Surgical Treatment of SLAP Lesions

In this review article, orthopedic surgeons from the American Sports Medicine Institute in Alabama offer five points to help guide the surgical treatment of SLAP lesions.

SLAP stands for superior labrum anterior posterior tear. The labrum is a thin rim of cartilage around the shoulder socket. A SLAP lesion describes a tear along the superior or top part of the labrum. It starts in the back of the shoulder and comes all the way up and over to the front. The point at which the biceps tendon attaches to the labrum is also torn.

SLAP injuries are most common in overhead athletes. The symptoms are similar to rotator cuff (RC) tendonitis or rotator cuff tear (RCT). Special imaging called magnetic resonance arthrography (MRA) may be used to diagnose the problem. In some cases, arthroscopy is needed to see the tear.

For day-to-day surgical treatment of SLAP lesions, the authors make these suggestions:

Don’t repair normal labral tissue. Look for frayed or rough edges. Natural
labral anatomy can look like a detachment when it isn’t.

Don’t fix it if it isn’t broke. Older adults often have labral damage from degenerative tears of the RCT. Surgeons are advised to repair the RCT and only lightly debride the labrum if it is frayed.

Position is important. The authors describe proper patient position and
placement of the anchor used to make the repair. This step can be very important to the recovery of the throwing athlete.

Make your knots carefully. To avoid sutures getting tangled, surgeons should insert one suture at a time through the arthroscope. Usually two or three suture anchors are used to repair a Type II SLAP lesion. The authors review the type of knot to use and where to place the anchors.

And finally, referral and communication with the physical therapist is essential. The wrong kind of rehab can tear the repair. And maintaining shoulder rotation is very important for the high-level throwing athlete. Basic principles for shoulder rehab of a SLAP lesion are provided.