Treatment of superior labrum anterior posterior lesions: a literature review (original) (raw)
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The American journal of sports medicine, 2014
Surgical repair remains the gold standard for most type II and type IV superior labral anterior and posterior (SLAP) lesions that fail nonoperative management. However, most recently, there have been data demonstrating unacceptably high failure rates with primary repair of type II SLAP lesions. Biceps tenodesis may offer an acceptable, if not better, alternative to primary repair of SLAP lesions. Subpectoral biceps tenodesis provides satisfactory, reproducible outcomes for the treatment of type II and type IV SLAP lesions. Case series; Level of evidence, 4. Patients who underwent subpectoral biceps tenodesis and labral debridement for type II and type IV SLAP lesions by a single board-certified shoulder surgeon from 2006 to 2012 were evaluated. Exclusion criteria included those patients who underwent biceps tenodesis with an associated rotator cuff repair, anterior labral repair, or posterior labral repair. Outcome measures included the visual analog scale (VAS) for pain, the Americ...
The American Journal of Sports Medicine, 2009
Glenoid labral tears involving the long head of the biceps were initially described by Andrews et al 2 in 1985, who noted an association between these lesions and overhead sports activities. In 1990, Snyder et al 33 further classified these labral tears and coined the term "SLAP lesion" for superiorlabrum-anterior-and-posterior (SLAP) lesion. Their prevalence varies depending on the patient population studied but has been reported to be between 1.2% and 23%. However, their cause is often uncertain. Other than a distinct traumatic event, sporting activities are the most common cause of SLAP lesions. Type II SLAP lesions correspond to a detached biceps anchor from the superior glenoid, accounting for the majority of described SLAP lesions (41%) and occur most commonly in overhead athletes. 4,23,32,33 Although such lesions are often associated with other shoulder injuries such as rotator cuff tears, glenohumeral instability, or Background: Overhead athletes report an inconsistent return to their previous level of sport and satisfaction after arthroscopic SLAP lesion repair.
Orthopedics, 2014
This study compared arthroscopic biceps tenodesis with biceps repair for isolated type II superior labrum anterior and posterior (SLAP) lesions in patients older than 35 years. The authors identified isolated type II SLAP lesions that were surgically managed over a 5-year period. Minimum 2-year follow-up data were available for 22 patients who underwent biceps repair (repair group) and for 15 patients who underwent a primary biceps tenodesis (tenodesis group). Mean age at surgery was 45.2±5.5 years in the repair group and 52.0±8.0 years in the tenodesis group. In the repair group, functional outcome improved from baseline to final follow-up using the American Shoulder and Elbow Surgeons (ASES) (47.5 to 87.4, respectively; P<.0001) and University of California, Los Angeles (UCLA) scores (18.5 to 31.2, respectively; P<.0001). In the tenodesis group, similar findings were observed for the ASES (43.4 to 89.9, respectively; P<.0001) and UCLA scores (19.0 to 32.7, respectively; P...
ARC Journal of Orthopedics, 2020
Andrews et al. (1) were the first to describe Superior glenoid labrum tears as a source of shoulder pain in the context of the high demand throwing athlete (professional baseball pitchers). The pathology correlated with the immense stress placed on the shoulder and the biceps brachial is muscle during the throwing motion. Snyder et al (2) authored the term Superior Labrum Anterior and Posterior (SLAP) tear to depict the pathology of the labrum in overhead tossing competitors. Superior labrum anterior to posterior (SLAP) sores are labral tears that stretch out from the posterior superior labrum, including the long head of the biceps tendon which originates from the glenoid labrum, and halting before the anterior glenoid notch (1). Lesions of the superior glenoid labrum and biceps anchor are a notable reason for shoulder torment (2). Advances in shoulder arthroscopy have prompted improvements in identification and treatment of superior labral anterior-posterior (SLAP) tears (3). Abstract
Orthopaedic Journal of Sports Medicine, 2020
Background: Biceps tenodesis is a surgical treatment for both superior labral anterior-posterior (SLAP) tears and long head of the biceps tendon (LHBT) abnormalities. Biceps tenodesis can be performed either above or below the pectoralis major tendon with arthroscopic or open techniques. Purpose: To analyze the outcomes and complications comparing primary arthroscopic suprapectoral versus open subpectoral biceps tenodesis for either SLAP tears or LHBT disorders. Study Design: Systematic review; Level of evidence, 4. Methods: A search strategy based on the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) protocol was used to include 18 articles (471 patients) from a total of 974 articles identified. Overall exclusion criteria included the following: non–English language, non–full text, biceps tenodesis with concomitant rotator cuff repair, review articles, meta-analyses, and case reports. Data were extracted and analyzed according to procedure type and tenodesis locati...
Cureus, 2022
Background The purpose of this epidemiologic study was to report general trends in the number of superior labrum from anterior to posterior (SLAP) tear repairs and biceps tenodesis performed along with the patient and hospital characteristics within the period of 2016-2018. Methods National Ambulatory Surgery Sample (NASS) database was used as the source of data for this epidemiologic study of the United States population. Current Procedural Terminology (CPT) codes were utilized to identify patients that underwent SLAP repair or biceps tenodesis between 2016 and 2018.
Role of the superior labrum after biceps tenodesis in glenohumeral stability
Journal of Shoulder and Elbow Surgery, 2014
Background: Little is known about the role that a torn superior labrum (SLAP) plays in glenohumeral stability after biceps tenodesis. This biomechanical study evaluated the contribution of a type II SLAP lesion to glenohumeral translation in the presence of biceps tenodesis. The authors hypothesize that subsequent to biceps tenodesis, a torn superior labrum does not affect glenohumeral stability and therefore does not require anatomic repair in an overhead throwing athlete. Methods: Baseline anterior, posterior, and abduction and maximal external rotation glenohumeral translation data were collected from 20 cadaveric shoulders. Translation testing was repeated after the creation of anterior (n ¼ 10) and posterior (n ¼ 10) type II SLAP lesions. Translation re-evaluation after biceps tenodesis was performed for each specimen. Finally, anatomic SLAP lesion repair and testing were performed. Results: Anterior and posterior SLAP lesions led to significant increases in glenohumeral translation in all directions (P < .0125). Biceps tenodesis showed no significance in stability compared with SLAP alone (P > .0125). Arthroscopic repair of anterior SLAP lesions did not restore anterior translation compared with the baseline state (P ¼ .0011) but did restore posterior (P ¼ .823) and abduction and maximal external rotation (P ¼ .806) translations. Repair of posterior SLAP lesions demonstrated no statistical difference compared with the baseline state (P > .0125). Conclusions: With no detrimental effect on glenohumeral stability in the presence of a SLAP lesion, biceps tenodesis may be considered a valid primary or revision surgery for patients suffering from symptomatic type II SLAP tears. However, biceps tenodesis should be considered with caution as the primary treatment of SLAP lesions in overhead throwing athletes secondary to its inability to completely restore translational stability.
Journal of Shoulder and Elbow Surgery, 2012
Hypothesis: Biomechanical studies have shown increased glenohumeral translation and loading of the long head biceps (LHB) tendon after superior labrum anterior to posterior (SLAP) tears. This may explain some of the typical clinical findings, including the prevalence of humeral chondral lesions, after SLAP lesions. The first hypothesis was that SLAP repair could restore the original glenohumeral translation and reduce the increased LHB load after SLAP lesions. The second hypothesis was that SLAP repair after LHB tenotomy could significantly reduce the increased glenohumeral translation. Materials and methods: Biomechanical testing was performed on 21 fresh frozen human cadaveric shoulders with an intact shoulder girdle using a sensor-guided industrial robot to apply 20 N of compression in the joint and 50 N translational force at 0 , 30 , and 60 of abduction. LHB loading was measured by a load-cell with 5 N and 25 N preload. Type IIC SLAP lesions were created arthroscopically, and a standardized SLAP repair was done combined with or without LHB tenotomy. Results: No significant difference of glenohumeral translation and increased LHB load in SLAP repair compared with the intact shoulder was observed under 5 N and 25 LHB preload, except for anterior translation under 25 N LHB preload. After LHB tenotomy after SLAP lesions, no significant difference of translation was observed with or without SLAP repair. Conclusions: SLAP repair without associated LHB tenotomy helps normalize glenohumeral translation and LHB loading. The stabilizing effect of the SLAP complex is dependent on the LHB. After biceps tenotomy, SLAP repair does not affect glenohumeral translation. Institutional Review Board approval was not necessary for this laboratory study.