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Results of Treatment for Isolated SLAP II Injury

When patients aren't happy with results of surgery, it's a good idea to take a look back over cases and see what's going on. In this study 41 athletes with a SLAP II lesion of the shoulder are treated with surgery. The goal was to repair the torn cartilage. Patients were followed for at least two years. The authors try to understand why patient satisfaction wasn't higher.

A type II SLAP injury means that the biceps tendon has pulled away from the bone and has taken a small piece of the cartilage with it. The cartilage called the labrum forms a rim around the shoulder. The labrum helps create a deeper socket for the shoulder. SLAP stands for superior-inferior labral anterior posterior lesion.

This study is unique because only patients with isolated type II SLAP injuries were included. Many times there are other structures also damaged. The presence of other injuries makes it hard to tell what operation works best for the SLAP injury.

The repair was done arthroscopically. A bioabsorbable device was used to anchor down the torn soft tissues. Bioabsorbable means it will dissolve over time without any other special treatment.

One-third of the patients were unhappy with the results. More than half couldn't go back to their preinjury level of sports. A few couldn't play at all anymore. Night pain was a problem for many patients.

The authors were confused because most patients tested well after the operation. Pain was less and activity level was better than before surgery. They posed two reasons for patient's poor results.

The first was high patient expectations and demands. The athletes wanted to return to their preinjury level of sports and couldn't always do so. The second was operative technique. Patients who had a repair right through the rotator cuff had worse results. They had pain day and night.

Labral tears in athletes are difficult to treat with good to excellent results. The results of this study help show that the surgeon should avoid inserting the arthroscope through the rotator cuff itself. More studies are needed to find an acceptable way to repair SLAP II injuries.

References: David B. Cohen, MD, et al. Outcomes of Isolated Type II SLAP Lesions Treated With Arthroscopic Fixation Using a Bioabsorbable Tack. In The Journal of Arthroscopy and Related Research. February 2006. Vol. 22. No. 2. Pp. 136-142.

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