Advertisement

How to Manage Failed Slap Repair

  • Néstor Zurita
  • Angel Calvo Díaz
Chapter

Abstract

Injuries to the superior labrum from anterior to posterior (SLAP) represent a significant cause of shoulder pain especially in people involved in repetitive overhead activities.

SLAP lesions are normally associated with other injuries to the long head of biceps (LHB) tendon, rotator cuff, and/or to glenohumeral instability. Missed diagnosis and treatment of associated pathology is one of the most common causes of persistent symptoms after SLAP repair.

As prior reports in the literature indicate poor clinical outcomes with revision repair, biceps tenotomy or tenodesis should be considered when SLAP repair fails.

Keywords

SLAP lesion Repair Failure Tenotomy Tenodesis 

References

  1. 1.
    Knesek M, Skendzel JG, Dines JS, Altchek DW, Allen AA, Bedi A. Diagnosis and management of superior labral anterior posterior tears in throwing athletes. Am J Sports Med. 2013;41:444–60.CrossRefPubMedGoogle Scholar
  2. 2.
    Park JY, Chung SW, Jeon SH, Lee JG, Oh KS. Clinical and radiological outcomes of type 2 superior labral anterior posterior repairs in elite overhead athletes. Am J Sports Med. 2013;41:1372–9.CrossRefPubMedGoogle Scholar
  3. 3.
    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;41:880–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Grauer JD, Paulos LE, Smutz WP. Biceps tendon and superior labral injuries. Arthroscopy. 1992;8:488–97.CrossRefPubMedGoogle Scholar
  5. 5.
    Maffet MW, Gartsman GM, Moseley B. Superior labrum-biceps tendon complex lesions of the shoulder. Am J Sports Med. 1995;23:93–8.CrossRefGoogle Scholar
  6. 6.
    Gobezie R, Zurakowski D, Lavery K, Millett PJ, Cole BJ, Warner JJ. Analysis of interobserver and intraobserver variability in the diagnosis and treatment of SLAP tears using the Snyder classification. Am J Sports Med. 2008;36:1373–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Aydin N, Sirin E, Arya A. Superior labrum anterior to posterior lesions of the shoulder: diagnosis and arthroscopic management. World J Orthop. 2014;5(3):344–50.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Katz LM, Hsu S, Miller SL, et al. Poor outcomes after SLAP repair: descriptive analysis and prognosis. Arthroscopy. 2009;25(8):849–55.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Park JH, Lee YS, Wang JH, Noh HK, Kim JG. Outcome of the isolated SLAP lesions and analysis of the results according to the injury mechanisms. Knee Surg Sports Traumatol Arthrosc. 2008;16(5):511–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Frank R, Nho SJ, McGill KC, Grumet RC, Cole BJ, Verma NN, Romeo AA. Retrospective analysis of arthroscopic superior labrum anterior to posterior repair: prognostic factors associated with failure. Adv Orthop. 2013;2013:1–7.CrossRefGoogle Scholar
  11. 11.
    Mazzocca AD, Cote MP, Solovyova O, Rizvi SH, Mostofi A, Arciero RA. Traumatic shoulder instability involving anterior, inferior, and posterior labral injury: a prospective clinical evaluation of arthroscopic repair of 270° labral tears. Am J Sports Med. 2011;39:1687–96.CrossRefPubMedGoogle Scholar
  12. 12.
    Van Kleunen JP, Tucker SA, Field LD, Savoie FH. Return to high-level throwing after combination infraspinatus repair, SLAP repair, and release of glenohumeral internal rotation deficit. Am J Sports Med. 2012;40:2536–41.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    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 Elb Surg. 2012;21:13–22.CrossRefGoogle Scholar
  14. 14.
    Karlsson J. Physical examination tests are not valid for diagnosing SLAP tears: a review. Clin J Sport Med. 2010;20:134–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Bennet WF. Specificity on the speed’s test: arthroscopic technique for evaluating the biceps tendon at the level of bicipital groove. Arthroscopy. 1998;14:789–96.CrossRefGoogle Scholar
  16. 16.
    Rockwood AC, Matsen FA, Wirth MA, Lippitt SB, editors. The shoulder. Amsterdam: Elsevier; 2009. p. 145–76.Google Scholar
  17. 17.
    Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology part I: pathoanatomy and biomechanics. Arthroscopy. 2003;19:404–20.CrossRefGoogle Scholar
  18. 18.
    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;14:553–65.CrossRefGoogle Scholar
  19. 19.
    Jee WH, McCauley TR, Katz LD, Matheny JM, Ruwe PA, Daigneault JP. Superior labral anterior posterior (SLAP) lesions of the glenoid labrum: reliability and accuracy of MR arthrography for diagnosis. Radiology. 2001;218:127–32.CrossRefGoogle Scholar
  20. 20.
    Bedi A, Allen A. Superior labral lesions anterior to posterior-evaluation and arthroscopic management. Clin Sports Med. 2008;27:607–30.CrossRefPubMedGoogle Scholar
  21. 21.
    Kanatli U, Ozturk BY, Bolukbasi S. Anatomical variations of te anterosuperior labrum: prevalence and association with type II superior labrum antero-superior (SLAP). J Shoulder Elb Surg. 2010;19(8):1199–203.CrossRefGoogle Scholar
  22. 22.
    Waterman BR, Arroyo W, Heida K, Burks R, Pallis M. SLAP repairs with combined procedures have lower failure rate than isolated repairs in a military population. Surgical outcomes with minimum 2-year follow-up. Orthop J Sports Med. 2015;3(8):2325967115599154.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Ozbaydar M, Elhassan B, Warner JJ. The use of anchors in shoulder surgery: a shift from metallic to bioabsorbable anchors. Arthroscopy. 2007;23:1124–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Milano G, Grasso A, Santagada DA, Saccomanno MF, Deriu L, Fabbriciani C. Comparison between metal and biodegradable suture anchors in the arthroscopic treatment of traumatic anterior shoulder instability: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc. 2010;18:1785–91.CrossRefPubMedGoogle Scholar
  25. 25.
    Freehill MQ, Harms DJ, Huber SM, Atlihan D, Buss DD. Poly-L-lactic acid tack synovitis after arthroscopic stabilization of the shoulder. Am J Sports Med. 2003;31:643–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Wilkerson JP, Zvijac JE, Uribe JW, Schürhoff MR, Green JB. Failure of polymerized lactic acid tacks in shoulder surgery. J Shoulder Elb Surg. 2003;12:117–21.CrossRefGoogle Scholar
  27. 27.
    Dhawan A, Ghodadra N, Karas V, Salata MJ, Cole BJ. Complications of bioabsorbable suture anchors in the shoulder. Am J Sports Med. 2012;40:1424–30.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Stein T, Mehling AP, Ulmer M, Reck C, Efe T, Hoffmann R, Jäger A, Welsch F. MRI graduation of osseous reaction and drill hole consolidation after arthroscopic Bankart repair with PLLA anchors and the clinical relevance. Knee Surg Sports Traumatol Arthrosc. 2012;20:2163–73.CrossRefPubMedGoogle Scholar
  29. 29.
    McCarty LP, Buss DD, Datta MW, Freehill MQ, Giveans MR. Complications observed following labral or rotator cuff repair with use of poly-L-lactic acid implants. J Bone Joint Surg Am. 2013;95:507–11.CrossRefPubMedGoogle Scholar
  30. 30.
    Kocaoglu B, Guven O, Nalbantoglu U, Aydin N, Haklar U. No difference between knotless sutures and suture anchors in arthroscopic repair of Bankart lesions in collision athletes. Knee Surg Sports Traumatol Arthrosc. 2009;17:844–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Uggen C, Wei A, Glousman RE, ElAttrache N, Tibone JE, McGarry MH, Lee TQ. Biomechanical comparison of knotless anchor repair versus simple suture repair for type II SLAP lesions. Arthroscopy. 2009;25:1085–92.CrossRefPubMedGoogle Scholar
  32. 32.
    Brockmeier SF, Voos JE, Williams RJ, Altchek DW, Cordasco FA, Allen AA. Outcomes after arthroscopic repair of type-II SLAP lesions. J. Bone Joint Surg. A. 2009;91(7):1595–603.CrossRefGoogle Scholar
  33. 33.
    Boileau P, Parratte S, Chuinard C, Roussanne Y, Shia D, Bicknell R. Arthroscopic treatment of isolated type II SLAP lesions: biceps tenodesis as an alternative to reinsertion. Am J Sports Med. 2009;37:929–36.CrossRefGoogle Scholar
  34. 34.
    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;38:2299–303.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Park S, Glousman RE. Outcomes of revision arthroscopic type II superior labral anterior posterior repairs. Am J Sports Med. 2011;39:1290–4.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Katz LM, Hsu S, Miller SL, et al. Poor outcomes after SLAP repair: descriptive analysis and prognosis. Arthroscopy. 2009;25:849–55.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© ESSKA 2018

Authors and Affiliations

  • Néstor Zurita
    • 1
  • Angel Calvo Díaz
    • 2
  1. 1.IMED Elche HospitalElcheSpain
  2. 2.Arthrosport ZaragozaZaragozaSpain

Personalised recommendations