title: External rotation and active supination CT arthrography for the postoperative evaluation of type II superior labral anterior to posterior lesions.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Case series, Level IV.
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea. drjacobkim@gmail.com.
authors.forename: Sae Hoon
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, Korea. drchoi01@gmail.com.
authors.forename: Ja-Young
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, Korea. dalnara3@gmail.com.
authors.forename: Hye Jin
authors.initials: HJ
authors.lastname: Yoo
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, Korea. drhong@snu.ac.kr.
authors.forename: Sung Hwan
authors.initials: SH
authors.lastname: Hong
mesh_terms: D000328:Adult; D001175:Arthrography; D001182:Arthroscopy; D005260:Female; D051445:Fibrocartilage / Q000000981:diagnostic imaging* / Q000293:injuries / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012399:Rotation; D012540:Scapula / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D012785:Shoulder Joint / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D013484:Supination; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Biceps anchor stability; CT arthrography; External rotation and active supination; Repair; SLAP lesion