Poor outcomes after SLAP repair: descriptive analysis and prognosis.

PURPOSE: In the first part of this study, we analyzed a subset of patients to determine what factors may have been present in those with poor outcomes after SLAP repair. In part 2, we evaluated clinical outcomes of these patients after further treatment. METHODS: We completed a retrospective medical record review of consecutive patients presenting between 2000 and 2007 with pain, stiffness, and/or mechanical symptoms after a SLAP repair. To evaluate for similarities among this cohort, data collection included demographics, age at initial SLAP repair, history of trauma, medical history, nonoperative and operative treatments, and physical examination. Outcome measures included patient satisfaction and the Simple Shoulder Test questionnaire. Subsequent treatment was then reviewed, investigating whether patients received physical therapy, cortisone injection, and/or revision surgery in an attempt to improve satisfaction. Outcome measures again included patient satisfaction and the Simple Shoulder Test questionnaire. RESULTS: We found 40 shoulders in 39 patients who met inclusion criteria. The mean age at the time of initial SLAP repair was 43 years. Of the patients, 30 (75%) presented with pain and decreased range of motion, 9 (22.5%) presented with pain but full range of motion, and 1 (2.5%) presented with pain and mechanical symptoms but full range of motion. The mean Simple Shoulder Test score upon presentation after SLAP repair was 3.04 out of 12 (SD, 2.18; range, 0 to 7). We included 34 shoulders in the analysis of treatment outcome. Of these, 29% (10 of 34) were satisfied after conservative treatment, 62% (13 of 21) were satisfied after revision surgery, and 68% (23 of 34) were satisfied overall after either type of further treatment. The mean Simple Shoulder Test score after further treatment was 8.73 out of 12 (SD, 3.45; range, 0 to 12). CONCLUSIONS: In this study 71% of patients (mean patient age, 43 years) with a poor outcome after SLAP repair were dissatisfied with conservative treatment. Therefore, once a patient has a poor outcome after SLAP repair, there is a high chance of conservative treatment failing. Although patients have better outcomes with operative intervention, 32% will continue to have a suboptimal result. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

A retrospective comparison of the incidence of bacterial infection following anterior cruciate ligament reconstruction with autograft versus allograft.

PURPOSE: To compare the incidence of bacterial infection in anterior cruciate ligament (ACL) reconstruction with autograft versus allograft. METHODS: We completed a retrospective medical record review of ACL reconstructions performed at our institutions between 2001 and 2005. These included 170 autograft, 628 allograft, and 3 combined autograft/allograft reconstructions. Data collection included patient demographics, comorbidities, preoperative antibiotics, fixation type, and the occurrence of deep postoperative infection. RESULTS: Of the 801 patients who underwent ACL reconstruction, 6 (0.75%) developed a confirmed deep infection. There were 2 confirmed deep infections in 170 autograft reconstructions (1.2%) compared with 4 confirmed deep infections in 628 allograft reconstructions (0.6%). Multivariate analysis revealed that ACL reconstruction using autograft had a nearly twice the risk of infection compared to allograft reconstructions (adjusted odds ratio, 1.83; 95% confidence interval, 0.16 to 12.94). CONCLUSIONS: This study failed to find a higher rate of deep bacterial infection in ACL reconstructions when allograft tissue was used. We therefore feel that surgeons should consider allograft tissue as an alternative to autograft when there is a concern about donor-site morbidity, or for revision reconstructions. LEVEL OF EVIDENCE: Level III, therapeutic retrospective comparative study.