Superior Labrum Anterior And Posterior Research Articles

Traumatic Shoulder Instability Involving Anterior, Inferior, and Posterior Labral Injury

Background Traumatic labral tears involving the anterior, inferior, and posterior aspects of the glenoid fossa represent a unique subpopulation of shoulder instability. Purpose This study was undertaken to evaluate prospectively the clinical results of patients who underwent arthroscopic repair of 270° labral tears. Study Design Case series; Level of evidence, 4. Methods This was a prospective outcomes analysis of patients who underwent arthroscopic stabilization of a 270° labral tear. Inclusion criteria included patients with traumatic injury and primarily anteroinferior instability but several had posterior instability as well. Imaging revealed extensive labral injury in all patients. Indications for repair included symptomatic instability, 2+ anterior-inferior and posterior-inferior load-shift testing, and arthroscopic confirmation of labral lesions that extended anteriorly, inferiorly, and with extension to the midglenoid posteriorly. Exclusion criteria were SLAP (superior labrum anterior and posterior) lesions, revisions, and nontraumatic injuries. All patients underwent an arthroscopic repair utilizing modern suture anchor technique. Outcome measures included preoperative and postoperative Rowe, American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (SST), and Constant Murley scores. The Western Ontario Shoulder Instability Index (WOSI) and the Single Assessment Numeric Evaluation (SANE) scores were collected postoperatively. Failure was defined as any days missed from sport activity or work due to an instability event. Results Twenty-three 270° labral repairs were performed in 21 patients by a single surgeon. Twenty shoulders in 19 patients (92%) were followed for a mean of 28 months (range, 14-47 months) postoperatively. The mean preoperative and postoperative outcome scores showed statistically significant improvements (P ≤ .001): Rowe (59 to 92), ASES (76 to 93), SST (9 to 11), and Constant scores (73 to 95). The mean SANE score was 91 of 100 and the mean WOSI score was 302. Three of the 20 shoulders (in 19 patients) had subsequent episodes of instability for a failure rate of 15%. One required a second procedure for continued instability for a revision rate of 5%. Two patients developed adhesive capsulitis postoperatively of which one required an arthroscopic arthrolysis. Conclusion Arthroscopic repair of these extensive labral injuries involving 270° of the glenoid fossa was an effective surgical treatment and restored mechanical stability of the shoulder. The arthroscopic approach allowed for complete visualization and repair of all labral pathology.

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.

The Effect of Age on the Outcomes of Arthroscopic Repair of Type II Superior Labral Anterior and Posterior Lesions

Background The majority of clinical outcome studies of type II superior labral anterior and posterior (SLAP) repair assess patients younger than age 40. Biceps tenotomy or tenodesis is often recommended for patients older than age 40 with superior labrum-biceps complex injury. Hypothesis There is no difference in patient clinical outcomes comparing arthroscopic type II SLAP repair in patients younger or older than age 40. Study Design Cohort study; Level of evidence, 3. Methods Fifty-two patients stratified to groups younger than age 40 (21 patients; average age, 32.9 years) and older than age 40 (31 patients; average age, 55.1 years) were identified at a minimum 2-year follow-up (average, 28 months) after type II SLAP repair by a single surgeon using suture anchors. Outcome scores included American Shoulder and Elbow Society scores (ASES), Short Form-12 scores, Simple Shoulder Test scores, and visual analog pain scale. Results At follow-up, there was no statistical difference in visual analog pain scale (P = .16), ASES scores (P = .07), Simple Shoulder Test scores (P =.41), Short Form-12 testing, or range of motion testing. Patients older than age 40 noted their shoulder to be 87% of normal; 26 of 31 (84%) were satisfied to completely satisfied, and 28 of 31 (90%) would have the surgery again. Patients younger than 40 noted their shoulder to be approximately 89% of normal; 20 of 21 (95%) were satisfied to completely satisfied, and 18 of 21 (86%) would have the same procedure performed again. Conclusion Our findings support that arthroscopic treatment of isolated type II SLAP repair using suture anchors can yield good to excellent results in patients older and younger than age 40. We found no statistically significant difference in patient outcome scores, satisfaction levels, or willingness to have the same procedure again when comparing arthroscopic SLAP repair in patients younger or older than age 40.

Results of concomitant rotator cuff and SLAP repair are not affected by unhealed SLAP lesion

To verify the anatomic results of combined repair of a full-thickness rotator cuff tear and superior labral anterior and posterior (SLAP) lesion. In addition, we compared the anatomic and functional outcomes according to the status of the repaired SLAP lesion. We enrolled 61 patients who underwent cuff repair with concomitant SLAP repair and were available for both functional and radiologic outcome evaluation at least 1 year after the operation. There were 40 male and 21 female patients with a mean age of 57.4 years (range, 39-70 years). We measured various clinical outcomes and evaluated the structural outcomes of the rotator cuff and the superior labrum and rotator cuff using computed tomography arthrography at the final follow-up visit. We also evaluated the functional outcome according to anatomic healing of the superior labrum. Labral healing to the bony glenoid was achieved in 49 patients (80.3%), and anatomic healing of the rotator cuff was observed in 44 patients (72.1%). The retear rate of the rotator cuff was not statistically different with respect to labral healing status. All functional outcomes improved significantly (P < .001), and there were no statistical differences in functional outcome with respect to postoperative healing of the superior labrum. An unhealed SLAP lesion did not preclude the successful outcome of concomitant rotator cuff repair. Therefore, repair of a concomitant SLAP lesion may not be an essential procedure for a successful outcome of a rotator cuff repair.

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

Effects of Zone-Specific Superior Labral Detachment on Biceps Anchor Stability

Purpose This study aimed to elucidate the degree of biceps anchor displacement that occurs when specific zones of the superior labrum are detached from the glenoid. Study Design Descriptive laboratory study. Methods Twelve cadaveric scapulae with intact labrums were prepared by removing the surrounding musculature with the labrum, biceps anchor, and biceps tendon carefully preserved. Pulleys were used to apply traction in 3 different directions— superior, lateral, and combined posterior/superior/lateral, to simulate the “peel-back” mechanism—while a continuous 1.13 kg of traction was applied to the biceps tendon. Labral tears were created by sharp incisions in isolation and in combinations of 3 zones defined relative to the glenoid fossa: anterior, posterior, or superior. The displacement of the biceps anchor (position of the marker after the simulated lesion relative to the marker position with the labrum intact) was measured relative to a rigid reference frame. Results The greatest degree of displacement occurred with the sectioning of all 3 zones, followed by the sectioning of 2 adjacent zones. Superior traction created the least displacement in all combinations, while lateral traction created maximal displacement, with one exception: in the setting of anterosuperior/superior lesions, maximal displacement was observed using the peel-back mechanism. Conclusion Biceps anchor displacement, particularly the degree and direction of displacement, is affected by the labral detachment pattern. All 3 labral zones assessed in this study have important biomechanical contributions to biceps anchor displacement. Clinical Significance These findings have important implications relating to the clinician’s arthroscopic assessment of superior labrum anterior and posterior (SLAP) tears, as well as the determination of need for stabilization. This information is particularly useful when treating SLAP tears in certain laborers and athletes, whose activities may cause specific biceps anchor displacement patterns.

Clinical and Imaging Assessment for Superior Labrum Anterior and Posterior Lesions

In the evaluation of the painful shoulder, especially in the overhead athlete, diagnosing superior labrum anterior and posterior (SLAP) lesions continues to challenge the clinician because of 1) the lack of specificity of examination tests for SLAP; 2) a paucity of well-controlled studies of those tests; and 3) the presence of coexisting confounding abnormalities. Some evidence indicates that multiple positive tests increase the likelihood that a SLAP lesion is present, but no one physical examination finding conclusively makes that diagnosis. The goals of this article were to review the physical examination techniques for making the diagnosis of SLAP lesions, to evaluate the clinical usefulness of those examinations, and to review the role of magnetic resonance imaging in making the diagnosis.

Risk of Motion Loss With Combined Bankart and SLAP Repairs

We have performed arthroscopic Bankart procedures using absorbable or metallic suture anchors for traumatic anterior shoulder instability for over a decade. This article describes the frequency, pathology, and therapeutic results of patients treated for superior labrum anterior and posterior (SLAP) lesions concomitant with Bankart lesions. Twenty patients (Group A) had a mean age of 33.8 years at the time of surgery. On arthroscopic findings, SLAP lesions were classified type 2 in 15 patients and type 4 in 5, based on Snyder's criteria. In addition, intra-articular free bodies were present in 2 SLAP lesions, and a capsular tear was present in 1. We performed debridement (Group A1) or reattachment (Group A2) to the superior glenoid edge of these lesions, considering whether they communicated to Bankart lesions. The therapeutic results were evaluated according to the Japanese Orthopaedic Association (JOA) score and Japan Shoulder Society (JSS) shoulder instability score. Mean JOA and JSS shoulder instability scores were 95.1 and 90.8 points, respectively. All Group A patients remained pain free, and no instability recurred in any patient. Meanwhile, mean JSS shoulder instability function and range of motion scores were 18.9 and 15.1 points, respectively, in Group A1, and 17.5 and 10.1 points, respectively, in Group A2. A significant correlation in range of motion was observed in Groups A1 and A2 (P=.04). Regarding postoperative limitation in external rotation with the arm at the side, the difference in range from that on the healthy side was 9.8 degrees in Group A (7.0 degrees in Group A1 and 12.6 degrees in Group A2). When SLAP lesions communicated to Bankart lesions, we had satisfactory results without SLAP repair; therefore, unnecessary repairs for the concomitant pathology should be avoided, and different postoperative care should be performed for patients with Bankart repair with reattachment of a SLAP lesion.

An evaluation of the anatomical basis of the Biceps Load tests I and II for superior labral anterior and posterior (SLAP) lesions

Both Biceps Load tests I and II rely on an increase in tension in the long head of biceps to identify a superior labral anterior and posterior (SLAP) lesion. This study aimed to evaluate the anatomical basis of Biceps Load tests I and II by measuring activity in the long head of biceps in the two clinical tests. Activity in the long head of biceps was measured in 12 healthy young participants using surface electromyography. Activity was only minimally increased in both Biceps Load I and II compared with the resting position. In the absence of convincing support for the anatomical basis of the test, investigations of diagnostic accuracy need to be replicated in order for the reported high accuracy of Biceps Load I and II tests to be supported with confidence.

Arthroscopic Management of Superior Labral Anterior and Posterior (SLAP) and Associated Lesions: Clinical Features and Functional Outcome

The superior labral anterior and posterior (SLAP) lesion is a cause of chronic shoulder pain and significant disability. This study aims to review the distribution of types of SLAP lesions, associated lesions and the outcome of arthroscopic management. This series involved all 33 patients who underwent arthroscopic management of SLAP and associated lesions by a single surgeon. The pre- and postoperative disability scores were assessed using the disabilities of the arm, shoulder and hand (DASH) outcome measure. Type 2 SLAP lesion (64%) was the most common. Forty-eight per cent of the cases were associated with an ipsilateral shoulder lesion. A 10- point pre- and postoperative DASH score reduction was noted in 63% of the patients with isolated SLAP lesions and 73% of those with associated lesions. Arthroscopic management of the SLAP and its associated lesions results in improved functional outcome. The presence of associated lesions should be actively sought and managed in the same operative session.

No Advantages in Repairing a Type II Superior Labrum Anterior and Posterior (SLAP) Lesion When Associated with Rotator Cuff Repair in Patients over Age 50

Background Arthroscopic management has been recommended for some superior labrum anterior and posterior (SLAP) lesions, but no studies have focused on patients over 50 years of age with rotator cuff tear and a type II SLAP lesion. Hypothesis In patients over 50 years of age with an arthroscopically confirmed lesion of the rotator cuff and a type II SLAP lesion, there is no difference between (1) repair of both lesions and (2) repair of the rotator cuff tear without repair of the SLAP II lesion but with a tenotomy of the long head of the biceps. Study Design Randomized controlled clinical trial; Level of evidence, 1. Methods We recruited 63 patients. In 31 patients, we repaired the rotator cuff and the type II SLAP lesion (group 1). In the other 32 patients, we repaired the rotator cuff and tenotomized the long head of the biceps (group 2). Seven patients (2 in group 1 and 5 in group 2) were lost to final follow-up. Results At a minimum 2.9 years’ follow-up, statistically significant differences were seen with respect to the University of California, Los Angeles (UCLA) score and range of motion values. In group 1 (SLAP repair and rotator cuff repair), the UCLA showed a statistically significant improvement from a preoperative average rating of 10.4 (range, 6–14) to an average of 27.9 (range, 24–35) postoperatively (P < .001). In group 2 (biceps tenotomy and rotator cuff repair), the UCLA showed a statistically significant improvement from a preoperative average rating of 10.1 (range, 5–14) to an average of 32.1 (range, 30–35) postoperatively (P < .001) There was a statistically significant difference in total postoperative UCLA scores and range of motion when comparing the 2 groups postoperatively (P < .05). Conclusions There are no advantages in repairing a type II SLAP lesion when associated with a rotator cuff tear in patients over 50 years of age. The association of rotator cuff repair and biceps tenotomy provides better clinical outcome compared with repair of the type II SLAP lesion and the rotator cuff.

Biceps Tendon and Superior Labrum Injuries

Although the anatomy of the biceps tendon and the restraining structures within the rotator interval are well defined, biceps function is not clearly understood. Biceps pathology is often associated with rotator cuff disease. Although careful clinical examinations along with diagnostic testing can accurately identify patients with biceps pathology, arthroscopy is extremely valuable in the diagnosis and treatment of biceps pathology. Surgical treatment options for biceps pathology include decompression, débridement, tenotomy, and tenodesis. Several factors must be considered in this decision. The most important factors when deciding between tenodesis or tenotomy are the activity expectations of the patient, cosmesis, patient compliance, associated pathology, and patient age. Those older than 60 years tolerate a tenotomy with the fewest adverse effects. Various arthroscopic tenodesis techniques exist, including an interference screw in bone, suture anchor fixation, and suture to adjacent tissue fixation. An open subpectoral tenodesis is another option and appropriate for a retracted biceps rupture or when the biceps disease extends distal to the bicipital groove. A superior labrum anterior and posterior (SLAP) lesion at the attachment site of the biceps tendon to the superior glenoid labrum is uncommon. Clinically significant SLAP lesions are found in about 5% of all shoulder arthroscopies and may be mistaken for normal superior labral variations. Clinical examinations and diagnostic imaging tests for SLAP lesions are often unreliable, and the ultimate diagnostic confirmation is made by arthroscopy. Surgical treatment is focused on the reattachment of the unstable biceps-labral complex.

Outcome of arthroscopic repair of type II SLAP lesions in worker's compensation patients.

Arthroscopic stabilization has become the accepted treatment for type II superior labral anterior and posterior (SLAP) lesions. Short-term results using a variety of techniques were promising, but most reports focus on motivated athletes. The purpose of our report is to evaluate the results of arthroscopic fixation of type II SLAP lesions in 21 patients who suffered a work-related injury and are receiving workers' compensation. The hypothesis was that in patients with a single event trauma who were receiving workers' compensation, clinical results would be inferior to those previously reported. Twenty-two consecutive workers' compensation patients with type II SLAP lesions underwent arthroscopic stabilization between October 1994 and December 1996. All patients received suture anchors with nonabsorbable suture secured around the labrum for definitive fixation. Average age at surgery was 43 and average follow-up time was 27.9 months. Seventeen patients (89%) had an acromioplasty at the time of labral stabilization. Outcome was assessed by analysis of visual analog pain scale, simple shoulder test (SST) and general health status questionnaire (SF-36), subjective patient satisfaction, and ability to return to work. Visual analog pain scales improved by an average of 3 points although all patients had significant complaints of pain at follow-up. Simple shoulder test responses showed improvement in 9 out of 12 categories. The SF-36 results showed significant improvements only in the bodily pain category and role: physical category. Five patients required reoperation for persistent pain. However, only seven patients (437%) returned to work at their previous functional level, nine patients (47%) returned to work but at less strenuous jobs, and three patients (16%) did not return to work. Currently recommended treatment for type II SLAP lesions is arthroscopic stabilization. When this procedure is performed in workers' compensation, patients a with single event trauma to the shoulder, objective parameters, and patient self-assessment surveys do show improvement. However, results are inferior to those previously reported in the literature.

Arthroscopic Management of Superior Labrum Anterior and Posterior (SLAP) Lesions

Shoulder injuries, including tears of the superior labrum, are common in the active-duty military population. When sufficiently symptomatic, repairs may be undertaken using arthroscopic techniques. Currently, repair of unstable tears generally involves the use of suture anchors and arthroscopic suture passage and tying. Surgical repair of unstable superior labrum anterior and posterior (SLAP) lesions is predictably successful in the majority of patients with most able to return to their preinjury level of function including active military duty.

Accuracy of clinical tests to diagnose superior labral anterior and posterior (SLAP) lesions

Numerous clinical tests to diagnose superior labral anterior and posterior (SLAP) lesions of the glenoid labrum have been described. The current systematic review of the relevant literature was undertaken to ascertain the accuracy of these tests as determined by likelihood ratios. Searching of electronic databases yielded 16 papers that had reported test accuracy on a total of 16 separate clinical tests for SLAP lesions, and some combinations of these tests. Although many tests appeared to be highly accurate when initially reported, all tests that had been evaluated by authors other than those who devised the test typically showed poor levels of accuracy in subsequent studies. The results of this review suggest that no one clinical test can be recommended for use in clinical practice to diagnose accurately the presence or absence of a SLAP lesion. It is possible that further investigations into the anatomical basis of these tests may explain the variability in accuracy.

The diagnosis, classification, and treatment of SLAP lesions

SLAP (superior labrum, anterior and posterior) lesions have been identified as a cause of instability and pain in the shoulder. This review describes clinical features, mechanism of injury, physical examination, classification and associated lesions, normal and pathologic anatomy, as well as a treatment algorithm for SLAP lesions.

The diagnosis and treatment of superior labrum, anterior and posterior (SLAP) lesions.

The advent of shoulder arthroscopy, as well as our improved understanding of shoulder anatomy and biomechanics, has led to the identification of previously undiagnosed lesions involving the superior labrum and biceps tendon anchor. Although the history and physical examination, as well as improved imaging modalities such as magnetic resonance arthrography, are extremely important in understanding the abnormalities, the definitive diagnosis of superior labrum, anterior and posterior lesions is best made through diagnostic arthroscopy. Treatment of these lesions is directed according to its type. In general, type I and III lesions are debrided, whereas type II and many type IV lesions are repaired. The purpose of this article is to review the anatomy, biomechanics, classification, diagnosis, and current treatment recommendations for these lesions, as well as to review the literature.

A review of the special tests associated with shoulder examination. Part II: laxity, instability, and superior labral anterior and posterior (SLAP) lesions.

This is the second of a two-part article describing the various tests that have been used to examine the shoulder to find and treat problems in that area. Part I of this article (January/February 2003, pages 154-160) focused on tests used to examine rotator cuff abnormalities. This article attempts to clarify the tests of laxity, instability, and the superior labral anterior and posterior (SLAP) lesions by presenting them as described by the original authors, with the additional aim of providing a source for those wishing to refresh their knowledge without the need to refer to the original source material.

Biceps load test II: A clinical test for SLAP lesions of the shoulder

Purpose: The purpose of this report is to describe the biceps load test II for evaluating the superior labral anterior and posterior (SLAP) lesions. Type of Study: This is a double-blind study in consecutive data, which includes diagnostic accuracy of a test using sensitivity, specificity, and interexaminer reliability. Methods: In the supine position, the arm is elevated to 120° and externally rotated to its maximal point, with the elbow in the 90° flexion and the forearm in the supinated position. The patient is asked to flex the elbow while resisting the elbow flexion by the examiner. The test is considered positive if the patient complains of pain during the resisted elbow flexion. The test is negative if pain is not elicited or if the pre-existing pain during the elevation and external rotation of the arm is unchanged or diminished by the resisted elbow flexion. A prospective study was performed in 127 patients to evaluate the diagnostic accuracy for the biceps load test II. Two independent examiners were assigned to perform the new diagnostic test. The results of the tests were confirmed during the arthroscopic examination. Results: A positive test result in 38 subjects correlated with a SLAP lesion in 35 patients and an intact biceps-superior labrum in 3 patients. A negative test result in 89 patients correlated with an intact superior labrum complex in 85 patients, whereas 4 patients with a negative test result had a type II SLAP lesion. The biceps load test II had a sensitivity of 89.7%, a specificity of 96.9%, a positive-predictive value of 92.1%, a negative-predictive value of 95.5%, and a kappa coefficient of 0.815. The abduction and external rotation of the shoulder during the test changes the relative direction of the biceps fiber in a position of oblique angle to the posterosuperior labrum. The resisted contraction of the biceps increases the pain generated on the superior labrum that is already peeled off the glenoid margin in the abducted and externally rotated position. Conclusions: The biceps load test II is an effective diagnostic test for SLAP lesions.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 2 (February), 2001: pp 160–164

Arthroscopic stabilization of type II SLAP lesions using an absorbable tack

Purpose: To document the outcomes of arthroscopic stabilization of Snyder type II SLAP (superior labrum, anterior and posterior) lesions, using a bioabsorbable tack. Type of Study: A case series. Methods: Twenty-five SLAP lesions were repaired arthroscopically using a bioabsorbable tack. There were 22 recreational, 2 high school, and 1 professional athlete in this group. Shoulder function was surveyed at a mean follow-up of 35 months (range, 24 to 51 months) using the UCLA and ASES shoulder scoring algorithms. Results: Shoulder function improved in 24 of the 25 cases. Follow-up UCLA scores averaged 32 points with 9 patients scoring as excellent, 13 good, 2 fair, and 1 poor, for an overall success rate of 88%. ASES shoulder scores similarly improved from a preoperative average of 45 points to a postoperative average of 92. All but 2 of the athletes had returned to their preinjury level of sports participation. Conclusions: Detachment of the superior labrum from the glenoid is recognized as a problematic injury in throwing athletes and others who engage in repetitive overhead activities. We conclude from our experience that using an absorbable tack to repair type II SLAP lesions is an effective treatment, even in athletes with high demands and expectations for shoulder function.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 1 (January), 2001: pp 19–24