Arthroscopic Repair of SLAP Lesions

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • Type I: debridement
  • Type II: debridement and attachment of biceps anchor
  • Type III: debridement of flaps with possible repair
  • Type IV: excision if tendon propagation less than one third; otherwise repair
  • A Bankart repair will be necessary for lesions that extend inferiorly.
  • A posterior capsule release may be required if GIRD is present.
CONTRAINDICATIONS
  • Patients with medical comorbidities that prevent surgery
  • Incidentally discovered lesions without symptoms
EQUIPMENT
  • Shoulder arthroscopy equipment
  • Suture anchors (e.g., Arthrex Bio-FASTak, Arthrex BioSutureTak) and associated equipment (e.g., Arthrex Spear Guide, Arthrex BirdBeak suture passers, Arthrex Surgeon's Sixth Finger)
ANATOMY
  • The labrum encircles the glenoid, increasing its depth around the humeral head, and thus provides increased stability.
    • Adding the glenoid labrum increases the glenoid surface to 75% of the humeral head vertically and 57% horizontally.
  • The labrum consists of dense fibrocartilaginous tissues and some elastic fibers.
    • It acts as a fibrocartilaginous anchor.
      • On the inner side, the labrum is continuous with the hyaline cartilage of the glenoid.
      • On the outer side, the labrum is continuous with the fibrous tissue of the capsule.
      • The capsule and ligaments of the shoulder, including the biceps tendon, are attached to and become part of the glenoid labrum, which in turn attaches to the glenoid.
  • The labrum is triangular in cross section and varies in size and thickness.
  • The glenoid labrum is supplied by branches of the suprascapular artery, the circumflex scapular artery, and the posterior humeral circumflex artery.
    • The vascular supply is typically limited to the outermost aspect, with the inner rim being relatively avascular.
      • This is akin to the menisci in the knee.

PROCEDURE
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  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE

The protocol was developed for patients after SLAP repair. Surgery and rehabilitation will differ depending on the type of lesion. Types I and III lesions usually are treated with debridement. The biceps tendon is stable, so postoperative rehabilitation can usually progress as tolerated. Types II and IV lesions indicate an unstable biceps tendon requiring repair. This protocol addresses range of motion (ROM) limitations and limited active biceps work necessary for the type II/IV repairs. This is a guideline and may be adjusted to the clinical presentation as well as the doctor's guidance.

COMPLICATIONS
  • As with any arthroscopic procedure in the shoulder, there is a risk of infection and brachial plexus neuropathy.
  • Persistent pain and nonhealing of the lesion
RESULT ANALYSIS
  • Occult instability may be associated with most labral tears, and debridement may be indicated for short-term relief in competitive athletes or in patients who are willing to decrease their overhead activities.
  • Initial debridement shows good to excellent results in 70% to 90% of patients at 1-year follow-up.
  • Long-term follow-up studies of labral debridement, however, have shown that results deteriorate over time.
  • Repair of type II lesions has a 95% success rate in young patients.
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