuroQol (EQ-5D and EQ-VAS), patient satisfaction and complications.

Results There were no significant between-group differences at any follow-up in any outcome. Between-group differences in Rowe scores at 2 years were: biceps tenodesis versus labral repair: 1.0 (95% CI −5.4 to 7.4), p=0.76; biceps tenodesis versus sham surgery: 1.6 (95% CI −5.0 to 8.1), p=0.64; and labral repair versus sham surgery: 0.6 (95% CI −5.9 to 7.0), p=0.86. Similar results—no differences between groups—were found for WOSI scores. Postoperative stiffness occurred in five patients after labral repair and in four patients after tenodesis.

Conclusion Neither labral repair nor biceps tenodesis had any significant clinical benefit over sham surgery for patients with SLAP II lesions in the population studied.

Trial registration number ClinicalTrials.gov identifier: NCT00586742

  • Randomised trial
  • SLAP lesions
  • labral repair
  • biceps tenodesis
  • sham surgery

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors CPS, OR and JIB conceived and designed the study. ØS and PM participated in setting up of the study. ØS participated in patient recruitment and data collection. PM conducted the analysis and, together with JIB, ØS, OR and CPS, interpretation. CPS and JIB drafted the first version of the manuscript. All authors helped revise the manuscript and gave their final approval of the submitted version.

  • Competing interests None declared.

  • Ethics approval This study was approved (IRB00001870) by the Ethics Commitee Health Region Southeast, Oslo, Norway.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available on request.

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