Surgical Management of Type IV SLAP Lesions (SS-13)

Abstract

Repair of type II SLAP lesions has been shown to be effective in numerous studies. Repair of type IV SLAP lesions has been more controversial. Repair would allow theoretical preservation of the biceps anchor, and more normal shoulder function. This represents the first report outlining the outcome of repair of type IV SLAP lesions. Twenty-five patients had isolated type IV SLAP lesions which were repaired and followed for at least two years. Lesions which split directly vertically into the biceps in a red-on-red pattern were repaired side to side using multiple PDS sutures. Lesions which presented with a white-on–white bucket handle portion were treated with excision of the bucket and the repair of the remaining biceps anchor to bone. Patients were immobilized in a sling for three weeks, and then started on active assisted range of motion. No complications occurred. Two patients were reoperated for persistent pain and treated successfully with biceps tenodesis; both had labral excision and repair with loss of 30% or greater of the biceps substance. Primary repair provided good to excellent results in most patients, with improvement in UCLA scores from 18 to 31.7 and ASES scores from 66 to 91. Second-look data was available for two patients in this group, showing solid healing. Repair of type IV SLAP lesions can be anticipated to be successful provided no more than 30% of the biceps root is compromised by the injury; arthroscopic biceps tenodesis will provide a more predictable outcome for these patients.