Labrum Anterior Posterior Lesions Research Articles

Reproducibility and Reliability of the Snyder Classification of Superior Labral Anterior Posterior Lesions Among Shoulder Surgeons

Background: Previous studies of the reliability of classifications for superior labral anterior and posterior (SLAP) lesions suggest that intraobserver/interobserver reliability is poor. Purpose: The goals were to (1) evaluate intraobserver/interobserver reliability of the Snyder classification of labrum tears among experienced surgeons, (2) determine the effect of simplifying that classification into normal versus abnormal labrums, (3) determine the reliability of subdividing type II SLAP lesions, and (4) evaluate the effect of videotape quality on diagnostic confidence. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: At 2 separate times, 5 experienced shoulder surgeons (all >10 years of practice) evaluated 90 videotapes of shoulder arthroscopy performed for SLAP lesions to identify lesion type, to grade video quality, and to determine degree of confidence in diagnosis. The results were compared for intraobserver reliability (κ analysis) and interobserver reliability (intraclass correlation coefficients) and effect of video quality on diagnostic confidence. Significance was set at P < .05. Results: When the choices were normal labrum or the 4 types of SLAP lesions, the intraobserver agreements (mean κ, 0.670) and interobserver agreements (mean correlation, 0.804) were substantial. When the labrums were divided into normal (normal and type I) and abnormal (types II-IV), the intraobserver agreements (mean κ, 0.792) and interobserver agreements (mean correlation, 0.648) were substantial. When the 3 type II SLAP lesion subvariants were evaluated, the intraobserver agreement (mean κ, 0.598) was moderate, and the interobserver agreement (mean correlation, 0.804) was substantial. The confidence of the diagnosis was highly correlated with the perceived video quality (average Pearson correlation, 0.718; P < .01). Repeated measures analysis showed a significant relationship between confidence and quality (parameter estimate, 0.732; standard error, 0.021; P < .01) adjusting for rater and review. Conclusion: For experienced shoulder surgeons, the Snyder classification is a reliable system for identifying SLAP lesions.

A Meta-analysis Examining Clinical Test Utility for Assessing Superior Labral Anterior Posterior Lesions

A Meta-analysis Examining Clinical Test Utility for Assessing Superior Labral Anterior Posterior Lesions

Superior labral anterior-posterior (SLAP) lesion repair using the needle-catch technique and a bioabsorbable knotless suture anchor

The primary objectives of surgical repair of a torn superior labrum are restoration of its anatomic position and fixation to its bony bed on the superior glenoid. This report describes a simple arthroscopic procedure that accomplishes these objectives. In shoulder arthroscopic surgery, the procedure utilizes the “needle-catch technique” and a bioabsorbable knotless anchor, to achievement of superior labral anterior-posterior lesion repair. Arthroscopic superior labrum repair, using a bioabsorbable knotless suture anchor, is a procedure that minimizes the need for complex suture management and arthroscopic knot tying. It is easily reproducible and appears to allow for a safe and stable repair. Given the simplicity and efficacy of the “needle-catch technique”, it is likely that this procedure will prove extendable to other types of arthroscopic surgery.

Arthroscopic Repair of Anterior-Inferior Glenohumeral Instability Using a Portal at the 5:30-o’Clock Position

Background: Traumatic anterior-inferior shoulder joint dislocations are common injuries among the young athletic population. The aim of this study was to assess which factors, including concomitant injury (rotator cuff tears, superior labral anterior posterior [SLAP] lesions), patient age, and fixation methods, led to redislocation after arthroscopic stabilization. Hypothesis: There are several risk factors for the outcome after arthroscopic anterior-inferior glenohumeral stabilization. Study Design: Cohort Study; Level of evidence, 3. Methods: Between 1996 and 2000, 221 patients were treated with arthroscopic stabilization for anterior-inferior shoulder dislocation. Of these 221 consecutive patients, 190 (140 male, 50 female) with an average age of 28.0 years (range, 14.4-59.2 years) were available for follow-up (average follow-up, 37.4 ± 15.8 months). Fixation methods were FASTak (n = 138), Suretac (n = 28), or Panalok (n = 24) anchors. Concomitant SLAP lesions were seen in 38 of 190 cases (20%). Results: Redislocation rates varied between anchor systems (FASTak, 6.5%; Suretac, 25%; Panalok, 16.8%). Superior labral anterior posterior lesions, when treated, did not influence clinical outcomes or redislocation rate. A concomitant rotator cuff tear did not influence redislocation rate. Postoperative outcomes (Rowe score, Constant score, American Shoulder and Elbow Surgeons [ASES] shoulder index, 12-item questionnaire) in patients with a partial tear were also not altered. On the other hand, the redislocation rate correlated with patient age and number of prior dislocations. Return to sports at preinjury level was possible in 80% of cases. Conclusion: Arthroscopic repair of anterior-inferior instability using the 5:30-o’clock portal is dependent on anchor type and can show good to excellent results. Because of several coinjuries in anterior-inferior instability, an arthroscopic approach may be required to identify and treat such lesions.

Shoulder Pain After Surfing

HISTORY: A 16 year old male was referred to our clinic by his orthopaedist for evaluation and management of pain in his right, dominant shoulder. He had no previous problems with his shoulder until 2 months prior to presentation, when he suffered a forceful blow to his shoulder against the sand while surfing. His pain slightly improved after 3 days of ibuprofen, ice, and rest, but worsened when he returned to competitive swimming. The patient did not have any neck pain or parasthesias. He was initially diagnosed with an anterior shoulder dislocation, but the pain persisted, and MRI examination was performed. This was interpreted as having a Hill-Sachs lesion and he was given a diagnosis of shoulder instability. He was referred to our clinic on the suspicion of continued shoulder instability and for consideration of surgical intervention. EXAMINATION: The patient was in no acute distress with no atrophy or deformity. He had no scapular dykinesis or winging. He had full range of motion except for the loss of 2 spinal levels of internal rotation up the back. His sensory exam was normal to light touch including his axillary nerve distribution. Manual muscle testing was unremarkable except for mild shoulder pain with resisted external rotation and resisted abduction. He had a positive Neer impingement sign and positive Hawkins sign. He had negative posterior and anterior apprehension signs, and was too painful for laxity testing. He was tender over his anterolateral proximal humerus on the greater tuberosity area. DIFFERENTIAL DIAGNOSIS: Anterior shoulder instability Rotator cuff tear Superior labrum anterior posterior lesion (SLAP) Fracture of humerus or glenoid TESTS AND RESULTS Plain shoulder radiograph: minimally displaced greater tuberosity fracture MRI: minimally displaced greater tuberosity fracture; no Hill-Sachs lesion, rotator cuff tear or labral lesion. FINAL/WORKING DIAGNOSIS: Minimally displaced greater tuberosity fracture TREATMENT AND OUTCOMES Activity modifications: cross training if no pain NSAIDs as needed Follow up in 6 weeks time a. X-rays: healing of fracture b. Returned to sports/activities with no pain 4 months after injury

Diagnosis and management of superior labrum anterior posterior lesions in overhead athletes

Shoulder pain is a common complaint in overhead athletes, and superior labrum anterior posterior (SLAP) lesions are a common cause of this pain. The pathological cascade which results in the...

Schultergelenkverletzungen bei Überkopfsportarten

Overhead sport places great demands on the shoulder joint. Shoulder pain in overhead athletes and throwers can in the majority of cases be attributed to lesions resulting from chronic overuse of tendons and capsuloligamentous structures or to sequels of microinstability and secondary impingement. Due to its great impact on therapeutic decisions, imaging in athletes with unclear shoulder pain is a challenge. In this connection, magnetic resonance (MR) arthrography represents the cross-sectional imaging modality of first choice, as it allows depiction and exclusion of pathologic alterations of all relevant joint structures with sufficient confidence.This article reviews the biomechanical and clinical aspects and MR arthrographic features of the most common shoulder pathologies in overhead athletes, including biceps tendinopathy, superior labral anterior-posterior (SLAP) lesions, rotator cuff lesions, as well as extrinsic and intrinsic impingement syndromes.

Management of type II superior labrum anterior posterior lesions: a review of the literature.

Superior labrum anterior and posterior lesions were first described in 1985 by Andrews et al. and later classified into four types by Synder et al. The most prevalent is type II which is fraying of the superior glenoid labrum with detachment of the biceps anchor. Superior labrum anterior posterior (SLAP) lesions can also be associated with other shoulder pathology. Both MRI and MRA can be utilized in making the diagnosis with the coronal images being the most sensitive. The mechanism of injury can be either repetitive stress or acute trauma with the superior labrum most vulnerable to injury during the late cocking phase of throwing. A combination of the modified dynamic labral shear and O'Brien test can be used clinically in making the diagnosis of SLAP lesion. However, the most sensitive and specific test used to diagnosis specifically a type II SLAP lesion is the Biceps Load Test II. The management of type II SLAP lesions is controversial and dependent on patient characteristics. In the young high demanding overhead athlete, repair of the type II lesion is recommended to prevent glenohumeral instability. In middle-aged patients (age 25–45), repair of the type II SLAP lesion with concomitant treatment of other shoulder pathology resulted in better functional outcomes and patient satisfaction. Furthermore, patients who had a distinct traumatic event resulting in the type II SLAP tear did better functionally than patients who did not have the traumatic event when the lesion was repaired. In the older patient population (age over 45 years), minimum intervention (debridement, biceps tenodesis/tenotomy) to the type II SLAP lesion results in excellent patient satisfaction and outcomes.

Follow-up Result in Repairing a Type II Superior Labrum Anterior and Posterior (SLAP) Lesion when Associated with Shoulder Impingement Syndrome

Purpose: Type II superior labral anterior posterior (SLAP) lesions can occur in the setting of impingement syndrome. The authors compared the clinical results of patients who had undergone either an isolated acromioplasty or a combined type II SLAP repair and acromioplasty. Materials and Methods: Between 2003 and 2008, a total of 75 cases of SLAP II lesions associated with impingement syndrome were recruited. In 39 patients, the type II SLAP lesion was repaired and acromioplasty was performed. In the other 35 patients, acromioplasty was performed alone. All patients were evaluated using the American Shoulder and Elbow Surgeons (ASES) questionnaire and range of motion. Results: At an average of 33 months postoperatively, the ASES scores significantly increased in both groups (p

The Spectrum of Lesions and Clinical Results of Arthroscopic Stabilization of Acute Anterior Shoulder Instability

PurposeThe purpose of this study is to investigate and analyze accom-panying lesions including injury types of anteroinferior labrum lesion in young and active patients who suffered traumatic anterior shoulder dislocation for the first time.Meterials and MethodsThe study used magnetic resonance angiography (MRA) to 40 patients with acute anterior shoulder dislocation from April 2004 to April 2008, and of those, 36 with abnormal MRA finding were treated with arthroscopy.ResultsThere was a total of 25 cases of anteroinferior glenoid labrum lesions. A superior labrum anterior-posterior lesion (SLAP) lesion was observed in 8 cases. For bony lesions, 22 cases of Hill-sachs lesions, 4 cases of lesions in greater tuberosity fracture of humerus, and 4 cases of loose body were found. For lesions involving rotator cuff, partial articular side rupture was found in 2 cases and 2 cases were found to have a complete rupture.ConclusionUnder MRA and arthroscopy performed on patients with acute anterior shoulder dislocation, it was observed to have varying types of anteroinferior labrum lesions such as Perthes, Bankart, ALPSA, and bony Bankart lesion. that MRA is a remar-kably useful tool to classify various lesions in acute anterior dislocation of the shoulder and to make a diagnosis, making it a useful tool to decide a treatment method while consulting patients and their families.

The Effect of Rotator Cuff Tears on Surgical Outcomes after Type II Superior Labrum Anterior Posterior Tears in Patients Younger than 50 Years

Background Rotator cuff injury in the setting of type II superior labrum anterior posterior lesions is a common finding. Although predictable surgical outcomes can be expected after type II superior labrum anterior posterior repair, the effect of rotator cuff tears on surgical outcome is unknown. Hypothesis Rotator cuff tears will not negatively affect surgical outcome of type II superior labrum anterior posterior repairs. Study Design Cohort study; Level of evidence, 3. Methods The study group included 93 patients younger than 50 years who underwent arthroscopic type II superior labrum anterior posterior repair and were available for review at a minimum of 2 years after surgery. Group 1 patients were identified as having normal rotator cuffs at the time of repair. Group 2 patients were identified as having rotator cuff injury at the time of repair (either partial-thickness or full-thickness tears). Statistical analysis was performed comparing the postoperative University of California, Los Angeles shoulder scores and overall improvement in University of California, Los Angeles score using the Student t test for significance. Results Mean follow-up was 2.54 years; 52.7% of patients had evidence of rotator cuff tears at the time of surgery. The mean postoperative University of California, Los Angeles score for group 1 was 32.9 (improvement of 11.0), and the mean postoperative University of California, Los Angeles score for group 2 was 33.3 (improvement of 12.2). There was not a significant difference in any of the outcome measures between groups. Conclusion Predictable short-term surgical results and return to activity can be expected after repair of type II superior labrum anterior posterior lesions in patients younger than 50 years who have coexistent rotator cuff tear. Although cuff lesions did not have a negative effect on the short-term outcome in patients with type II superior labrum anterior posterior lesions, longer-term follow-up is needed to determine natural history of this pathologic condition.

Inter- and intraobserver variability of MR arthrography in the detection and classification of superior labral anterior posterior (SLAP) lesions: evaluation in 78 cases with arthroscopic correlation

The purpose of this study was to determine inter- and intraobserver variability of MR arthrography of the shoulder in the detection and classification of superior labral anterior posterior (SLAP) lesions. MR arthrograms of 78 patients who underwent MR arthrography before arthroscopy were retrospectively analysed by three blinded readers for the presence and type of SLAP lesions. MR arthrograms were reviewed twice by each reader with a time interval of 4 months between the two readings. Inter- and intraobserver agreement for detection and classification of SLAP lesions were calculated using kappa coefficients. Arthroscopy confirmed 48 SLAP lesions: type I (n = 4), type II (n = 37), type III (n = 3), type IV (n = 4). Sensitivity and specificity for detecting SLAP lesions with MR arthrography for each reader were 88.6%/93.3%, 90.9%/80.0% and 86.4%/76.7%. MR arthrographic and arthroscopic grading were concurrent for 72.7%, 68.2% and 70.5% of SLAP lesions for readers 1-3, respectively. Interobserver agreement was excellent (kappa = 0.82) for detection and substantial (kappa = 0.63) for classification of SLAP lesions. For each reader intraobserver agreement was excellent for detection (kappa = 0.93, kappa = 0.97, kappa = 0.97) and classification (kappa = 0.94, kappa = 0.84, kappa = 0.93) of SLAP lesions. MR arthrography allows reliable and accurate detection of SLAP lesions. In addition, SLAP lesions can be diagnosed and classified with substantial to excellent inter- and intraobserver agreement.

The Effect of Physical Characteristics and Field Position on the Shoulder and Elbow Injuries of 490 Baseball Players: Confirmation of Diagnosis by Magnetic Resonance Imaging

To evaluate the distribution of shoulder and elbow injuries confirmed by magnetic resonance imaging in throwing athletes. Descriptive epidemiological study. Tertiary institution. Five hundred fifty-four baseball players referred to our institute for shoulder and elbow rehabilitation. All injured players except those with fractures underwent magnetic resonance imagings, which were read by a radiologist, and players were diagnosed by orthopedic surgeons based on the clinical and imaging findings. Analysis of baseball-related injuries was performed according to the physical characteristics of each athlete and his positions on the team. Junior high school players sustained a higher proportion of osteochondritis dissecans compared with high school and collegiate players. High school and collegiate players were more likely to have ulnar collateral ligament (UCL) injuries or superior labrum anterior-posterior (SLAP) lesions than junior high school players. Pitchers and outfielders were more likely to have UCL injuries than the infielders. In the junior high school group, the players with UCL injuries were taller and heavier than the players in the control group. In the high school group with UCL injuries or SLAP lesions, the players were both taller and heavier than the players in the control group. These data support the conclusion that there is a significant difference in the distribution of injuries according to the player's age and position. For the age-matched comparison, taller and heavier players are more likely to be affected by UCL injury or SLAP lesion.

Shoulder Pain In An Adolescent Due To Fly Fishing

HISTORY: A previously healthy 14 year old male presented to our clinic for a second opinion about pain in his right, dominant arm. He had no previous problems with his shoulder until 4 months prior to seeing us. At that time he and his Father had gone fly fishing in Canada. He used standard fly fishing rod and tackle and they fished 10 hours per day for 3 days in a row. He never had an injury to his shoulder, but the last day he began to have soreness in his right anterior shoulder which worsened over the next few days. He saw an orthopedic surgeon who took radiographs and an MRI of the shoulder but failed to come up with a diagnosis. The pain was worsened with abduction or reaching across his body. He had no parasthesias or neck pain. He was in good health with no systemic illnesses. Low doses of ibuprofen did not resolve his pain. PHYSICAL EXAMINATION: He was in no acute distress with no atrophy or deformity. He had full range of motion except for a loss of 5 spinal levels of internal rotation up the back. He had pain with resisted internal rotation but no weakness. His strength testing otherwise was normal and without pain. He had a negative lift off test but he had pain with a resisted lift off test. He had a positive Neer impingement sign, Hawkins impingement sign, shrug sign, active compression test and Whipple test. He was tender along his lesser tuberosity area but not when palpating the biceps tendon 4 to 5 centimeters distal to the acromion. His sensory examination was normal and he had a negative anterior and posterior apprehension tests. DIFFERENTIAL DIAGNOSIS: Rotator cuff inflammation Biceps tendonitis Superior labrum anterior posterior lesion (SLAP) Occult instability Epiphyseal irritation similar to Little League Shoulder TEST AND RESULTS: Plain radiographs of the shoulder: Anterior-posterior views negative, Axillary radiograph of shoulder: avulsion fracture lesser tuberosity, MRI: edema around fragment lesser tuberosity FINAL WORKING DIAGNOSIS: Subscapularis tendon avulsion injury lesser tuberosity TREATMENT AND OUTCOMES: Restricted throwing or abduction-ER motions, bench press, Allowed to do sports which did not cause pain, Radiographic follow up showed no change in fragment, He returned to all sports with no symptoms 4 months later

Arthroscopic Treatment of Concomitant Superior Labral Anterior Posterior (SLAP) Lesions and Rotator Cuff Tears in Patients over the Age of 45 Years

Background Rotator cuff tears commonly occur in combination with other shoulder injuries such as superior labral anterior posterior (SLAP) lesions. The incidence of these associated lesions increases with age; however, the management of concomitant SLAP and rotator cuff tears has yet to be convincingly addressed in the literature. Hypothesis Patients over the age of 45 years who have concomitant arthroscopic rotator cuff repair and debridement of their type II SLAP lesions will have improved patient satisfaction and functional outcome compared with those who undergo simultaneous rotator cuff and type II SLAP repair. Study Design Cohort study; Level of evidence, 2. Methods We recruited 48 patients (mean age, 51.9 years; range, 45-60 years) who had concomitant rotator cuff and type II SLAP tears. All underwent arthroscopic rotator cuff repair with subacromial decompression. Patients were randomized intraoperatively into 2 groups: repair versus debridement of their type II SLAP lesions. Ten patients were lost at final follow-up (4 in debridement and 6 in repair group). The outcome was assessed by the Tegner score and University of California at Los Angeles (UCLA) score and clinically to evaluate range of motion (forward elevation/internal rotation/external rotation). Results At 2 years postoperatively, both the debridement and repair groups showed significant improvement in Tegner score, UCLA score, and range of motion. Patients who underwent rotator cuff repair in combination with debridement of their SLAP tears had significantly better overall UCLA scores (34 vs 31; P < .001) and improved function (5.5 vs 3.8; P < .005) and pain relief (9.6 vs 7.7; P < .001) compared with those who underwent simultaneous rotator cuff and SLAP repair. Range of motion in both internal and external rotation was also significantly better in those patients who had SLAP debridement as compared to SLAP repair. Conclusion In patients over the age of 45 years with a minimally retracted rotator cuff tear and associated SLAP lesion, arthroscopic repair of the rotator cuff with combined debridement of the type II SLAP lesion may provide greater patient satisfaction and functional outcome in terms of pain relief and motion.

Special physical examination tests for superior labrum anterior posterior shoulder tears are clinically limited and invalid: a diagnostic systematic review

Objective The diagnosis of a superior labrum anterior posterior (SLAP) lesion through physical examination has been widely reported in the literature. Most of these studies report high sensitivities and specificities, and claim to be accurate, valid, and reliable. The purpose of this study was to critically evaluate these studies to determine if there was sufficient evidence to support the use of the SLAP physical examination tests as valid and reliable diagnostic test procedures. Study Design and Setting Strict epidemiologic methodology was used to obtain and collate all relevant articles. Sackett's guidelines were applied to all articles. Confidence intervals and likelihood ratios were determined. Results Fifteen of 29 relevant studies met the criteria for inclusion. Only one article met all of Sackett's critical appraisal criteria. Confidence intervals for both the positive and negative likelihood ratios contained the value 1. Conclusion The current literature being used as a resource for teaching in medical schools and continuing education lacks the validity necessary to be useful. There are no good physical examination tests that exist for effectively diagnosing a SLAP lesion.

Three-dimensional Isotropic Shoulder MR Arthrography: Comparison with Two-dimensional MR Arthrography for the Diagnosis of Labral Lesions at 3.0 T

To compare the diagnostic accuracy of three-dimensional (3D) isotropic magnetic resonance (MR) arthrography with two-dimensional (2D) MR arthrography for the diagnosis of labral lesions of the shoulder performed by using a 3.0-T imager. Institutional review board approval was given for this retrospective study and informed consent was waived. From March 2006 to January 2007, 100 patients underwent 3D isotropic and 2D MR shoulder arthrographic imaging by using a 3.0-T imager and subsequent arthroscopic surgery. The 3D isotropic sequences were performed by using fast gradient-echo imaging with fat suppression (voxel size, 0.6 x 0.6 x 0.6 mm; imaging time, 5 minutes 32 seconds) and were evaluated for the presence of superior, anterior, and posterior labral lesions by using 3D isotropic and 2D MR arthrography. The statistical differences between the sensitivity and specificity for both methods were analyzed by using the McNemar test, with arthroscopic findings regarded as reference standard. Surgical findings confirmed 53 superior labral anterior posterior (SLAP) lesions, 17 anterior labral lesions, and five posterior labral lesions. Respective sensitivity and specificity were 85% and 96% for SLAP lesions, 100% and 98% for anterior labral lesions, and 80% and 99% for posterior labral lesions by using 2D MR arthrography and 83% and 96% for SLAP lesions, 100% and 96% for anterior labral lesions, and 80% and 99% for posterior labral lesions by using 3D isotropic MR arthrography. There was no significant difference in sensitivities and specificities of both methods; however, the power of this study was limited and larger comparison is needed. Isotropic 3D shoulder MR arthrography combined with a multiplanar reconstruction technique can help in the diagnosis of shoulder labral lesions as does 2D MR arthrography, but with shorter imaging times.

A Meta-analysis Examining Clinical Test Utility for Assessing Superior Labral Anterior Posterior Lesions

Background The reported accuracy of clinical tests for superior labral anterior posterior lesions is extremely variable. Pooling results from multiple studies of higher quality is necessary to establish the best clinical tests to use. Hypothesis Certain clinical tests are superior to others for diagnosing the presence or absence of a superior labral anterior posterior lesion. Study Design Meta-analysis. Methods A literature search of MEDLINE (1966–2007), CINAHL (1982–2007), and BIOSIS (1995–2007) was performed for (labrum OR labral OR SLAP OR Bankart) AND (shoulder OR shoulder joint OR glenoid) AND (specificity OR sensitivity AND specificity). Identified articles were reviewed for inclusion criteria. Sensitivity and specificity values were recorded from each study and used for meta-analysis. Results Six of 198 identified studies satisfied the eligibility criteria. Active compression, anterior slide, crank, and Speed tests were analyzed using receiver operating characteristic curves. The accuracy of the anterior slide test was significantly inferior to that of the active compression, crank, and Speed tests. There was no significant difference in test accuracy found among active compression, crank, and Speed tests. Between studies, methodological scores did not significantly affect sensitivity and specificity values. Conclusion The anterior slide test is a poor test for detecting the presence of a labral lesion in the shoulder. Active compression, crank, and Speed tests are more optimal choices. Clinicians should choose the active compression test first, crank second, and Speed test third when a labral lesion is suspected.

Arthroscopic treatment of superior labrum anterior posterior lesions

Objective To discuss the clinical results of arthroscopic treatment of superior labrum anterior posterior (SLAP) lesions of the shoulder. Methods A retrospective study was conducted for the 29 cases of shoulder SLAP lesions who had been treated by arthroscopy from January 2000 to December 2007. They were followed up for a mean period of 26.1(9 to 89) months and evaluated by UCLA (University of California at Los Angeles) and ASES (American Shoulder and Elbow Surgeons) score systems before and after operation. Cases of subacromial impingement syndrome, rotator cuff tear and shoulder dislocation were ex-cluded from this study. Results The SLAP lesions were classified into 9 typos. There were 2 eases of type L 17 cases of type Ⅱ 1 case of type Ⅲ, 3 cases of type Ⅳ, 1 ease of type Ⅴ, 1 ease of type VI, and 4 cases of type Ⅷ. The average preoperative ASES score was 9.19±1.77 and the average preoperative UCLA score was 19.23± 3.88. After the operation, the average ASES score was 16.08±0.94 and the average UCLA score was 33.23± 2.08. The differences before and after surgery were statistically significant (P<0.05). After surgery 25 cases achieved the same sports level as before and reported no complains. Three cases had slightly limited range of movement. In I case, the pain was only lightly alleviated. All the 13 athletes restored the same sports level as before. The reply was positive by all patients to the question: Do you want to accept the same operation if you are injured again? Conclusion Arthreseopic treatment of SLAP lesions is safe and effective. Key words: Shoulder joint; Arthroseopy; Superior labrum anterior posterior (SLAP) lesions

Arthroscopic repair of isolated type II superior labrum anterior–posterior lesion

The effectiveness of arthroscopic repair of type II superior labrum anterior-posterior lesion (SLAP) was unclear as previous studies examined this treatment with patients of combined types of SLAP lesions. To address this research gap, we evaluated the clinical and functional outcomes of arthroscopic repair for 16 patients (mean=24.2, SD=6.5) with clinical evidence of isolated type II SLAP lesion. After having arthroscopic stabilizations with Bioknotless suture anchors (Mitek), the patients were offered post-operative rehabilitation programs (e.g., physiotherapy) for 6 months. The symptoms of SLAP lesion and the functions of the shoulder were assessed pre-operatively and 28-month post-operatively by O'Brien test, Speed test, Yergason test, and University of California at Los Angeles rating for pain and function of the shoulder. Wilcoxon Signed Ranks test and McNemar test were employed to analyze the difference between assessment in pre-operation and post-operation phases. The result showed that patients' shoulder functions improved (UCLA Shoulder Score), and symptoms of SLAP lesion reduced (O'Brien test, Speed test, and Yergason test) significantly (P<0.05). Time for returning to play with pre-injury level was in average 9.4 months (range 4-24), and no complication or recurrence was detected. We concluded that arthroscopic repair is an effective operation of type II SLAP lesion with good clinical and functional outcomes; however, athletes with high demand of overhead throwing activities are likely to take longer duration of rehabilitation to attain full recovery.