Superior Labrum Anterior To Posterior Research Articles

Arthroscopic Treatment of Type II Superior Labral Anterior to Posterior (SLAP) Lesions in a Younger Population: Traditional Repair versus Biceps Tenodesis with Accelerated Rehabilitation

Objectives:Biceps tenodesis is a viable surgical alternative to repair for type II SLAP lesions in an older population; however, its efficacy in a younger population is not well studied. The objective of this study was to compare clinical outcomes between arthroscopic biceps tenodesis and labral repair for type II SLAP lesions in a young active population.Methods:Patients aged 15 to 40 who underwent primary arthroscopic shoulder surgery for type II SLAP tear between 2009 and 2015 with either a suprapectoral biceps tenodesis or labral repair were included in the study. Shoulders with intraarticular chondral damage, full thickness rotator cuff tear or rotator cuff repair, labral repair outside of the superior labrum, bony subacromial decompression, and acromioclavicular joint resection were excluded. Patient-reported outcomes (PRO) pre-operatively and at a minimum of one year after surgery were evaluated using the American Shoulder and Elbow Surgeons (ASES) score, Disabilities of the Arm, Shoulder, and Hand Sports/Performing Arts Module (DASH-sport), visual analog scale (VAS) for pain, and patient satisfaction. Complications and reoperation rates were also recorded. Statistical comparisons between the two groups were performed using the student t-test and chi-squared test with an alpha level of 0.05 indicating statistical significance.Results:Fifty-three patients were available for follow-up at an average of 3.2 years (range: 1.0-6.5 years). Twenty underwent biceps tenodesis and 33 underwent repair. Pre-operatively, there were no significant differences in mean ASES, DASH-sport, and VAS between biceps tenodesis and repair groups. Both groups had significant postoperative improvement in all PROs, and the average amount of change from preoperative to postoperative scores between the two groups was not significantly different for any of the PRO scores. Post-operatively, there were no significant differences in mean ASES, DASH-sport, VAS, and satisfaction between biceps tenodesis and repair groups (ASES: biceps tenodesis 87.1 vs. repair 86.9, P=0.97; DASH-sport: 17.0 vs. 19.5, P=0.75; VAS: 1.8 vs. 1.6, P=0.73; Satisfaction: 8.6 vs. 8.2, P=0.45). Rate of return to pre-injury level of play in sport/physical activity was also similar between groups (biceps tenodesis 55% vs. repair 50%, P=0.73). In the repair group, there was one minor complication involving a superficial paresthesia, and one other patient required reoperation (capsular release) after two years for persistent difficulty throwing in softball. There were no complications or reoperations in the biceps tenodesis group.Conclusion:In a young active population, biceps tenodesis may be a viable surgical alternative for type II SLAP lesions and may facilitate earlier return to activity compared to repair. Further research, particularly prospective randomized studies with longer time to follow-up, is warranted given the limitations of this preliminary study.

Diagnosis of Superior Labrum Anterior-to-Posterior Tears by Using MR Imaging and MR Arthrography: A Systematic Review and Meta-Analysis.

Purpose To evaluate the diagnostic accuracies of nonenhanced magnetic resonance (MR) imaging and MR arthrography for diagnosis of superior labrum anterior-to-posterior (SLAP) tears by using a systematic review and meta-analysis. Materials and Methods A comprehensive literature search was performed on the two main concepts of MR imaging (MR imaging, and direct and indirect MR arthrography) and SLAP tears. Inclusion criteria consisted of original studies that assessed the diagnostic accuracy of MR imaging, direct MR arthrography, and/or indirect MR arthrography for the detection of SLAP tears, by using surgical findings as the reference standard. The Quality Assessment of Diagnostic Accuracy Studies 2, or QUADAS-2 Quality Assessment of Diagnostic Accuracy Studies 2 Quality Assessment of Diagnostic Accuracy Studies 2 , tool was used to assess methodologic quality. Meta-analyses were performed that compared MR imaging studies to direct MR arthrography studies and indirect MR arthrography studies, 3-T studies to 1.5-T studies, and low-bias MR imaging studies to low-bias direct MR arthrography studies. Study variation was analyzed by using the Cochran Q test of heterogeneity and the I2 statistic. Results Thirty-two studies met inclusion and exclusion criteria, including 3524 imaging examinations: 1963 direct MR arthrography examinations (23 studies), 1402 MR examinations (14 studies), and 159 indirect MR arthrography examinations (three studies). Twelve studies had low risk for bias, two had questionable risk, and 18 had high risk. Mean sensitivities of direct MR arthrography, MR imaging, and indirect MR arthrography for SLAP tear diagnosis were 80.4%, 63.0%, and 74.2%, respectively. Mean specificities of direct MR arthrography, MR imaging, and indirect MR arthrography were 90.7%, 87.2%, and 66.5%, respectively. Summary receiver operator characteristic (ROC) curve demonstrated superior accuracy of direct MR arthrography compared with those of MR imaging and indirect MR arthrography. Similar findings were observed in the low-bias subanalysis. Summary ROC curve demonstrated overall superiority of 3-T imaging, with or without intra-articular contrast material compared with 1.5-T imaging, with or without intra-articular contrast material. Significant variance was observed for MR imaging and direct MR arthrography (P < .001) studies for both mean sensitivity and specificity. Conclusion Direct MR arthrography appears to be more accurate than nonenhanced MR imaging for diagnosis of SLAP tears, whereas 3-T MR imaging with or without intra-articular contrast material appears to improve diagnostic accuracy compared with 1.5-T MR imaging with or without intra-articular contrast material. © RSNA, 2017 Online supplemental material is available for this article.

Concomitant SLAP repair does not influence the surgical outcome for arthroscopic Bankart repair of traumatic shoulder dislocations.

Prior studies revealed the presence of superior labrum anterior-to-posterior (SLAP) injury together with Bankart lesions in some patients. The purpose of the study is to compare the clinical results of isolated Bankart repairs with the clinical results of Bankart repairs when performed with concomitant SLAP repairs. The patients who underwent arthroscopic surgery for treatment of anterior glenohumeral instability were evaluated retrospectively. Group 1 consisted of 19 patients who had arthroscopic SLAP repair together with Bankart repair. The mean age of the patients was 23. Group 2 consisted of 38 patients who underwent isolated Bankart repair. The mean age was 24. Knotless anchors were used in both groups. The mean follow-up was 34 months (range: 26-72). In group 1, the mean preoperative Constant score was 84 (range: 74-90, standard deviation (SD): 5.91) and Rowe score was 64.1 (range: 40-70, SD: 8.14). In group 2, the preoperative Constant score was 84.4 (range: 70-96, SD: 5.88) and Rowe score was 60 (range: 45-70, SD: 7.95). In group 1, the postoperative mean Constant score raised to 96.8 (range: 88-100, SD: 2.91) and the mean Rowe score raised to 92.3 (range: 85-100, SD: 5.17). In group 2, the postoperative mean Constant score was 94.9 (range: 88-100, SD: 3.70) and the mean Rowe score was 94.2 (range: 80-100, SD: 4.71). The difference between the scores of two groups was insignificant ( p > 0.05). When the numbers of redislocations and range of motion were compared, no significant difference was found ( p > 0.05). Accompanying SLAP repair in surgical treatment with Bankart repair for shoulder instability does not affect the results negatively. Properly repaired labral tears extending from anterior inferior to the posterior superior of the glenoid in instability treatment have the same outcome in overall results as repaired isolated Bankart lesions.

SLAP Yırtığı Şüphesi Olan Hastaların Konservatif Tedavisi

Objective: Outcome following non-operative management of superior labral anterior to posterior (SLAP) lesions has been under reported with little empirical data demonstrating the effectiveness of conservative treatment. Material and Methods: 10 patients, 5 matched pairs, presenting with symptoms consistent with a SLAP lesion performed a standardized phased rehabilitation program completing patient reported outcome (PRO) and pain measures before and following rehabilitation. Physical therapy notes and home exercise logs were reviewed and all exercises were recorded and coded using the phased rehabilitation protocol as a guide. At followup, patients were divided into two groups; responders and non-responders to treatment based on PRO. The volume of exercise and type of exercise performed for each patient were compared using frequency counts. Results: The non-responders did on average 33 more stretching exercises than the responders. The non-responders did on average 21 more scapular orientation exercises than the responders. There were few to no differences in the volume of strengthening exercises between the two groups except responders performed 38 more scapular retraction exercises at shoulder level while non-responders performed 49 more scapular retraction exercises below shoulder level. Conclusions: This case series identified few exercises that were beneficial to patients' responding to conservative intervention but more often identified exercises that were performed that did not facilitate an improved patient outcome. Therapeutic exercises are often the cornerstone of a rehabilitation program, yet limited evidence exists in which specific exercises are beneficial or not beneficial in patients with symptoms consistent with a SLAP lesion.

Problem Solving for Failed Superior Labrum Anterior to Posterior (SLAP) Repair

Problem Solving for Failed Superior Labrum Anterior to Posterior (SLAP) Repair

Arthroscopic Evaluation of Subluxation of the Long Head of the Biceps Tendon and Its Relationship with Subscapularis Tears.

BackgroundThe purpose of this study was to evaluate the angle between the long head of the biceps tendon (LHBT) and the glenoid during arthroscopic surgery and its correlation with biceps subluxation on magnetic resonance imaging (MRI). Furthermore, we evaluated the relationship of this angle with subscapularis tears and biceps pathologies.MethodsMRI and arthroscopic images of 270 consecutive patients who had undergone arthroscopic surgery were retrospectively evaluated. On MRI, 60 shoulders with biceps subluxation and 210 shoulders without subluxation were identified. On the arthroscopic view from the posterior portal, the angle between the LHBT and the glenoid (biceps-glenoid angle) was measured. The biceps-glenoid angle, tears of the LHBT, degenerative superior labrum anterior to posterior (SLAP) lesions, and presence of a subscapularis tear were compared according to the presence of biceps subluxation on MRI.ResultsIn the subluxation group, 51 (85%) had a subscapularis tendon tear and all shoulders showed biceps tendon pathologies. In the non-subluxation group, 116 (55.2%) had a subscapularis tendon tear, 125 (60%) had tears in the biceps tendon, and 191 (91%) had degenerative SLAP lesions. The incidences of subscapularis tears (p < 0.001) and biceps pathologies (p < 0.001) showed significant differences. The mean biceps-glenoid angle was 87.0° (standard deviation [SD], 11.4°) in the subluxation group and 90.0° (SD, 9.6°) in the non-subluxation group, showing a statistically significant difference (p = 0.037).ConclusionsShoulders with subluxation of the biceps tendon on the preoperative MRI revealed more pathologies in the subscapularis tendon and biceps tendon during arthroscopy. However, the arthroscopically measured biceps-glenoid angle did not have clinical relevance to the determination of subluxation of the LHBT from the bicipital groove.

Is There a Clinically Important Superior Labrum Anterior to Posterior (SLAP) Lesion?

Is There a Clinically Important Superior Labrum Anterior to Posterior (SLAP) Lesion?

Dynamic Ultrasonography of the Intra-Articular Long Head Biceps Tendon and Superior Labrum.

This feature is a unique combination of text (voice) and video that more clearly presents and explains procedures in musculoskeletal medicine. These videos will be available on the journal’s Website. We hope that this new feature will change and enhance the learning experience. URL: http://journals.lww.com/ajpmr/Pages/videogallery.aspx?videoId=32 URL: http://journals.lww.com/ajpmr/Pages/videogallery.aspx?videoId=33 URL: http://journals.lww.com/ajpmr/Pages/videogallery.aspx?videoId=34 The long head of the biceps tendon (LHBT) originates from the superior labrum and the glenoid of the scapula. It lies between the supraspinatus and subscapularis tendons, namely, the rotator interval. Superior labrum anterior to posterior (SLAP) lesion is a tear of the superior labrum near the attachment of the LHBT.1 It is frequently encountered in overhead throwing activities when overloading of the LHBT occurs during extreme range of shoulder external rotation at late-cocking phase, or rapid deceleration of the arm at follow-through phase.2,3 The clinical diagnosis can be quite challenging because of its nonspecific symptoms and its frequent association with other shoulder pathology such as rotator cuff tears.1,4 Ultrasound (US) had not been considered feasible for evaluation of LHBT insertion at the superior labrum, partly owing to blocking of surrounding bony structures and inadequate penetration of ultrasound beam. Arthroscopy, arthrography, or magnetic resonance imaging is usually required for a definite diagnosis.2,5 We propose a novel method for dynamic evaluation of the LHBT insertion at the superior labrum. A low-frequency (5–8 MHz) curvilinear probe is required for better penetration and extended view. The patient places the ipsilateral hand on the waist, with the elbow pointing laterally. In this position, the LHBT is slightly rotated anteriorly and shifted from beneath the acromion. The probe is put in the oblique coronal plane at the window between the coracoid process and acromioclavicular joint, parallel to the orientation of the LHBT (Fig. 1A, left lower insert). The LHBT appears as a fibrillar hyperechoic band, coursing around the superior humeral head, and inserts on the triangular hyperechoic superior labrum (Fig. 1A). Note that the intra-articular portion of LHBT becomes hypoechoic owing to anisotropy, as the tendon goes deeper gradually. Video 1 demonstrates tracing of the LHBT from the bicipital groove to its proximal insertion.FIGURE 1: A, Long head of the biceps tendon (LHBT) (arrowheads) appears as a fibrillar hyperechoic band, coursing around the superior humeral head, and inserts on the triangular hyperechoic superior labrum (crosses). The intra-articular portion of LHBT is hypoechoic owing to anisotropy. B, Forearm supination causes the LHBT traction at the superior labrum, making the edge of the superior labrum much clear as well as the intra-articular portion of LHBT. The left lower inserts indicate probe positioning and patient posture.Dynamic examination is performed by supinating and pronating the forearm while keeping the upper arm fixed. The LHBT is stretched when the forearm is actively supinated, causing traction of the tendon at the superior labrum. The lateral edge of the superior labrum becomes better visualized as well as the intra-articular portion of LHBT (Fig. 1B). The integrity of the anterior superior glenohumeral joint and peritendinous fluid can be assessed in this maneuver. The dynamic imaging is also presented in the attached video (Video 2). The demonstration of labral insertion of LHBT allows for evaluation of a possible SLAP lesion. A dynamic stress test, by applying an inferior distraction force to the humerus, can also be done (Fig. 2 and Video 3). Investigation of a proximal LHBT lesion must be cautious owing to the anisotropy effect. It should be noted that part of the superior labrum, other than the insertion of LHBT, is difficult to evaluate by US, and arthrography or magnetic resonance imaging remains the diagnostic choices in case of SLAP lesion. Yet, with the advantages of excellent diagnostic power for accompanying rotator cuff lesions, noninvasiveness, accessibility, and relatively low-cost US can serve as a useful tool for screening for suspected SLAP and accompanying lesions and for follow-up of treatment.FIGURE 2: By applying an inferior distraction force (red arrow in the insert) to the humerus in a dynamic stress test, the integrity of the labral insertion (crosses) of the long head of the biceps tendon (arrowheads) can be evaluated for a possible superior labrum anterior and posterior lesion. The right lower insert indicates probe positioning and patient posture.

Correlation between physical examination and intraoperative findings in shoulder disease treated by arthroscopy. Statistical analysis of 150 patients

IntroductionOnly a few clinical exploratory manoeuvres are truly discriminatory and useful in shoulder disease. The aim of this study is to correlate the physical examination results of the shoulder with the true diagnosis found by arthroscopy. MethodsA retrospective case series of 150 patients with the most common surgical conditions of the shoulder. Data were collected on the suspicion of each pathology, the physical examination of the patient, and the actual discovery of the disease during arthroscopic surgery. ResultsThe Bankart examination manoeuvres of the lesion show the best results, with a 92.1% positive prediction value (PPV), a 99.1% negative predictive value (NPV), followed by the impingement syndrome, with a PPV of 94.4%, and total cuff rupture with a PPV of 92.3%.Exploration of the superior labrum anterior to posterior (SLAP) lesion had an NPV of 99.1%. ConclusionPhysical examination is sufficient to diagnose or rule out Bankart. A positive physical examination provides the complete rupture of the rotator cuff, and requires further studies. The patients suspected of subacromial syndrome only need an NMR if the physical tests are negative.The conclusions drawn from this work can have a significant impact on both cost savings (by reducing forward tests), and saving time in certain cases in which, after appropriate physical examination, surgery may be indicated without losing time in intermediate steps.

Correlación entre la exploración física y los hallazgos intraoperatorios de patología de hombro tratada mediante artroscopia. Análisis estadístico de 150 pacientes

IntroductionOnly a few clinical exploratory manoeuvres are truly discriminatory and useful in shoulder disease. The aim of this study is to correlate the physical examination results of the shoulder with the true diagnosis found by arthroscopy. MethodsA retrospective case series of 150 patients with the most common surgical conditions of the shoulder. Data were collected on the suspicion of each pathology, the physical examination of the patient, and the actual discovery of the disease during arthroscopic surgery. ResultsThe Bankart examination manoeuvres of the lesion show the best results, with a 92.1% positive prediction value (PPV), a 99.1% negative predictive value (NPV), followed by the impingement syndrome, with a PPV of 94.4%, and total cuff rupture with a PPV of 92.3%.Exploration of the superior labrum anterior to posterior (SLAP) lesion had an NPV of 99.1%. ConclusionPhysical examination is sufficient to diagnose or rule out Bankart. A positive physical examination provides the complete rupture of the rotator cuff, and requires further studies. The patients suspected of subacromial syndrome only need an NMR if the physical tests are negative.The conclusions drawn from this work can have a significant impact on both cost savings (by reducing forward tests), and saving time in certain cases in which, after appropriate physical examination, surgery may be indicated without losing time in intermediate steps.

Supraspinatus Unusual Atrophy Pattern: A Case Report

We present the case of an unusual atrophy pattern of the supraspinatus muscle subsequent to suprascapular nerve compression by a paralabral cyst located in the spinoglenoid notch. A 58-year-old right-handed manual female worker presented to a specialized shoulder consultation with severe progressive pain in her right shoulder. Clinical exam revealed isolated limitation in active abduction and a painful Jobe test. MR-arthrogram showed a 12 × 10 mm paralabral cyst consecutive to a superior labral anterior to posterior (SLAP) II lesion, associated with an isolated supraspinatus Thomazeau stage II atrophy and Goutallier stage II fatty infiltration. A rotator cuff tear was excluded. After a failed nonoperative management, the patient underwent arthroscopic cyst decompression, SLAP debridement and biceps tenodesis, and presented satisfactory pain relief at 12 months follow-up with a constant score of 76 points. A control MR-arthrogram showed no recurrence of the cyst with regression of atrophy to stage I. In addition to confirm the known association between SLAP lesions and paralabral cysts, and to support the debated reversibility of atrophy, this presented case reveals the existence of a new type of lesion induced by suprascapular nerve compression, consisting in isolated denervation of the supraspinatus muscle. This can be explained by an anatomic variation of the supraspinatus branch of the nerve which had an unusually distal origin, whereas typical compression patterns involve either supraspinatus and infraspinatus, or infraspinatus alone.

Usefulness of Unenhanced MRI and MR Arthrography of the Shoulder in Detection of Unstable Labral Tears.

Shoulder surgeons commonly intervene to repair unstable labral tears (tears that displace with patient movement). Surgeons can detect unstable tears at surgery. It is difficult to be certain if a tear is unstable from a static MR image. This study reports the comparative benefits of using unenhanced MRI and MR arthrography together to detect unstable labral tears. One hundred fifty consecutive unenhanced shoulder MRI and MR arthrography examinations performed on the same patients were reviewed retrospectively by consensus reading of two musculoskeletal radiologists. Both unenhanced MRI and MR arthrography were performed on each patient on the same day. Labral tears were assessed. It was also determined if there was any difference in position of the labral tear between unenhanced MR images and MR arthrograms. A change in position of 4 mm or more between unenhanced MR images and MR arthrograms was considered indicative of an unstable tear. All patients proceeded to arthroscopy. Of these 150 patients, 94 had superior labral anterior-to-posterior (SLAP) tears, 53 had posterior labral tears, and 42 had anterior labral tears on MRI. All lesions described on MRI were described on arthroscopy. Twenty-three SLAP tears, 16 posterior labral tears, and 17 anterior labral tears showed a change in the position of the labral tear when comparing unenhanced MR images versus MR arthrograms of 4 mm or more. All of these labral tears were considered unstable by the surgeon, and all of these patients had surgical tacking performed. The other labral tears showed motion on unenhanced MR images and MR arthrograms of less than 4 mm. All of these tears except for three were considered stable on arthroscopic examination. There were five SLAP tears, three anterior labral tears, and four posterior labral tears seen on arthroscopy that were not seen on unenhanced MRI or MR arthrography. The tears not seen on unenhanced MRI or MR arthrography were considered stable at arthroscopy. In this study, unenhanced MRI and MR arthrography of the shoulder was useful in diagnosing unstable labral tears in 23 patients with SLAP tears, 16 patients with posterior labral tears, and 17 patients with anterior labral tears. This information was useful in surgical planning. Of 133 tears that moved less than 4 mm on unenhanced MR images and MR arthrograms, 130 were considered stable on arthroscopy.

The shoulder.

The shoulder.

Age-related Outcome of Arthroscopic Repair of Isolated Type II Superior Labral Anterior to Posterior Lesions

Background: Repair of superior labral anterior to posterior (SLAP) lesion in patients older than 40 years is controversial. The purpose of this study was to evaluate clinical outcomes of arthroscopic repair of SLAP lesions between younger and older patient groups. Methods: We reviewed 50 patients with isolated type II SLAP lesions who underwent arthroscopic repair. Patients were divided into 2 groups: group 1 included 20 patients aged Results: No significant differences in functional scores or postoperative ROM were observed between the 2 groups. In group 2, later recovery of ROM (forward flexion, p=0.025; internal rotation, p=0.034) and lower satisfaction score (p=0.06) were observed for atraumatic patients (n=16) compared to patients with traumatic injury (n=14). Fifteen patients in group 1 (15/17, 88%) and 21 patients in group 2 (21/26, 81%) demonstrated a healed labrum on postoperative CT arthrography, and this difference was not significant. Conclusions: The results of this study suggest that arthroscopic repair of type II SLAP lesions can yield good functional and anatomical outcomes regardless of age, if patient selection is adequate. However, the delay in ROM recovery and lower satisfaction, particularly in older patients without traumatic injury, should be considered.

Is Age a Factor in Diagnosis and Treatment for Superior Labral Anterior to Posterior (SLAP) Lesion?

Copyright © 2015 Korean Shoulder and Elbow Society. All Rights Reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. pISSN 2383-8337 eISSN 2288-8721 EDITORIAL

Type 2 Superior Labral Anterior to Posterior Lesion-Related Paralabral Cyst Causing Isolated Infraspinatus Paralysis: Two Case Reports.

Type 2 superior labral anterior to posterior (SLAP) lesion is a common cause of shoulder pain requiring surgical operation. SLAP tears are often associated with paralabral cysts, but they rarely cause nerve compression. However, we experienced two cases of type 2 SLAP-related paralabral cysts at the spinoglenoid notch which were confirmed as isolated nerve entrapment of the infraspinatus branch of the suprascapular nerve by electrodiagnostic assessment and magnetic resonance imaging. In these pathological conditions, comprehensive electrodiagnostic evaluation is warranted for confirmation of neuropathy, while surgical decompression of the paralabral cyst combined with SLAP repair is recommended.

Arthroscopic tenodesis of the long head of the biceps.

The long head of the biceps (LHB) is commonly implicated in shoulder pathology due to its anatomic course and intimacy with the rotator cuff and superior labrum of the glenoid. Treatment of tendinosis of the LHB may be required secondary to partial thickness tears, instability/subluxation, associated rotator cuff tears, or SLAP (superior labrum, anterior to posterior) lesions. Treatment options include open or arthroscopic techniques for tenodesis vs tenotomy. Controversy exists in the orthopedic literature regarding the preferred procedure. The all-arthroscopic biceps tenodesis technique is a viable and reproducible option for treatment. This article provides a review of the all-arthroscopic biceps tenodesis technique using proximal interference screw fixation and its subsequent postoperative regimen. All-arthroscopic biceps tenodesis maintains elbow flexion and supination power, minimizes cosmetic deformities, and leads to less fatigue soreness after active flexion. Thus, arthroscopic biceps tenodesis should be offered and encouraged as a treatment option for younger, active patients.

External rotation and active supination CT arthrography for the postoperative evaluation of type II superior labral anterior to posterior lesions.

To evaluate the effectiveness of external rotation and active supination CT arthrography in postoperative evaluation by comparing it with neutral CT arthrography and analyzing its agreement with postoperative clinical results after the repair of type II superior labral anterior to posterior (SLAP) lesions. A total of 25 patients who had undergone CT arthrography in neutral, external rotation and active supination position at least 1 year after the arthroscopic repair of SLAP lesions were enrolled. Two radiologists independently evaluated the status of the repaired SLAP lesions with neutral CT arthrography and then with external rotation and active supination CT arthrography. Five patients had residual symptoms and positive findings upon SLAP-specific examinations. Agreements between the presence of symptoms and radiologic diagnoses based on neutral CT arthrography were insignificant for reader 1 (κ = 0.138, p = n.s.) and significant for reader 2 (κ = 0.328, p = 0.027). However, agreements were highly significant in the analysis following the evaluation of external rotation and active supination CT arthrography for both readers (κ = 0.694, p < 0.001 in reader 1; κ = 0.783, p < 0.001 in reader 2). The presence of contrast-filled gaps between the labrum and glenoid on neutral CT arthrography after SLAP repair is frequent with satisfactory clinical outcomes. Gaps without additional widening upon external rotation and active supination CT arthrography may suggest postoperatively stable biceps anchors, so this new method could minimize the overdiagnosis of recurrent SLAP lesions. Additional gap widening on external rotation and active supination CT arthrography could be related to a true recurrent SLAP lesion and the symptoms of the patients. Case series, Level IV.

The Impact of Superior Labral Anterior to Posterior Lesions on Functional Status in Shoulder Instability: A Multicenter Cohort Study.

Background:Type IV superior labral anterior to posterior (SLAP) lesions, which are superior labral detachments associated with Bankart tears, are reported to occur in up to 25% of recurrent shoulder instability patients. However, the clinical implications of this finding are debatable.Purpose:To determine whether there are any functional differences between anterior instability patients with and without type IV SLAP lesions at the time of presentation and at short-term follow-up after surgical intervention.Study Design:Cohort study; Level of evidence, 2.Methods:A prospective, multicenter database was established to follow the clinical evolution of patients with shoulder instability. Patients were diagnosed as having a type IV SLAP lesion at the time of arthroscopic Bankart surgery (SLAP+). These patients were compared with a group of patients who simply had a Bankart lesion (SLAP–). The 2 groups had their functional outcomes (Western Ontario Shoulder Instability Index [WOSI]; Disability of the Arm, Shoulder, and Hand [QuickDASH]; and Walch-Duplay) compared prior to surgery and 1 year postoperatively.Results:A total of 103 subjects were included in the study; of these, 56 (43 men, 13 women) completed 1-year follow-up. Twenty-three subjects had a type IV SLAP tear, and most had this repaired along with their Bankart lesion. At baseline, SLAP+ subjects had inferior QuickDASH scores compared with SLAP– subjects (37.8 vs 29.0) as well as poorer pain subscores on both the WOSI and QuickDASH. At 1-year follow-up, however, there were no significant differences in any of the outcome measures.Conclusion:A type IV SLAP lesion can be expected in 22% of patients with recurrent shoulder instability. This finding implies that at baseline, the patient will have slightly worse functional scores related to pain. However, following surgical management of the labral pathology, these patients will have equivalent functional outcomes at short-term follow-up.Clinical Relevance:With surgical management of the superior and anteroinferior labrum, patients with type IV SLAP lesions will do as well as those with only Bankart tears. Thus, the presence of SLAP lesions should not alter the decision to provide surgical management and should not change the prognosis for a specific patient.

The arterial supply of the tendon of the long head of the biceps brachii in the human: A combined anatomical and radiological study

PurposeArthroscopic repair of superior labral anterior to posterior (SLAP) lesions is often associated with a prolonged period of pain during the rehabilitation process. This might possibly be due to hypoxia in the biceps tendon anchor caused by sutures. The purpose of the study was to investigate the arterial supply of the long head of the biceps brachii tendon (LHBT) that may be impaired by surgery in the region of the biceps tendon anchor. MethodsOn 20 human formalin-fixed bodies, the anterior circumflex humeral artery (ACHA) was located and followed into the intertubercular groove until it reached the LHBT. On 10 fresh-frozen anatomic specimens of the upper extremities, contrast medium was injected into the axillary artery, a 3D scan was performed, and multiplanar reconstructed (MPR) slices were generated. A set of maximum intensity projection (MIP) reconstructions from 10 computed tomography angiographies (CTA) of the upper extremities was used to confirm the findings of the 3D scan. ResultsAll anatomical dissections and radiological investigations revealed that the proximal portion of the LHBT was consistently supplied by an ascending branch of the ACHA. No artery was found to supply the biceps tendon anchor from the proximal aspect. ConclusionsAs the arterial supply of the LHBT is mainly provided by the ACHA, which enters the glenohumeral joint from the distal aspect, surgery at the bony origin of the LHBT may not interfere with this specific vessel.