title: The Impact of Superior Labral Anterior to Posterior Lesions on Functional Status in Shoulder Instability: A Multicenter Cohort Study.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Université de Montréal and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Gaudelli
authors.affiliation: Université de Montréal, Montréal, Québec, Canada.
authors.forename: Jonah
authors.initials: J
authors.lastname: Hébert-Davies
authors.affiliation: Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Balg
authors.affiliation: Centre Hospitalier Affilié Universitaire de Québec, Québec, Canada.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Pelet
authors.affiliation: Centre Hospitalier Universitaire de Vaudois, Lausanne, Switzerland.
authors.forename: Ali
authors.initials: A
authors.lastname: Djahangiri
authors.affiliation: Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
authors.forename: Véronique
authors.initials: V
authors.lastname: Godbout
authors.affiliation: Université de Montréal and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
authors.forename: Dominique M
authors.initials: DM
authors.lastname: Rouleau
keywords: SLAP tear; functional outcome measures; shoulder instability