Avoiding and Managing Complications for Shoulder Superior Labrum (SLAP) Repair

Abstract

Clinically significant injuries to the superior labrum are uncommon. Most arthroscopic shoulder series report an incidence around 6%.1–3 In 1985, Andrews et al. described tears of the anterosuperior labrum in 73 overhead athletes.4 They recommended debridement alone as an effective treatment but made no mention or need for fixation of the biceps anchor. Snyder et al. in 1990 first described superior labral and biceps anchor pathology as a Superior Labrum Anterior and Posterior (SLAP) lesions. They characterized and classified these lesions as injuries occurring posteriorly, extending anteriorly to and including the biceps anchor.1 Subsequent laboratory studies have defined the biomechanical importance of the biceps anchor,5–10 while clinical data report significant pain and prolonged disability in patients with untreated SLAP tears.1,2,4 However, diagnosis of SLAP lesions is still challenging even when based on history, physical examination, and modern imaging modalities. Knowledge of the numerous normal anatomic variations diminishes the likelihood of over diagnosis of SLAP tears and unnecessary surgical treatment of normal anatomy. Proper surgical repair technique requires understanding and arthroscopic skill and is fraught with potential complications.