Skip to main content
SpringerLink
Log in

SLAP Lesion: Part IV. Management of Concomitant Rotator Cuff Tear

  • Chapter
Sports Injuries to the Shoulder and Elbow

  • 3081 Accesses

Abstract

Rotator cuff tears (RCT) and SLAP tears may occur concomitantly, representing a challenging therapeutic problem. Careful use of history, physical exam, and radiologic modalities is imperative in delineating the pathology that is most contributing to the patient’s pain or dysfunction. As the biceps-labral complex contributes to shoulder stability, SLAP lesions promote instability which increases the stresses upon the rotator cuff. Thus, some surgeons advocate for SLAP repair with concomitant rotator cuff repair; however, others recommend against SLAP repair in the setting of rotator cuff tears given concerns for postoperative stiffness.

In patients with combined lesions, surgical management of the rotator cuff is similar to that employed in patients with isolated rotator cuff pathology, with debridement of partial-thickness tears <50 % width and repair of partial-thickness tears greater than 50 % width, bursal-sided tears greater than 3 mm in thickness, and full-thickness tears. Concurrent type I, III, and IV SLAP tears are managed in a similar manner to isolated lesions. In overhead and throwing athletes, more extensive conservative treatment is employed, and if rotator cuff repair is indicated, a single-row repair is preferred to prevent restriction of end range of motion. Management of type II SLAP lesions in the setting of RCT is more controversial given concerns regarding postoperative stiffness; furthermore, treatment decisions are ultimately made on an individual basis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Huberty DP, Schoolfield JD, Brady PC, Vadala AP, Arrigoni P, Burkhart SS. Incidence and treatment of postoperative stiffness following arthroscopic rotator cuff repair. Arthroscopy. 2009;25(8):880–90.

    Article  PubMed  Google Scholar 

  2. Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am. 2004;86-A(2):219–24.

    PubMed  Google Scholar 

  3. Bishop J, Klepps S, Lo IK, Bird J, Gladstone JN, Flatow EL. Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study. J Shoulder Elbow Surg. 2006;15(3):290–9.

    Article  PubMed  Google Scholar 

  4. Liem D, Bartl C, Lichtenberg S, Magosch P, Habermeyer P. Clinical outcome and tendon integrity of arthroscopic versus mini-open supraspinatus tendon repair: a magnetic resonance imaging-controlled matched-pair analysis. Arthroscopy. 2007;23(5):514–21.

    Article  PubMed  Google Scholar 

  5. Miller C, Savoie FH. Glenohumeral abnormalities associated with full-thickness tears of the rotator cuff. Orthop Rev. 1994;23(2):159–62.

    CAS  PubMed  Google Scholar 

  6. Snyder SJ, Banas MP, Karzel RP. An analysis of 140 injuries to the superior glenoid labrum. J Shoulder Elbow Surg. 1995;4(4):243–8.

    Article  CAS  PubMed  Google Scholar 

  7. Vangsness CT, Jorgenson SS, Watson T, Johnson DL. The origin of the long head of the biceps from the scapula and glenoid labrum. An anatomical study of 100 shoulders. J Bone Joint Surg Br. 1994;76(6):951–4.

    PubMed  Google Scholar 

  8. Tuoheti Y, Itoi E, Minagawa H, Yamamoto N, Saito H, Seki N, et al. Attachment types of the long head of the biceps tendon to the glenoid labrum and their relationships with the glenohumeral ligaments. Arthroscopy. 2005;21(10):1242–9.

    Article  PubMed  Google Scholar 

  9. Rao AG, Kim TK, Chronopoulos E, McFarland EG. Anatomical variants in the anterosuperior aspect of the glenoid labrum: a statistical analysis of seventy-three cases. J Bone Joint Surg Am. 2003;85-A(4):653–9.

    PubMed  Google Scholar 

  10. Williams MM, Snyder SJ, Buford D. The Buford complex—the “cord-like” middle glenohumeral ligament and absent anterosuperior labrum complex: a normal anatomic capsulolabral variant. Arthroscopy. 1994;10(3):241–7.

    Article  CAS  PubMed  Google Scholar 

  11. Ilahi OA, Labbe MR, Cosculluela P. Variants of the anterosuperior glenoid labrum and associated pathology. Arthroscopy. 2002;18(8):882–6.

    Article  PubMed  Google Scholar 

  12. Panossian VR, Mihata T, Tibone JE, Fitzpatrick MJ, McGarry MH, Lee TQ. Biomechanical analysis of isolated type II SLAP lesions and repair. J Shoulder Elbow Surg. 2005;14(5):529–34.

    Article  PubMed  Google Scholar 

  13. Rodosky MW, Harner CD, Fu FH. The role of the long head of the biceps muscle and superior glenoid labrum in anterior stability of the shoulder. Am J Sports Med. 1994;22(1):121–30.

    Article  CAS  PubMed  Google Scholar 

  14. 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(7):1003–10.

    CAS  PubMed  Google Scholar 

  15. Pagnani MJ, Deng X-H, Warren RF, Torzilli PA, O'Brien SJ. Role of the long head of the biceps brachii in glenohumeral stability: a biomechanical study in cadavera. J Shoulder Elbow Surg. 1996;5(4):255–62.

    Article  CAS  PubMed  Google Scholar 

  16. 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(6):553–65.

    Article  CAS  PubMed  Google Scholar 

  17. Clavert P, Bonnomet F, Kempf JF, Boutemy P, Braun M, Kahn JL. Contribution to the study of the pathogenesis of type II superior labrum anterior-posterior lesions: a cadaveric model of a fall on the outstretched hand. J Shoulder Elbow Surg. 2004;13(1):45–50.

    Article  PubMed  Google Scholar 

  18. Bey MJ, Elders GJ, Huston LJ, Kuhn JE, Blasier RB, Soslowsky LJ. The mechanism of creation of superior labrum, anterior, and posterior lesions in a dynamic biomechanical model of the shoulder: the role of inferior subluxation. J Shoulder Elbow Surg. 1998;7(4):397–401.

    Article  CAS  PubMed  Google Scholar 

  19. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology part I: pathoanatomy and biomechanics. Arthroscopy. 2003;19(4):404–20.

    Article  PubMed  Google Scholar 

  20. Forsythe B, Guss D, Anthony SG, Martin SD. Concomitant arthroscopic SLAP and rotator cuff repair. J Bone Joint Surg. 2010;92(6):1362–9.

    Article  PubMed  Google Scholar 

  21. Andrews JR, Carson WG, McLeod WD. Glenoid labrum tears related to the long head of the biceps. Am J Sports Med. 1985;13(5):337–41.

    Article  CAS  PubMed  Google Scholar 

  22. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthroscopy. 1990;6(4):274–9.

    Article  CAS  PubMed  Google Scholar 

  23. Maffet MW, Gartsman GM, Moseley B. Superior labrum-biceps tendon complex lesions of the shoulder. Am J Sports Med. 1995;23(1):93–8.

    Article  CAS  PubMed  Google Scholar 

  24. Altchek DW, Warren RF, Skyhar MJ, Ortiz G. T-plasty modification of the Bankart procedure for multidirectional instability of the anterior and inferior types. J Bone Joint Surg Am. 1991;73(1):105–12.

    CAS  PubMed  Google Scholar 

  25. Bradley JP, Forsythe B, Mascarenhas R. Arthroscopic management of posterior shoulder instability: diagnosis, indications, and technique. Clin Sports Med. 2008;27(4):649–70.

    Article  PubMed  Google Scholar 

  26. Hawkins RJ, Belle RM. Posterior instability of the shoulder. Instr Course Lect. 1989;38:211–5.

    CAS  PubMed  Google Scholar 

  27. Bahk M, Keyurapan E, Tasaki A, Sauers EL, McFarland EG. Laxity testing of the shoulder: a review. Am J Sports Med. 2007;35(1):131–44.

    Article  PubMed  Google Scholar 

  28. Gerber C, Ganz R. Clinical assessment of instability of the shoulder. With special reference to anterior and posterior drawer tests. J Bone Joint Surg Br. 1984;66(4):551–6.

    CAS  PubMed  Google Scholar 

  29. Millett PJ, Clavert P, Hatch 3rd GF, Warner JJ. Recurrent posterior shoulder instability. J Am Acad Orthop Surg. 2006;14(8):464–76.

    PubMed  Google Scholar 

  30. Kibler WB. The role of the scapula in athletic shoulder function. Am J Sports Med. 1998;26(2):325–37.

    CAS  PubMed  Google Scholar 

  31. Petersen SA. Posterior shoulder instability. Orthop Clin North Am. 2000;31(2):263–74.

    Article  CAS  PubMed  Google Scholar 

  32. Warner JJ, Micheli LJ, Arslanian LE, Kennedy J, Kennedy R. Patterns of flexibility, laxity, and strength in normal shoulders and shoulders with instability and impingement. Am J Sports Med. 1990;18(4):366–75.

    Article  CAS  PubMed  Google Scholar 

  33. Gagey OJ, Gagey N. THE hyperabduction test: an assessment of the laxity of the inferior glenohumeral ligament. J Bone Joint Surg. 2001;83-B(1):69–74.

    Article  Google Scholar 

  34. Murachovsky J, Bueno RS, Nascimento LGP, Almeida LHO, Strose E, Castiglia MT, et al. Calculating anterior glenoid bone loss using the Bernageau profile view. Skeletal Radiol. 2012;41(10):1231–7.

    Article  PubMed  Google Scholar 

  35. Phillips JC, Cook C, Beaty S, Kissenberth MJ, Siffri P, Hawkins RJ. Validity of noncontrast magnetic resonance imaging in diagnosing superior labrum anterior-posterior tears. J Shoulder Elbow Surg. 2013;22(1):3–8.

    Article  PubMed  Google Scholar 

  36. McCauley TR. MR imaging of the glenoid labrum. Magn Reson Imaging Clin N Am. 2004;12(1):97–109.

    Article  PubMed  Google Scholar 

  37. Gartsman GM, Taverna E. The incidence of glenohumeral joint abnormalities associated with full-thickness, reparable rotator cuff tears. Arthroscopy. 1997;13(4):450–5.

    Article  CAS  PubMed  Google Scholar 

  38. Abbot AE, Li X, Busconi BD. Arthroscopic treatment of concomitant superior labral anterior posterior (SLAP) lesions and rotator cuff tears in patients over the age of 45 years. Am J Sports Med. 2009;37(7):1358–62.

    Article  PubMed  Google Scholar 

  39. 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(2):247–53.

    Article  PubMed  Google Scholar 

  40. 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(12):2786–93.

    Article  PubMed  Google Scholar 

  41. Levy HJ, Schachter AK, Hurd JL, Lassen B, Panagopoulos G. The effect of rotator cuff tears on surgical outcomes after type II superior labrum anterior posterior tears in patients younger than 50 years. Am J Sports Med. 2010;38(2):318–22.

    Article  PubMed  Google Scholar 

  42. Uggen C, Wei A, Glousman RE, ElAttrache N, Tibone JE, McGarry MH, et al. Biomechanical comparison of knotless anchor repair versus simple suture repair for type II SLAP lesions. Arthroscopy. 2009;25(10):1085–92.

    Article  PubMed  Google Scholar 

  43. McCulloch PC, Andrews WJ, Alexander J, Brekke A, Duwani S, Noble P. The effect on external rotation of an anchor placed anterior to the biceps in type 2 SLAP repairs in a cadaveric throwing model. Arthroscopy. 2013;29(1):18–24.

    Article  PubMed  Google Scholar 

  44. McCormick F, Nwachukwu B, Solomon D, Dewing C, Golijanin P, Gross DJ, et al. The efficacy of biceps tenodesis in the treatment of failed superior labral anterior posterior repairs. Am J Sports Med. 2014;11.

    Google Scholar 

  45. Strauss EJ, Salata MJ, Sershon RA, Garbis N, Provencher MT, Wang VM, et al. Role of the superior labrum after biceps tenodesis in glenohumeral stability. J Shoulder Elbow Surg. 2014;23(4):485–91.

    Article  PubMed  Google Scholar 

  46. Fedoriw WW, Ramkumar P, McCulloch PC, Lintner DM. Return to play after treatment of superior labral tears in professional baseball players. Am J Sports Med. 2014;42:1155–60.

    Article  PubMed  Google Scholar 

  47. Economopoulos KJ, Brockmeier SF. Rotator cuff tears in overhead athletes. Clin Sports Med. 2012;31(4):675–92.

    Article  PubMed  Google Scholar 

  48. Reynolds SB, Dugas JR, Cain EL, McMichael CS, Andrews JR. Débridement of small partial-thickness rotator cuff tears in elite overhead throwers. Clin Orthop Relat Res. 2008;466(3):614–21.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Midwest Orthopedics at RUSH, 1611 W. Harrison, Ste. 1611, Chicago, IL, 60612, USA

    Andrew J. Riff MD, Rachel M. Frank MD & Brian Forysthe MD

Authors
  1. Andrew J. Riff MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rachel M. Frank MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brian Forysthe MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brian Forysthe MD .

Editor information

Editors and Affiliations

  1. NEON Orthopaedic Clinic, Global Center for Shoulder, Elbow & Sports, Seoul, Korea, Republic of (South Korea)

    Jin-Young PARK

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Riff, A.J., Frank, R.M., Forysthe, B. (2015). SLAP Lesion: Part IV. Management of Concomitant Rotator Cuff Tear. In: PARK, JY. (eds) Sports Injuries to the Shoulder and Elbow. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-41795-5_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-41795-5_13

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-41794-8

  • Online ISBN: 978-3-642-41795-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation