The Impact of Lateral Decubitus vs. Beach Chair Positioning on the Clinical Outcome of the Patients with Isolated SLAP Type II Repair: A Systematic Review and Meta-analysis

Background: A superior labrum from anterior to posterior (SLAP) repairs can be performed in either beach chair (BC) orlateral decubitus (LD). The purpose of this study was to perform a systematic review and meta-analysis to compare theoutcomes of surgical repair of type II SLAP injuries between the BC vs. LD positions. We hypothesized no statisticallysignificant differences in the functional, pain, and motion outcomes between the BC vs. LD positions after type II SLAP repair.Methods: A comprehensive literature search was performed using MEDLINE, Scopus, Web of Science, Embase, andCochrane to identify studies reporting outcomes after type II SLAP repair. Outcome measures consisted of pain usingthe visual analog score (VAS), range of motion (ROM), and functional scores, including the University of California at LosAngeles Shoulder (UCLA) score, American Shoulder and Elbow Surgeons (ASES), and Constant score. The outcomeswere pooled and analyzed for eligibility and stratified into two subgroups for a random-effects model meta-analysis.Results: Of the 8,016 identified studies through a database search, 13 papers (378 patients) were eligible for statisticalanalysis in the BC and 10 articles (473 patients) were included in the LD group. The mean follow-up for BC and LD was35 and 44 months, respectively. The SLAP repair in both positions demonstrated improvements in postoperative clinicaloutcomes and ROM. Comparing the two positions, the LD group demonstrated significantly greater improvements inVAS which contributed to better functional outcomes, while the BC group showed a significantly greater improvement inabduction. No other differences were identified including ASES, UCLA, and Constant score as well as remaining ROM.Conclusion: Based on the findings of this systematic review and meta-analysis, both the BC and LD positions providepatients better outcomes following operative repair of type II SLAPs. While LD represented a better improvement infunctional outcome measures, the BC position demonstrated better abduction with no other significant differencesbetween both positions. An individualized approach to position selection concerning the patient’s complaint (pain vs.motion) as well as the surgeon’s discretion is recommended.Level of evidence: IV