More SLAP Diagnosis but LESS Surgical Repair?

Between 2003 and 2013, superior labrum anterior-to-posterior (SLAP) tear diagnoses increased, but the number of arthroscopic SLAP repairs plateaued after initially doubling, according to new research.

In the study, “National trends in the diagnosis and repair of SLAP lesions in the United States,” published in the Journal of Orthopaedic Surgery, patients with a SLAP tear diagnosis or arthroscopic SLAP repair surgery were identified through private insurance claims in MarketScan from 2003 to 2013.

SLAP tear was first introduced as an International Classification of Diseases Ninth Revision, Clinical Modification diagnosis in 1994. According to the data collected, 329,643 patients in the MarketScan database were diagnosed with a SLAP tear between 2003 and 2013. And 62.8% of them had some form of shoulder surgery.

Overall, SLAP diagnoses increased from 28.0 per 100,000 in 2003 to 142.2 per 100,000 in 2013 (p < 0.0001) and the rate of shoulder surgery in these patients increased from 20.1 per 100,000 in 2003 to 74.1 per 100,000 in 2013 (p < 0.0001).

Despite this, the percentage of patients with SLAP tears who underwent shoulder surgery decreased (p < 0.001). In 2003, very few patients got biceps tenodesis for SLAP tears, but by 2013, 18.1% of surgeries for SLAP tears were biceps tenodesis. Isolated arthroscopic SLAP repairs peaked in 2009.

The researchers wrote, “We confirmed prior reports that SLAP diagnosis increased from 2003 to 2013, although the percentage of these patients who underwent surgery decreased over this period.”

They added, “Biceps tenodesis now account for a substantial portion of surgeries for SLAP tear. This may reflect an improved understanding of superior labrum anatomy and biomechanics.”