Arthroscopy: The Journal of Arthroscopic & Related Surgery
SLAP lesions of the shoulder
Abstract
A specific pattern of injury to the superior labrum of the shoulder was identified arthroscopically in twenty-seven patients included in a retrospective review of more than 700 shoulder arthroscopies performed at our institution. The injury of the superior labrum begins posteriorly and extends anteriorly, stopping before or at the mid-glenoid notch and including the “anchor” of the biceps tendon to the labrum. We have labeled this injury a “SLAP lesion” (SuperiorLabrumAnterior andPosterior). There were 23 males and four females with an average age of 37.5 years. Time from injury to surgery averaged 29.3 months. The most common mechanism of injury was a compression force to the shoulder, usually as the result of a fall onto an out-stretched arm, with the shoulder positioned in abduction and slight forward flexion at the time of the impact. The most common clinical complaints were pain, greater with overhead activity, and a painful “catching” or “popping” in the shoulder. No imaging test accurately defined the superior labral pathology preoperatively. We divided the superior labrum pathology into four distinct types. Treatment was performed arthroscopically based on the type of SLAP lesion noted at the time of surgery. The SLAP lesion, which has not been previously described, can be diagnosed only arthroscopically and may be treated successfully by arthroscopic techniques alone in many patients.
References (3)
- DetrisacD.A. et al.
Arthroscopic shoulder anatomy: pathologic and surgical implications
(1986)
Cited by (1178)
Surgical management of SLAP lesions: Which technique has better surgical outcomes?
2024, Journal of OrthopaedicsThe gold-standard surgical management for superior labral anterior to posterior (SLAP) lesions is unclear. This meta-analysis compares the outcomes of different surgical SLAP lesion management techniques including labral repair, long head of biceps (LHB) tenodesis and LHB tenotomy with consideration to clinical scores, return to sports, re-operation, range-of-motion and patient satisfaction.
PRISMA guidelines were adhered. Web of Science, PubMed, Cochrane Central, Science direct and EMBASE were searched using relevant keywords. Eligible studies were screened, data extracted and synthesised using Review Manager (Version 5.4.1). Bayesian network meta-analysis (NMA) was conducted. Randomised control and clinical trials regarding SLAP lesion management in patients over 18 years old were included. Studies were excluded if patients had concomitant massive tears of the rotator cuff, Bankart lesions or instability of the shoulder.
Patient satisfaction with LHB tenodesis was superior to superior labral repair. No difference was demonstrated with respect to ASES score, pain VAS score, return to sports and pre-injury activities, reoperation rate or range-of-motion. LHB tenodesis and LHB tenotomy show no difference in ASES score or post operative deformity in management of SLAP lesions.
High-quality, standardised randomised control studies between the different surgical techniques is warranted.
Similar outcomes between biceps tenodesis and SLAP repair for SLAP tears in younger patients – A meta-analysis
2024, Journal of ISAKOSThe purpose of this study is to systematically review the comparative studies in the literature to ascertain if biceps tenodesis or superior-labrum anterior to posterior (SLAP) repair results in superior clinical outcomes in the treatment of type II SLAP tears in patients under 40.
A systematic search of articles in Pubmed, EMBASE and The Cochrane Library databases was carried out according to the PRISMA guidelines. Cohort studies comparing biceps tenodesis to repair in type II SLAP tears in patients under 40 were included. Clinical outcomes were extracted including return to play, reoperations, ASES, and VAS for pain. All statistical analysis was performed using Review Manager. A p-value of <0.05 was considered to be statistically significant.
Five studies were included. Biceps tenodesis resulted in comparable rates of return to play compared to SLAP repair (78.5% vs 67.7%, p = 0.33), and there was no significant difference in return to play in overhead athletes (83.6% vs 74%, p = 0.82). There was no significant difference in ASES score (87.2 vs 86.2, p = 0.27) or VAS score for pain (1.8 vs 2.1, p = 0.48). There was no significant difference in re-operation rates (2.9% vs 10.8%, p = 0.22).
This study found that biceps tenodesis has no significant difference in rates of return to play in athletes, as well as in functional outcome scores and rates of revision surgery in younger patients compared to SLAP repair.
Level III, Systematic review of Level III studies.
Deep-learning-based image quality enhancement of CT-like MR imaging in patients with suspected traumatic shoulder injury
2024, European Journal of RadiologyTo evaluate the diagnostic performance of CT-like MR images reconstructed with an algorithm combining compressed sense (CS) with deep learning (DL) in patients with suspected osseous shoulder injury compared to conventional CS-reconstructed images.
Thirty-two patients (12 women, mean age 46 ± 14.9 years) with suspected traumatic shoulder injury were prospectively enrolled into the study. All patients received MR imaging of the shoulder, including a CT-like 3D T1-weighted gradient-echo (T1 GRE) sequence and in case of suspected fracture a conventional CT. An automated DL-based algorithm, combining CS and DL (CS DL) was used to reconstruct images of the same k-space data as used for CS reconstructions. Two musculoskeletal radiologists assessed the images for osseous pathologies, image quality and visibility of anatomical landmarks using a 5-point Likert scale. Moreover, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated.
Compared to CT, all acute fractures (n = 23) and osseous pathologies were detected accurately on the CS only and CS DL images with almost perfect agreement between the CS DL and CS only images (κ 0.95 (95 %confidence interval 0.82–1.00). Image quality as well as the visibility of the fracture lines, bone fragments and glenoid borders were overall rated significantly higher for the CS DL reconstructions than the CS only images (CS DL range 3.7–4.9 and CS only range 3.2–3.8, P = 0.01–0.04). Significantly higher SNR and CNR values were observed for the CS DL reconstructions (P = 0.02–0.03).
Evaluation of traumatic shoulder pathologies is feasible using a DL-based algorithm for reconstruction of high-resolution CT-like MR imaging.
Radiographic evaluation of the bicipital groove morphology does not predict intraarticular changes in the long head of biceps tendon
2023, RadiologiaEl objetivo de este estudio es examinar la utilidad clínica de la evaluación radiográfica del surco intertubercular para pronosticar la patología del tendón de la porción larga del bíceps (TPLB).
Se llevó a cabo un estudio prospectivo y se seleccionaron 60 pacientes consecutivos propuestos para artroscopia de hombro. Antes de la cirugía, se realizó una evaluación radiográfica con una radiografía en decúbito supino y una radiografía con la técnica de Fisk. La mayoría de las radiografías realizadas en decúbito supino (>75%) no pudieron interpretarse y fueron excluidas del estudio. Como algunas radiografías con la técnica de Fisk (26,7%) tampoco pudieron interpretarse, quedaron 44 radiografías interpretables en el estudio. En ellas, se realizaron mediciones del ángulo de abertura medial, el ángulo de abertura total, la anchura y la profundidad del surco intertubercular. Se observó una correlación entre las mediciones radiográficas y la presencia de patología del TPLB, evaluadas en la artroscopia.
La evaluación radiográfica del surco intertubercular mostró un ángulo medio de abertura medial de 53 ± 15o (23-90o), un ángulo medio de abertura total de 80 ± 26o (30-135o), una anchura media de 10,3 ± 2,5 mm (6-19) y una profundidad media de 4,1 ± 1,5 mm (1-8). Los hombres tenían un ángulo de abertura medial mayor (60° frente a 50o, p = 0,044) y surcos más anchos (11,9 frente a 9,7 mm, p = 0,019). Había 25 (56,8%) pacientes con un TPLB anómalo. No se observó correlación entre las mediciones radiográficas y la patología del TPLB. Solo se observó correlación de la edad con una lesión del TPLB (61,8 frente a 46,3 años, p< 0,001).
Nuestros resultados indican que no hay correlación entre la evaluación morfológica radiográfica del surco intertubercular y la patología del TPLB.
This study aimed to examine the clinical utility of the radiographic evaluation of the bicipital groove in predicting long head of biceps tendon (LHBT) pathology.
A prospective study was conducted, and sixty consecutive patients proposed to shoulder arthroscopic surgery were selected. Before surgery, a radiographic evaluation was performed with a supine and a Fisk radiograph. Most supine radiographs (>75%) were non-interpretable and were excluded from the study. As some Fisk radiographs (26.7%) were also non-interpretable, that left 44 interpretable radiographs in the study. These were measured for medial opening angle, total opening angle, width and depth of the bicipital groove. The radiographic measurements and the presence of LHBT pathology, as assessed at arthroscopy, were correlated.
Radiographic evaluation of the bicipital groove showed a mean medial opening angle of 53 ± 15o (23 – 90), a mean total opening angle of 80 ± 26o (30 – 135), a mean width of 10.3 ± 2.5 mm (6 – 19) and a mean depth of 4.1 ± 1.5 mm (1 – 8). Men had higher medial opening angle (60 vs 50o, p = 0.044) and wider grooves (11.9 vs 9.7 mm, p = 0.019). Twenty-five patients (56.8%) were found to have an abnormal LHBT. No correlation was found between the radiographic measurements and LHBT pathology. Only age was correlated with a LHBT lesion (61.8 vs 46.3 years, p < 0.001).
Our results show that there is no correlation between radiographic morphologic evaluation of the bicipital groove and LHBT pathology.
Dynamic Anterior Stabilization of the Shoulder: Onlay Biceps Transfer to the Anterior Glenoid Using the Double Double-Pulley Technique
2023, Arthroscopy TechniquesThe treatment of anterior glenohumeral instability includes several surgical options, ranging from soft tissue to bony procedures—open or arthroscopic. In arthroscopic dynamic anterior stabilization (DAS) of the shoulder, the long head of the biceps is transferred to the anterior glenoid through a subscapularis tendon split. The biceps may be fixed either in an inlay or in an onlay position. Inlay DAS theoretically increases anterior glenohumeral stability through 3 different effects: the hammock effect, sling effect, and the tensioning effect. Onlay DAS may additionally increase stability through a labroplasty effect, produced by the onlay positioning of the biceps on the anterior glenoid rim. The current technical note presents tips and tricks, and pearls and pitfalls, to reproducibly perform onlay DAS using all-suture anchors and the double double-pulley technique.
American Shoulder and Elbow Surgeons SLAP/Biceps Anchor Study Group evidence review: pathoanatomy and diagnosis in clinically significant labral injuries
2023, Journal of Shoulder and Elbow SurgeryGlenoid superior biceps-labral pathology diagnosis, treatment, and outcomes are an evolving area of shoulder surgery. Historically, described as superior labrum anterior posterior (SLAP) tears, these lesions were identified as a source of pain in throwing athletes. Diagnosis and treatments applied to these SLAP lesions resulted in less than optimal outcomes in some patients and a prevailing sense of confusion. The purpose of this paper is to perform a reappraisal of the anatomy, examination, imaging, and diagnosis by the American Shoulder and Elbow Surgeons/SLAP biceps study group. We sought to capture emerging concepts and suggest a more unified approach to evaluation and identify specific needs for future research.
The technique described in this article will be demonstrated in a forthcoming Video Supplement to Arthroscopy.