Management of type II superior labrum anterior posterior lesions: a review of the literature

Abstract

Superior labrum anterior and posterior lesions were first described in 1985 by Andrews et al. and later classified into four types by Synder et al. The most prevalent is type II which is fraying of the superior glenoid labrum with detachment of the biceps anchor. Superior labrum anterior posterior (SLAP) lesions can also be associated with other shoulder pathology. Both MRI and MRA can be utilized in making the diagnosis with the coronal images being the most sensitive. The mechanism of injury can be either repetitive stress or acute trauma with the superior labrum most vulnerable to injury during the late cocking phase of throwing. A combination of the modified dynamic labral shear and O'Brien test can be used clinically in making the diagnosis of SLAP lesion. However, the most sensitive and specific test used to diagnosis specifically a type II SLAP lesion is the Biceps Load Test II. The management of type II SLAP lesions is controversial and dependent on patient characteristics. In the young high demanding overhead athlete, repair of the type II lesion is recommended to prevent glenohumeral instability. In middle-aged patients (age 25–45), repair of the type II SLAP lesion with concomitant treatment of other shoulder pathology resulted in better functional outcomes and patient satisfaction. Furthermore, patients who had a distinct traumatic event resulting in the type II SLAP tear did better functionally than patients who did not have the traumatic event when the lesion was repaired. In the older patient population (age over 45 years), minimum intervention (debridement, biceps tenodesis/tenotomy) to the type II SLAP lesion results in excellent patient satisfaction and outcomes.

Outcomes of Arthroscopic Repair of Panlabral Tears of the Glenohumeral Joint

“…Furthermore, no significant differences were found in preoperative symptoms or postoperative outcomes in analyzing results by patient age, a finding in contrast with several recent reports suggesting poorer outcomes after labral repair in older patient populations. 3,10,13,17,35 Postoperative outcomes were also not significantly different in patients presenting with pain alone and no instability. The current study had a 30% reported postoperative complication rate, compared with the 15% rate in Tokish et al This disparity may be the result of a broader definition of postoperative complications in the present report.…”

The rising incidence of arthroscopic superior labrum anterior and posterior (SLAP) repairs

“…8,10 Isolated SLAP lesions are believed to be relatively uncommon. In addition, when they occur with other concurrent shoulder pathology, SLAP lesions are unlikely to be the primary cause of pain or dysfunction.…”

Return to Sport After the Surgical Treatment of Superior Labrum Anterior to Posterior Tears: A Systematic Review

“…These injuries are often a result of either direct trauma to the shoulder or degeneration from chronic overuse. 21 Tears from chronic overuse are often encountered in overhead athletes and are proposed to be the result of either deceleration of the arm during the follow-through phase of throwing or the “peel-back mechanism” seen in the cocking phase in abduction and external rotation. 3,7 While conservative treatment may be effective in some patients, 11 if it fails, arthroscopic SLAP repair using suture anchor fixation is an effective treatment modality, yielding good results in young patients.…”