J Korean Orthop Assoc.  2017 Oct;52(5):371-377. 10.4055/jkoa.2017.52.5.371.

Is There a Clinically Important Superior Labrum Anterior to Posterior (SLAP) Lesion?

• Kim JW
• Bae KH
• Joo MS

• KMID: 2393508
• DOI: http://doi.org/10.4055/jkoa.2017.52.5.371

Abstract

Superior labrum anterior to posterior (SLAP) lesion is a tear of the superior labrum, which starts posteriorly and extends anteriorly to include the anchor of the biceps tendon to the superior labrum. Symptoms of SLAP tear may include pain or instability. Recently, with the development of arthroscopy, the diagnosis and treatment of SLAP lesion have been made a lot. However, the diagnosis of clinically relevant SLAP tears remains challenging because of the lack of specific examination findings and the frequency of concomitant shoulder lesion. And there is still controversy regarding the treatment. Accordingly, proper treatment is important through accurate evaluation of whether or not it is a clinically important SLAP lesion.

Keyword

superior labrum anterior to posterior lesion; long head of biceps tendon

MeSH Terms

Arthroscopy
Diagnosis
Shoulder
Tears
Tendons

Figure

• 

  Figure 1 Coronal T2-weighted magnetic resonance imaging scan of a left shoulder demonstrating the typical appearance of a type 2 superior labrum anterior to posterior tear, with high signal intensity under the superior labrum and extension of contrast dye between the superior glenoid and labrum.

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  Figure 2 (A) Arthroscopic photograph of a type 2 superior labrum anterior to posterior (SLAP) lesion. (B) Type II SLAP lesion was repaired with bio-suture anchor fixation.

Reference

1. Andrews JR, Carson WG Jr, McLeod WD. Glenoid labrum tears related to the long head of the biceps. Am J Sports Med. 1985; 13:337–341.

2. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthroscopy. 1990; 6:274–279.

3. Onyekwelu I, Khatib O, Zuckerman JD, Rokito AS, Kwon YW. The rising incidence of arthroscopic superior labrum anterior and posterior (SLAP) repairs. J Shoulder Elbow Surg. 2012; 21:728–731.

4. Kibler WB. What is a clinically important superior labrum anterior to posterior tear? Instr Course Lect. 2013; 62:483–489.

5. Howell SM, Galinat BJ. The glenoid-labral socket. A constrained articular surface. Clin Orthop Relat Res. 1989; (243):122–125.

6. Pagnani MJ, Deng XH, Warren RF, Torzilli PA, Altchek DW. Effect of lesions of the superior portion of the glenoid labrum on glenohumeral translation. J Bone Joint Surg Am. 1995; 77:1003–1010.

7. Jobe CM. Posterior superior glenoid impingement: expanded spectrum. Arthroscopy. 1995; 11:530–536.

8. Burkhart SS, Morgan CD. The peel-back mechanism: its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation. Arthroscopy. 1998; 14:637–640.

9. Morgan CD, Burkhart SS, Palmeri M, Gillespie M. Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears. Arthroscopy. 1998; 14:553–565.

10. Maffet MW, Gartsman GM, Moseley B. Superior labrumbiceps tendon complex lesions of the shoulder. Am J Sports Med. 1995; 23:93–98.

11. Modarresi S, Motamedi D, Jude CM. Superior labral anteroposterior lesions of the shoulder: part 2, mechanisms and classification. AJR Am J Roentgenol. 2011; 197:604–611.

12. Hegedus EJ, Goode AP, Cook CE, et al. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012; 46:964–978.

13. Oh JH, Kim JY, Kim WS, Gong HS, Lee JH. The evaluation of various physical examinations for the diagnosis of type II superior labrum anterior and posterior lesion. Am J Sports Med. 2008; 36:353–359.

14. Ben Kibler W, Sciascia AD, Hester P, Dome D, Jacobs C. Clinical utility of traditional and new tests in the diagnosis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder. Am J Sports Med. 2009; 37:1840–1847.

15. Cook C, Beaty S, Kissenberth MJ, Siffri P, Pill SG, Hawkins RJ. Diagnostic accuracy of five orthopedic clinical tests for diagnosis of superior labrum anterior posterior (SLAP) lesions. J Shoulder Elbow Surg. 2012; 21:13–22.

16. Chandnani VP, Yeager TD, DeBerardino T, et al. Glenoid labral tears: prospective evaluation with MRI imaging, MR arthrography, and CT arthrography. AJR Am J Roentgenol. 1993; 161:1229–1235.

17. Braun S, Kokmeyer D, Millett PJ. Shoulder injuries in the throwing athlete. J Bone Joint Surg Am. 2009; 91:966–978.

18. Snyder SJ, Banas MP, Karzel RP. An analysis of 140 injuries to the superior glenoid labrum. J Shoulder Elbow Surg. 1995; 4:243–248.

19. Neuman BJ, Boisvert CB, Reiter B, Lawson K, Ciccotti MG, Cohen SB. Results of arthroscopic repair of type II superior labral anterior posterior lesions in overhead athletes: assessment of return to preinjury playing level and satisfaction. Am J Sports Med. 2011; 39:1883–1888.

20. Nam EK, Snyder SJ. The diagnosis and treatment of superior labrum, anterior and posterior (SLAP) lesions. Am J Sports Med. 2003; 31:798–810.

21. Samani JE, Marston SB, Buss DD. Arthroscopic stabilization of type II SLAP lesions using an absorbable tack. Arthroscopy. 2001; 17:19–24.

22. Enad JG, Kurtz CA. Isolated and combined Type II SLAP repairs in a military population. Knee Surg Sports Traumatol Arthrosc. 2007; 15:1382–1389.

23. Higgins LD, Warner JJ. Superior labral lesions: anatomy, pathology, and treatment. Clin Orthop Relat Res. 2001; (390):73–82.

24. Patterson BM, Creighton RA, Spang JT, Roberson JR, Kamath GV. Surgical trends in the treatment of superior labrum anterior and posterior lesions of the shoulder: analysis of data from the American Board of Orthopaedic Surgery certification examination database. Am J Sports Med. 2014; 42:1904–1910.

25. Zhang AL, Kreulen C, Ngo SS, Hame SL, Wang JC, Gamradt SC. Demographic trends in arthroscopic SLAP repair in the United States. Am J Sports Med. 2012; 40:1144–1147.

26. Alpert JM, Wuerz TH, O'Donnell TF, Carroll KM, Brucker NN, Gill TJ. The effect of age on the outcomes of arthroscopic repair of type II superior labral anterior and posterior lesions. Am J Sports Med. 2010; 38:2299–2303.

27. Erickson J, Lavery K, Monica J, Gatt C, Dhawan A. Surgical treatment of symptomatic superior labrum anterior-posterior tears in patients older than 40 years: a systematic review. Am J Sports Med. 2015; 43:1274–1282.

28. Provencher MT, McCormick F, Dewing C, McIntire S, Solomon D. A prospective analysis of 179 type 2 superior labrum anterior and posterior repairs: outcomes and factors associated with success and failure. Am J Sports Med. 2013; 41:880–886.

29. Sayde WM, Cohen SB, Ciccotti MG, Dodson CC. Return to play after Type II superior labral anterior-posterior lesion repairs in athletes: a systematic review. Clin Orthop Relat Res. 2012; 470:1595–1600.

30. Gorantla K, Gill C, Wright RW. The outcome of type II SLAP repair: a systematic review. Arthroscopy. 2010; 26:537–545.

31. Neri BR, ElAttrache NS, Owsley KC, Mohr K, Yocum LA. Outcome of type II superior labral anterior posterior repairs in elite overhead athletes: effect of concomitant partial-thickness rotator cuff tears. Am J Sports Med. 2011; 39:114–120.

32. Virk MS, Arciero RA. Superior labrum anterior to posterior tears and glenohumeral instability. Instr Course Lect. 2013; 62:501–514.

33. Kessler MA, Stoffel K, Oswald A, Stutz G, Gaechter A. The SLAP lesion as a reason for glenolabral cysts: a report of five cases and review of the literature. Arch Orthop Trauma Surg. 2007; 127:287–292.

34. Franceschi F, Longo UG, Ruzzini L, Rizzello G, Maffulli N, Denaro V. No advantages in repairing a type II superior labrum anterior and posterior (SLAP) lesion when associated with rotator cuff repair in patients over age 50: a randomized controlled trial. Am J Sports Med. 2008; 36:247–253.

35. Kim SJ, Lee IS, Kim SH, Woo CM, Chun YM. Arthroscopic repair of concomitant type II SLAP lesions in large to massive rotator cuff tears: comparison with biceps tenotomy. Am J Sports Med. 2012; 40:2786–2793.