Superior Labrum Anterior Posterior Lesions Research Articles

Stress Distribution in the Superior Labrum during Throwing Motion

Background Superior labrum anterior posterior lesions are common among athletes participating in overhead throwing sports. One described mechanism of injury is application of high local stress via repetitive loading of the long head of the biceps tendon attached to the superior labrum; however, the stress environment within the labrum has not been investigated to date. Hypothesis Biceps origin locations and throwing phases determine the stress distributions causing lesions of the superior labrum within the labrum itself Study Design Descriptive laboratory study Methods Three-dimensional finite element models of the labrum glenoid complex with anterior, central, and posterior biceps origins were developed at 4 orientations to simulate the phases of pitching: early cocking, late cocking, acceleration, and deceleration. Results The stress magnitudes at the labrum glenoid interface for the deceleration phase were highest for all biceps origins. Anatomical variations of the biceps insertion affected the stress only during the deceleration phase. Both the biceps origin and throwing phase influenced the location of high stress. Conclusion Deceleration could be the throwing phase that causes tearing at the superior labrum. This finding provides further understanding for localizing the possible initiation of superior labrum anterior posterior lesions.

Type II SLAP lesions: A new scoring system— the sulcus score

A new scoring system-the sulcus score-was developed to differentiate between a large superior labral sulcus and a type II superior labrum anterior-posterior (SLAP) lesion. The sulcus scoring system permits quantification of the size of the superior labral sulcus and the severity of a type II SLAP lesion. Specifically, the depth of the superior labral sulcus was classified into 4 grades, and the length was recorded by clock position. The sulcus score was then calculated by multiplying the depth (grade) by the length (the number of "hours" from the clock position). After stretching of the anterior capsule into excessive humeral external rotation at 60 degrees glenohumeral abduction, the sulcus score of cadaveric shoulders increased significantly (before, 3.4; after, 6.8), indicating the extension of the superior labral sulcus and resulting in a pathologically created type II SLAP lesion. The intraclass correlation coefficient and mean difference were 0.77 and 0.8 +/- 0.7, respectively, for intraobserver repeatability and 0.72 and 0.9 +/- 0.6, respectively, for interobserver reproducibility. The sulcus score provided a consistent and objective means for quantitatively describing the size and severity of type II SLAP lesions. Clinical assessment of the superior labral sulcus by use of the sulcus score may be useful for the diagnosis and treatment of type II SLAP lesions.

Intraarticular lesions in primary frozen shoulder after manipulation under general anesthesia

The aim of this study was to find intraarticular lesions after manipulation under general anesthesia in patients with primary frozen shoulder. In a prospective trial conducted between 2001 and 2003 in 30 patients with primary frozen shoulder, the affected shoulders were manipulated while the patients were under general anesthetia. Exclusion criteria were secondary stiffness caused by rotator cuff tears and glenohumeral arthritis. After manipulation, each patient was examined by arthroscopy, and any intraarticular lesions were documented. In all patients, during manipulation, a significant improvement in the range of motion was achieved. Under anesthesia, flexion improved on average from 70 degrees +/- 33 degrees to 180 degrees +/- 15 degrees, abduction from 50 degrees +/- 20 degrees to 170 degrees +/- 25 degrees, and external rotation from -5 degrees +/- 10 degrees to +40 degrees +/- 20 degrees. Arthroscopy revealed hemarthrosis in all patients after manipulation. In 22 patients, localized synovitis was detected in the area of the rotator interval, whereas in 8 patients, disseminated synovitis was observed as a feature of adhesive capsulitis. After manipulation, the capsule was seen to be ruptured superiorly in 11 patients, the anterior capsule was ruptured up to the infraglenoid pole in 24 patients, and 16 patients each had a capsular lesion located posteriorly. In 18 patients no additional joint damage was found after manipulation. In 4 patients, iatrogenic superior labrum anterior-posterior lesions were observed. Further injuries detected were 3 fresh partial tears of the subscapularis tendon, 4 anterior labral detachments (1 with a small osteochondral defect), and 2 tears of the middle glenohumeral ligament. Even though manipulation under anesthesia is effective in terms of joint mobilization, the method can cause iatrogenic intraarticular damage.

Differences in the Ultimate Strength of the Biceps Anchor and the Generation of Type II Superior Labral Anterior Posterior Lesions in a Cadaveric Model

Background The pathogenesis of superior labral anterior posterior lesions remains controversial. Hypothesis The biceps anchor is more vulnerable to loading with a posterior vector as opposed to an in-line pull. Study Design Controlled laboratory study. Methods Eight pairs of cadaveric shoulders were dissected, and the biceps tendon was loaded to failure in 1 of 2 loading patterns. Loading pattern A was meant to simulate the eccentric load of the biceps in the deceleration phase of throwing; loading pattern B was meant to simulate the posterior biceps load of the late cocking phase. Results The biceps anchor demonstrated significantly increased ultimate strength with in-line loading (group A, 508 N) as opposed to posterior loading (group B, 262 N, P < .001). All group B specimens failed at the biceps anchor, resulting in a type II superior labral anterior posterior lesion. Specimens in group A did not create a superior labral anterior posterior lesion. Conclusions Direction of biceps loading resulted in significant differences in the ultimate strength of the biceps anchor and the generation of superior labral anterior posterior lesions. The biceps anchor was significantly weaker when loaded with a posterior vector. Relevance The superior labrum may be most vulnerable to injury in late cocking. The reproducible generation of type II superior labral anterior posteriorlesions may have applications as a biomechanical model.

Humeral head articular surface damage due to bioabsorbable tack placement: A case report

Over the last decade, arthroscopically inserted implants have been used with increasing frequency to secure labral and capsuloligamentous tissues to bone. Bioabsorbable tacks offer the advantages of gradual load transfer to the healing tissue, reduced need for hardware removal, and radiolucency for postoperative radiographic evaluation.3 The low-profile nature of tack devices presents distinct advantages over the more prominent staple.10,12,13 The ease of insertion and lack of need for knot tying make these devices attractive for arthroscopic shoulder stabilization and superior labrum anterior-posterior (SLAP) lesion repairs. Although tacks have great utility during arthroscopic shoulder surgery, there is potential for complications. This case study describes how a previously placed bioabsorbable tack contributed to humeral head articular surface injury.

An anatomic evaluation of the active compression test

The goal of this study was to describe the anatomic relationships present during the active compression test. Four pairs of cadaveric shoulders were positioned to simulate the active compression test. The shoulders were embedded in polyurethane and evaluated in the axial and coronal planes with a planer. In the axial plane, all internally rotated shoulders demonstrated contact between the lesser tuberosity and subscapularis tendon and the superior aspect of the glenoid and labrum. In the externally rotated position, there was no contact between the superior structures of the shoulder. In the coronal plane, the internally rotated specimens revealed contact between the supraspinatus tendon and the lateral aspect of the acromion. There was no contact between the supraspinatus tendon and the acromion when the shoulders were externally rotated in the coronal plane. The results demonstrate that the active compression test can be used to assist in the diagnosis of superior labrum anterior-posterior lesions as well as other shoulder pathology.

전방 급성 견열손상 후 발생한 변형된 SLAP Ⅱ손상과 전방 관절순 파열 -증례 보고 1 례-

Superior labrum anterior to posterior (SLAP) lesions of the shoulder has recently been a popular issue to shoulder surgeons. Now we are correlating many shoulder symptoms to this SLAP lesion. A 45 year-old female patient injured her shoulder when her arm sleeve was entrapped in moving automobile door. A forceful pull of the arm in external and abduction position was suspected. She complained continuous shoulder pain with limited range of motion for 2 months. Magnetic resonance image showed possible SLAP lesion but no definite diagnosis were made prior to the operation. Arthroscopic evaluation revealed SLAP type Ⅱ lesion with concomitant avulsion of the superior glenoid cartilage. In addition anterior labrocapsular tear was seen from 7 to 9 o`clock of anterior glenoid. The SLAP lesion and the anterior capsulolabral lesion were repaired properly to the glenoid. We report a case of glenoid-cartilage avulsion type of SLAP Ⅱwith anterior labrocapsular lesion.

Mobile Superior Glenoid Labrum

Background Arthroscopic differentiation between a pathologic superior labrum anterior posterior lesion and a normal anatomic variant may be difficult. Hypothesis Various anatomic patterns exist that systematically characterize superior biceps-labral configurations. One variant involves a mobile superior labrum with exposed articular cartilage on the superior glenoid tubercle. The authors seek to demonstrate that this is nonpathologic. Study Design A prospective, consecutive descriptive anatomic study with 1-year clinical follow-up of a subgroup with an identified mobile superior labrum. Methods A total of 191 consecutive patients were prospectively evaluated arthroscopically to quantify the dimensions of the labrum and articular cartilage on the supraglenoid tubercle. Results A subgroup of 49 patients was identified with articular cartilage on the supraglenoid tubercle, a mobile labrum, and no fibrous tearing or evident injury in this region. In postoperative follow-up, only 1 (2.0%) of these patients was clinically symptomatic in the region of the superior labrum-biceps origin. Conclusions Indication for repair of a mobile superior glenoid labrum must be carefully addressed in the context of normal anatomic morphologic variability. The labral and supraglenoid tubercle morphology was noted to be highly variable. Clinical Relevance Patients with mobile labral tissue overlying intact articular cartilage, and no evidence of trauma, are not candidates for repair.

A Biomechanical Comparison of Repair Techniques for Type II SLAP Lesions

Background Multiple options exist for repair of superior labral tears. Purpose To compare commonly used fixation techniques for superior labral tears. Study Design Biomechanical cadaveric study. Methods A comparison of the initial strengths of fixation for type II superior labral anterior posterior (SLAP) lesions was performed in three cadaveric shoulder groups, each containing seven specimens. Two groups were repaired with screw-in anchors; one group had vertical sutures, the other horizontal. Group 3 was repaired using bioabsorbable tacks. Cyclic traction was applied to the biceps tendon. Repair failure (2 mm of permanent displacement) and ultimate failure were measured. Results Specimen stiffness was similar between groups. The mean load to repair failure was 123 ± 17 N in group 1, 114 ± 11 N in group 2, and 95 ± 13 N in group 3. The mean load to ultimate failure was 163 ± 15 N, 161 ± 12 N, and 145 ± 12 N, respectively. Although the repair failure loads of groups 1 and 2 were 29% and 17%, respectively, greater than the tack group, the differences were not statistically significant (P> .05). All ultimate failures occurred at the labral-implant interface. Conclusion Initial fixation strength of tissue tack and suture anchor repairs of SLAP lesions are comparable.

Internal impingement of the shoulder in flexion.

Contact of the rotator cuff to the superior glenoid with the arm in flexion has been described and postulated to be a source of rotator cuff disease. The goals of the current study were to document the existence of internal impingement in flexion arthroscopically and to determine its prevalence in patients with various diseases. Also, we attempted to determine the clinical significance of internal impingement in flexion by investigating the associations between internal impingement in flexion and the preoperative and intraoperative findings. A consecutive case series of 376 patients having arthroscopy of the shoulder were entered prospectively into this study. During arthroscopy, intraarticular lesions were evaluated and the presence of contact of the rotator cuff to the superior glenoid and the degree of flexion making the contact were noted. Statistical analysis was done with two dependent variables defined: the presence of internal impingement in flexion and the flexion degree making internal impingement in flexion. Of the 376 patients, 277 (74%) had internal impingement in flexion and 99 (26%) did not have internal impingement in flexion. There were no statistically significant differences in the prevalence of internal impingement in flexion according to the primary diagnoses. Statistical analysis revealed that the presence of internal impingement in flexion was associated with Type II superior labrum anterior posterior (SLAP) lesions and the presence of internal impingement of the rotator cuff to the superior glenoid in abduction and external rotation. There was a significant relationship between rotator cuff disease and decreasing angle of contact for internal impingement in flexion. This study showed that internal impingement in flexion is common in a cohort of patients having shoulder surgery, with an overall prevalence of 74%, and that internal impingement in flexion may contribute to the development of Type II SLAP lesions and rotator cuff disease.

Glenohumeral translations are increased after a type II superior labrum anterior-posterior lesion: a cadaveric study of severity of passive stabilizer injury

The effects of simulated type II superior labrum anterior-posterior (SLAP) lesions were studied to determine whether the severity of the lesion affected glenohumeral joint translations. A robotic/universal force-moment sensor testing system was used to simulate load-and-shift tests by applying an anterior or posterior load of 50 N to each shoulder. The apprehension test for anterior instability was simulated by applying an anterior load of 50 N with an external rotation torque of 3 Nm at 30° and 60° of abduction. This loading protocol was repeated after creating two type II SLAP lesions of different severity. In the first the superior labrum and the biceps anchor were elevated subperiosteally from the glenoid bone (SLAP-II-1), and in the second the biceps anchor was completely detached (SLAP-II-2). Statistical analysis was performed with a 2-factor repeated-measures analysis of variance followed by multiple contrasts, and the significance level was set at P < .05. At 30° of abduction, anterior translation of the vented joint from anterior loading was 18.5 ± 8.5 mm. It was significantly increased (26.2 ± 6.5 mm, P = .03), after the SLAP-II-2 lesion and compared with the SLAP-II-1 lesion (25.0 ± 6.8 mm, P = .03). Increases in anterior translations at 60° of abduction were not significantly differ in comparison to the two SLAP lesions. Inferior translation also resulted from anterior loading. At 30° of abduction in the vented joint, it was 3.8 ± 4.0 mm and was significantly increased (8.5 ± 5.4 mm, P = .05) after the SLAP-II-2 lesion, no different than that after the SLAP-II-1 lesion (7.8 ± 4.9 mm). No significant increases in anterior translation occurred in response to the combined loading condition between the two SLAP lesions. Glenohumeral translation was increased, regardless of severity, after simulation of type II SLAP lesions. During stabilizing surgical interventions, passive stabilizers that are injured in the type II SLAP lesion should be considered as well as dynamic activity in the tendon of the long head of the biceps brachii.

Contribution to the study of the pathogenesis of type II superior labrum anterior-posterior lesions: a cadaveric model of a fall on the outstretched hand

With a cadaveric model, we studied the effects on the superior labrum–biceps tendon complex of a fall on the outstretched hand to assess one of the supposed mechanisms of creation of superior labrum anterior-posterior (SLAP) lesions. Ten shoulders were used to simulate either a forward or a backward fall with a custom shoulder-testing apparatus capable of simulating muscle forces, attached to a servohydraulic testing machine (INSTRON 8500+). Impaction of the humeral head on the glenoid cavity was applied in 0.1 seconds. The presence or absence of a SLAP lesion was determined. For the 5 shoulders used to simulate a forward fall, 5 type II SLAP lesions were found; for the 5 shoulders used to simulate a backward fall, only 2 type II SLAP lesions were observed. The role of shearing forces seems to be a major factor in the pathogenesis of these lesions, in association with predisposing anatomic factors.

MR imaging of variants of the superior labral-bicipital complex and SLAP lesions

In the detection of SLAP (superior labral anterior to posterior) lesions of the shoulder MR arthrography shows a significantly higher sensitivity compared with conventional MR techniques and therefore, represents the method of choice in diagnostic imaging of the superior labral-bicipital complex. On the basis of morphological criteria it mostly allows distinction of traumatic lesions and anatomic variants of the superior labrum and the biceps anchor as well as classification of detected SLAP lesions (types 1-4 according to Snyder). However, the differentiation of a SLAP type 2 lesion and a sublabral recess can be very difficult, even if all distinction criteria are considered.

Diagnosis of SLAP lesions with Grashey-view arthrography.

To examine the accuracy of Grashey views obtained during shoulder arthrography in the diagnosis of clinically relevant superior labrum anterior-posterior (SLAP) lesions. Grashey views obtained during diagnostic arthrography (conventional and MR) were used to examine the superior labrum. Twenty-eight of 118 shoulder arthrograms obtained during a 27-month period fulfilled study criteria and were correlated for accuracy using arthroscopically confirmed grade 2-4 SLAP lesions as the standard of reference. Arthrograms were graded using the consensus method. Prevalence, sensitivity, specificity, and accuracy were 21%, 50%, 86%, and 79%. The appearance of the superior labrum on the Grashey view was compared subjectively with MR arthrography. Sources of errors were analyzed. Grashey views obtained during shoulder arthrography can diagnose clinically relevant SLAP lesions with moderately high specificity, moderate accuracy, and limited sensitivity. Findings on the Grashey view closely resemble those seen on coronal oblique MR arthrography. Grashey views should be considered in patients undergoing shoulder arthrography.

Failure of polymerized lactic acid tacks in shoulder surgery

The purpose of this study was to evaluate 4 cases in which bioabsorbable polymerized lactic acid tacks failed after arthroscopic shoulder surgery. Four male elite athletes with recurrent shoulder pain were seen a mean of 7.5 months (range, 3-10 months) after initial arthroscopy. Three of the cases involved superior labrum anterior-to-posterior (SLAP) lesion stabilization, and the fourth case was a rotator cuff (RTC) repair. In the three labral repairs, the implant had broken and the unabsorbed fragments were visible with magnetic resonance imaging. The device used in the RTC repair showed no signs of absorption. All 4 patients underwent arthroscopic removal of the polymer tack fragments to alleviate their symptoms, 2 of whom had foreign-body reactions that required synovectomy. On the basis of clinical examination and magnetic resonance imaging, 2 of the SLAP lesions and the RTC tear had healed. The third patient with a SLAP lesion required arthroscopic debridement of a portion of the labrum. The intact RTC implant had backed out of its insertion point. In all 3 labral repairs, the polymerized lactic acid implant experienced a mechanical failure near the head-shaft junction. We theorize that the labral implants failed because of the variable rate of degradation along the shaft of the devices from the intraarticular to intraosseous regions. (J Shoulder Elbow Surg 2003;12:117-21)

CLINICAL FEATURES OF THE DIFFERENT TYPES OF SLAP LESIONS

Previous studies have suggested that SLAP (superior labrum anterior posterior) lesions are a distinct clinical entity. The goals of this study were to define the prevalence, associated pathological findings, and clinical features of the different types of SLAP lesions with use of a common classification system. Five hundred and forty-four patients undergoing shoulder arthroscopy for a variety of diagnoses were prospectively included in this consecutive case series. SLAP lesions were grouped with use of the Snyder classification. Demographic data, clinical data, and arthroscopic findings in the groups with SLAP lesions were compared with those in a control group with no SLAP lesion. Of 544 shoulder arthroscopy procedures, 139 (26%) demonstrated a SLAP lesion. One hundred and three (74%) of the SLAP lesions were Type I, twenty-nine (21%) were Type II, one (0.7%) was Type III, and six (4%) were Type IV. Most (123) of the SLAP lesions were found to be associated with other intra-articular lesions. Multivariate analysis revealed that a positive Speed test and a supraspinatus tear were significantly associated with Type-I lesions (p = 0.012 and p = 0.001, respectively). The findings associated with Type-II lesions differed according to the patient's age: Type-II lesions in patients who were forty years of age or younger were associated only with a Bankart lesion, whereas those in patients older than forty years of age were associated with a supraspinatus tear and osteoarthritis of the humeral head. Type-III and Type-IV lesions were associated with a high-demand occupation and a Bankart lesion. This study demonstrated that the prevalence, associated pathological findings, and clinical features of the different types of SLAP lesions vary with the patient population that is studied. Also, the clinical features and pathological findings associated with the different types of SLAP lesions often overlap. Isolated SLAP lesions with no associated pathological findings are uncommon, and care must be taken when ascribing symptoms to a SLAP lesion when other lesions are present. Diagnostic study, Level IV-1 (case-control study). See p. 2 for complete description of levels of evidence.

Isolated SLAP Lesions of the Shoulder: Surgical Treatment and Outcome

Purpose : To analyze the general characteristics of isolated SLAP (superior labrum anterior to posterior) lesions of shoulder and to evaluate efficacy of arthroscopic treatment. Materials and Methods : We retrospectively reviewed 43 athletic patients with 46 isolated SLAP lesions. The mean follow-up period was 21 months, and mean patient age was 25 years. Twenty seven patients presented with injury to the dominant shoulder, and 3 had bilateral involvement. Results : Pain and clicking were the most common symptoms. The mechanism of injury was assumed to be chafing in 27 cases, compression in 9 cases. Type 2 lesion was commonest (30 cases). The single most sensitive test was the compression-rotation test, which was positive in 92% of patients. The average UCLA score at the last follow-up was 31.6 points; 18 cases ranked as excellent and 21 as good. Postoperative performance data was obtained for in 27 athletes, 19 were able to return to their sports. Conclusion : Arthroscopic surgery for an isolated SLAP lesion resulted in 85% of patients being rated good or above, and 70% of athletic patients were able to resume sporting activity.

ACCURACY OF MRI AND MRA IN THE DIAGNOSIS OF SUPERIOR LABRUM ANTERIOR AND POSTERIOR (SLAP) LESIONS

Introduction: Superior labrum anterior posterior (SLAP) lesions of the glenoid labrum are now well described. Symptoms of SLAP lesions are non-specific and definitive diagnosis has relied heavily on arthroscopic findings. While magnetic resonance imaging (MRI) has been well established as a very useful diagnostic tool for glenohumeral pathology, there are conflicting reports in the literature regarding the value of MRI in identifying SLAP lesions. Whether MR arthrography (MRA) is superior to conventional MRI for evaluating the superior glenoid labrum also remains controversial. The objective of this study was to evaluate and compare the accuracy of MRI and MRA in detecting SLAP lesions in a cohort of patients who underwent shoulder arthroscopy. Methods: Between 1991 and 1999, 252 patients underwent a primary shoulder arthroscopy as well as pre-operative MRI or MRA at our institution. The operative reports and imaging reports were evaluated for each patient. There were 155 males and 97 females. The average age at the time of surgery was 43 (17–77) years. SLAP lesion were classified as type I, II, III and IV according to the system described by Synder et al., Imaging reports were positive for a SLAP lesion only if a superior labral tear or SLAP lesion was specifically sighted in the text of the report. The presence or absence of a SLAP lesion was determined by the operative report. Statistical analysis was performed. Results: One hundred and twenty-two SLAP lesions were identified at arthroscopy. There were 87 Type I, 20 Type II, 9 Type III, and 7 Type IV. Eighty-seven patients with a SLAP lesion underwent pre-operative MRI and 35 patients underwent pre-operative MRA, 4 underwent both. MRI was found to have an overall sensitivity of 35% and specificity of 92%. When classified by type, the sensitivity was 32% for a type I lesion, 31% for type II, 71% for type III, and 33% for type IV. MRA was found to have an overall sensitivity and specificity of 29% and 100%, respectively. According to type of lesion, the sensitivity was 25% for type I, 25% for type II, 50% for type III, and 50% for type IV. Conclusions: These results demonstrate that both MRI and MRA are highly specific for detecting SLAP lesions, but are less sensitive. As expected, there was a trend toward increased sensitivity with increased complexity or grade of the SLAP lesion. Overall, there does not seem to be any appreciable difference between MRI and MRA with respect to SLAP lesions. Therefore, both imaging studies are useful tools in the pre-operative diagnosis of SLAP lesions.

Baseball Shoulder and Elbow Injury Rehabilitation of Varsity, High School, Intercollegiate, and Professional Baseball Players

Principles of general and shoulder conditioning exercises for the healthy late adolescent and adult baseball player start this presentation. Subsequently, common throwing shoulder and elbow problems are discussed in a rehabilitative context. The reader will acquire skills in diagnosing and rehabilitating surgical and nonsurgical conditions of rotator cuff tendonitis, partial rotator cuff tears, superior labrum anterior posterior (SLAP) lesions, throwing acquired decreased shoulder internal rotation (TADSIR), microanterior shoulder instability, posterior elbow impingement, and medial elbow disorders. The alliance between athletic trainers, physical therapists, team physicians, and coaches is critical in returning mature serious baseball players to a game-ready state.

Superior labral anterior posterior (SLAP) lesions of the glenoid labrum: reliability and accuracy of MR arthrography for diagnosis.

To determine the reliability and accuracy of magnetic resonance (MR) arthrography for the diagnosis of superior labral anterior posterior (SLAP) tears. The MR arthrograms in 80 patients who underwent arthroscopy and MR arthrography during a 54-month period were retrospectively reviewed. MR arthrograms were independently scored by three observers for the presence and type of SLAP lesion. Type I SLAP lesions were regarded as negative as they most often are not clinically relevant. Interobserver agreement for detection of SLAP lesions was calculated by using kappa coefficients. The differences in areas under the receiver operating characteristic (ROC) curves were assessed with a univariate z score test. At arthroscopy, there were 25 SLAP tears: type II (n = 22), type III (n = 2), and type IV (n = 1). Sensitivity, specificity, and accuracy of each reader were 92%, 84%, and 86%; 92%, 82%, and 85%; and 84%, 69%, and 74%, respectively. Interobserver agreement for SLAP tears was substantial (kappa = 0.77) to moderate (kappa = 0.52, kappa = 0.44). The areas under the ROC curves for each reader were 0.94, 0.93, and 0.83, which were not significantly different. MR arthrography of the shoulder is reliable and accurate for detection of SLAP tears.