Arthroscopic Repair of Type II SLAP Lesions in Overhead Athletes

Abstract

For overhead athletes and, in particular, baseball pitchers, the rates of success and return to play for those who have undergone arthroscopic repair of type II SLAP lesions are poor, ranging from 7% to 62%. The reasons for the poor results and high failure rates in overhead athletes with type II SLAP repairs are multifactorial and are a combination of many factors. These factors include the failure to establish the diagnosis and treat these athletes preoperatively; the inability of the operating surgeon to differentiate normal anatomic variants from pathologic SLAP lesions at the time of surgery; the surgical technique, which may violate the rotator cuff; or the placement of suture anchors, which restricts external rotation and alters overhead throwing mechanics. The proper diagnosis of SLAP lesions can be difficult because SLAP tears rarely occur in isolation and are often associated with other shoulder pathology. A proper history detailing the onset of symptoms and whether there was an acute episode of trauma or a history of repetitive use is critical. It is important to remember that no single physical examination finding is pathognomonic for SLAP tears. When seen in isolation, SLAP tears may mimic impingement syndrome (52%) or even anterior instability (39%). Surgical treatment of type II SLAP lesions should not be undertaken lightly in overhead athletes. If a 3-month rehabilitation period followed by a return to sports over the following 3 months does not allow the athlete to return to his or her preinjury level, diagnostic arthroscopy with SLAP repair is a reasonable option and can yield excellent results using the proper techniques. The technique described in detail in this article and our video can be technically demanding, but with the key points outlined, it can be reproduced and provide excellent results for overhead athletes undergoing SLAP repair. By not violating the rotator cuff, using a mattress configuration and keeping the suture knot away from the articular surface, and by not going anterior to the biceps tendon for repair, external rotation and strength can be preserved, leading to an excellent result with a predictable return to play for overhead athletes.

Analysis of common shoulder injuries in collegiate baseball players

“…However, there were only eight patients with SLAP tears included in this study, which makes it difficult to draw a meaningful conclusion about the operation rate. Multiple studies demonstrate poor results regarding the outcome of SLAP repair in baseball players, with success rates for arthroscopic SLAP repair ranging from 7% to 62% [16][17][18][19][20][21][22][23].…”

SLAP Lesions in Overhead Athletes

“…An MRA is recommended as it has shown to increase the sensitivity and specificity for detecting labral tears and also partial articular sided rotator cuff tears, which is important in evaluating the overhead athlete with shoulder pain [79]. An MRI or an MRA that shows a SLAP lesion is not an automatic indication for surgery [16]. In our prospective study of U.S. Olympic Volleyball athletes, 46% of asymptomatic elite volleyball players had MRI evidence of SLAP tears but no history of complaints of shoulder problems [80].…”

“…Many surgeons including the senior author (WBS) believe that too many overhead athletes are undergoing arthroscopic SLAP repairs and that many athletes can be managed nonoperatively [16]. The operative treatment of SLAP tears remains controversial [17,18].…”

“…Or at the time of surgery, is it the inability of the operating surgeon to differentiate normal anatomic variants from SLAP lesions? Or is it the surgical technique that violates the rotator cuff or the improper placement of suture anchors that restricts range of motion postoperatively and disrupts overhead throwing mechanics [16]? These are all factors that will be explored in this chapter on the SLAP lesions in overhead athletes.…”

Stop, Drop, and Roll! An Arthroscopic Technique for Anterior Glenoid Labrum Repair in the Lateral Decubitus Position

“…This step establishes a bleeding bed to initiate the healing process of the repaired labrum. 2 A low anterior working portal is placed at the superior edge of the subscapularis, and an 8.5-mm Twist-in cannula (Arthrex) is inserted ( Fig 9 ). Next, the “stop, drop, and roll” technique can be applied to assist in passing sutures for repairing the shoulder glenoid labrum.…”