Regarding: Humeral head abrasion: an association with failed superior labrum anterior posterior repairs

Abstract

We are writing this letter in reference to the recently published study by Byram et al,1Byram I.R. Dunn W.R. Kuhn J.E. Humeral head abrasion: an association with failed superior labrum anterior posterior repairs.J Shoulder Elbow Surg. 2011; 20: 92-97https://doi.org/10.1016/j.jse.2010.05.013Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar who evaluated a significant association of a humeral head abrasion underneath the long head of the biceps tendon (LHB) and failed superior labrum anterior posterior (SLAP) repairs. Interestingly, the authors found significantly associated humeral chondral lesions in failed SLAP repairs but not in untreated SLAP lesions, as we did. In our own series, we evaluated 182 SLAP lesions in 3395 consecutive shoulder arthroscopies.6Patzer T. Lichtenberg S. Kircher J. Magosch P. Habermeyer P. Influence of SLAP lesions on chondral lesions of the glenohumeral joint.Knee Surg Sports Traumatol Arthrosc. 2010; 18 (doi 10.1007/s00167-009-0938-2): 982-987Crossref PubMed Scopus (33) Google Scholar We thereby observed a significant association of humeral chondral lesions typically located underneath the LHB with nonoperatively treated SLAP lesions in about 20% compared with less than 5% without a SLAP lesion present. The association of SLAP lesions with glenohumeral chondral lesions was confirmed by a clinical and magnetic resonance imaging arthrography-controlled study by Lehmann et al,3Lehmann L.J. Dinter D. Monateseri S. Scharf H.P. Weckbach S. Osteoarthritis after SLAP lesion? Clinical and arthro-MRI evaluation after arthroscopic SLAP refixation.Sportverletz Sportschaden. 2009; 23 (doi 10.1055/s-0028-1109541): 155-160Crossref PubMed Scopus (8) Google Scholar who evaluated glenohumeral chondral lesions after failed as well as after not-failed SLAP repairs. In addition to that, we have typically observed anteriorly located chondral lesions of the glenoid in untreated SLAP lesions as well. It would be of interest to the readership of the Journal of Shoulder and Elbow Surgery whether the referenced study could confirm our observations of a localized chondral lesion at the anterior glenoid rim. In a subsequent biomechanical study4Patzer T. Habermeyer P. Hurschler C. Bobrowitsch E. Paletta J.R. Fuchs-Winkelmann S. et al.Increased glenohumeral translation and biceps load after SLAP lesions with potential influence on glenohumeral chondral lesions: a biomechanical study on human cadavers.Knee Surg Sports Traumatol Arthrosc. 2011; ([Epub ahead of print]. doi 10.1007/s00167-011-1423-2)Google Scholar on human cadavers, we looked for an explanation for our findings. We evaluated the well-known increasing anterior, anterosuperior and anteroinferior shoulder instability after SLAP lesions as well as a consecutively increasing LHB load after SLAP lesions. Thus, we have postulated that the combination of an increased anterior shoulder instability and the increased LHB load might be responsible for the humeral head abrasion in the form of the LHB acting as a windshield wiper on the humeral head. The typical chondral lesion at the glenoid rim might be explained by the increased anterior instability after SLAP lesions. However, based on our clinical study,5Patzer T. Kircher J. Lichtenberg S. Sauter M. Magosch P. Habermeyer P. Is there an association between SLAP lesions and biceps pulley lesions?.Arthroscopy. 2011; 27: 611-618https://doi.org/10.1016/j.arthro.2011.01.005Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar we could not confirm the study of Castagna et al,2Castagna A. Mouhsine E. Conti M. Vinci E. Borroni M. Giardella A. et al.Chondral print on humeral head: an indirect sign of long head biceps tendon instability.Knee Surg Sports Traumatol Arthrosc. 2007; 15 (doi 10.1007/s00167-006-0211-x): 645-648Crossref PubMed Scopus (39) Google Scholar who evaluated a humeral chondral print in association with biceps pulley lesions. We only found an association of a humeral head abrasion with SLAP lesions but not with biceps pulley lesions. Thus, due to our clinical and biomechanical findings, an isolated LHB instability might not be the reason for the chondral lesion alone. It would be of interest if the referenced study could deliver some further information about the presence of biceps pulley lesions and a possible association with humeral chondral lesions. The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article. Humeral head abrasion: An association with failed superior labrum anterior posterior repairsJournal of Shoulder and Elbow SurgeryVol. 20Issue 1PreviewAn abrasion on the humeral head under the articulating portion of the biceps tendon has been observed in patients with pain and stiffness after superior labrum anterior posterior (SLAP) repair. This study examined this humeral head abrasion (HHA) and its association with various diagnoses involving pathology of the biceps-labral complex. We hypothesized that it would be more common in failed SLAP repairs than other diagnoses. Full-Text PDF