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Failed SLAP Repair Management

Typically, arthroscopic repair of SLAP (superior labrum anterior-posterior) shoulder lesions tend to produce good outcomes. However, there is a small amount of patients that continue to have pain, symptoms or suffer further injury after this repair and may seek additional treatment. A recent review wanted to investigate what the research demonstrates in management of patients whom have suffered a failed SLAP repair.

SLAP tears are a detachment of the superior glenoid labrum from anterior to posterior with or without involvement of the biceps head. Substantial variability exists in methods for diagnosis of these tears including use of orthopedic special tests, MRI (magnetic resonance imaging) and MRA (magnetic resonance arthrogram). Initial treatment usually consists of conservative management including physical therapy, anti-inflammatory agents and activity modification. When non-operative management fails, surgery may be indicated based on a variety of factors. As mentioned earlier these surgical outcomes generally fare well. However, if patients continue to have pain or symptoms following repair it’s important that a thorough workup be performed as the cause can be multifactorial. Differential injections into the subacromial and/or glenohumeral region can be utilized for diagnostic or therapeutic workup and physical therapy can be used for ROM (range of motion) and strengthening. According to the authors of this review, if pain and postoperative stiffness do not resolve with nonsurgical measures, this is defined as a failed SLAP repair. They concluded that recurrent injury secondary to return to the precipitating activity, misdiagnosis, and poor healing are the main causes of failed SLAP repair.

Management of failed SLAP repair can be nonsurgical or surgical. The authors of this review emphasize nonsurgical treatment particularly for overhead throwing athlete as satisfactory outcomes associated with revision have not been conclusively proven in the literature. Rotator cuff strengthening, proper throwing mechanics and physical therapy for ROM are emphasized. Surgical outcomes for failed SLAP repair include revision SLAP repair, and biceps tenotomy(long head of the biceps tendon is released from its attachment) or tenodesis (reattachment of the biceps tendon to the humerus) with or without revision SLAP repair. Revision SLAP repair were deemed most appropriate for young (aged <35 years), active patients without obvious pathology of the long head of the biceps tendon. It was shown that revision SLAP repair were inferior to those of primary repair. Biceps tenodesis is deemed most appropriate for middle aged patients, women and younger patients with known pathology of the biceps tendon. In patients over 65 tenotomy was preferred. It was suggested that select patients with failed type II SLAP repairs that biceps tenodesis may provide safe and effective treatment for failed SLAP repair. Otherwise, data reported demonstrates outcomes that surgical management of failed SLAP repairs are inferior to those of primary repair.

References: Brian C Werner, MD et al. Etiology, Diagnosis and Management of Failed SLAP Repair. JAAOS. Sept 2014. Vol 22. No 9. Pp 554-565.

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