title: SLAP lesions: a treatment algorithm.
abstract: Tears of the superior labrum involving the biceps anchor are a common entity, especially in athletes, and may highly impair shoulder function. If conservative treatment fails, successful arthroscopic repair of symptomatic SLAP lesions has been described in the literature particularly for young athletes. However, the results in throwing athletes are less successful with a significant amount of patients who will not regain their pre-injury level of performance. The clinical results of SLAP repairs in middle-aged and older patients are mixed, with worse results and higher revision rates as compared to younger patients. In this population, tenotomy or tenodesis of the biceps tendon is a viable alternative to SLAP repairs in order to improve clinical outcomes. The present article introduces a treatment algorithm for SLAP lesions based upon the recent literature as well as the authors' clinical experience. The type of lesion, age of patient, concomitant lesions, and functional requirements, as well as sport activity level of the patient, need to be considered. Moreover, normal variations and degenerative changes in the SLAP complex have to be distinguished from "true" SLAP lesions in order to improve results and avoid overtreatment. The suggestion for a treatment algorithm includes: type I: conservative treatment or arthroscopic debridement, type II: SLAP repair or biceps tenotomy/tenodesis, type III: resection of the instable bucket-handle tear, type IV: SLAP repair (biceps tenotomy/tenodesis if >50 % of biceps tendon is affected), type V: Bankart repair and SLAP repair, type VI: resection of the flap and SLAP repair, and type VII: refixation of the anterosuperior labrum and SLAP repair.
authors.affiliation: Department of Orthopedic Surgery, Saarland University, Kirrberger Str., 66421, Homburg/Saar, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Brockmeyer
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.|TRIA Orthopaedic Center, Minneapolis, MN, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Tompkins
authors.affiliation: Department of Orthopedic Surgery, Saarland University, Kirrberger Str., 66421, Homburg/Saar, Germany.
authors.forename: Dieter M
authors.initials: DM
authors.lastname: Kohn
authors.affiliation: Department of Orthopedic Surgery, Saarland University, Kirrberger Str., 66421, Homburg/Saar, Germany. olaf.lorbach@gmx.de.
authors.forename: Olaf
authors.initials: O
authors.lastname: Lorbach
mesh_terms: D000328:Adult; D000465:Algorithms; D001134:Arm Injuries / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D001182:Arthroscopy; D003646:Debridement; D051445:Fibrocartilage / Q000293:injuries / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D012086:Reoperation; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000601:surgery*; D020069:Shoulder Pain / Q000209:etiology; D013708:Tendon Injuries / Q000175:diagnosis / Q000601:surgery*
keywords: Biceps tendon; SLAP lesion; Shoulder; Superior labrum; Treatment algorithm
references.citation: Int J Surg. 2013;11(9):876-81
references.pmid: 23917210
references.citation: Arthroscopy. 1994 Jun;10(3):241-7
references.pmid: 8086014
references.citation: Am J Sports Med. 2003 Sep-Oct;31(5):724-7
references.pmid: 12975193
references.citation: Sports Med Arthrosc. 2010 Sep;18(3):162-6
references.pmid: 20711047
references.citation: J Bone Joint Surg Br. 1994 Nov;76(6):951-4
references.pmid: 7983126
references.citation: Radiology. 2001 Jan;218(1):127-32
references.pmid: 11152790
references.citation: Int Orthop. 2011 Aug;35(8):1187-95
references.pmid: 21369793
references.citation: Orthopade. 2000 Oct;29(10):917-27
references.pmid: 11142911
references.citation: J Shoulder Elbow Surg. 2012 Jun;21(6):728-31
references.pmid: 22608836
references.citation: Arthroscopy. 2004 Jul;20 Suppl 2:129-33
references.pmid: 15243446
references.citation: Am J Sports Med. 2011 Jan;39(1):114-20
references.pmid: 20940452
references.citation: J Shoulder Elbow Surg. 1992 Sep;1(5):238-45
references.pmid: 22959196
references.citation: Clin Orthop Relat Res. 1991 Aug;(269):162-73
references.pmid: 1864035
references.citation: Arthroscopy. 2004 Mar;20(3):231-6
references.pmid: 15007311
references.citation: Am J Sports Med. 2009 Sep;37(9):1840-7
references.pmid: 19509414
references.citation: Clin Sports Med. 2000 Jan;19(1):115-24
references.pmid: 10652668
references.citation: Orthop Clin North Am. 1993 Jan;24(1):45-53
references.pmid: 8421615
references.citation: J Sports Med Phys Fitness. 2012 Feb;52(1):71-9
references.pmid: 22327089
references.citation: Arthroscopy. 2002 Apr;18(4):372-7
references.pmid: 11951195
references.citation: AJR Am J Roentgenol. 1999 Oct;173(4):1117-22
references.pmid: 10511190
references.citation: Arthroscopy. 1990;6(4):274-9
references.pmid: 2264894
references.citation: Am J Sports Med. 1995 Jan-Feb;23 (1):93-8
references.pmid: 7726358
references.citation: Sports Health. 2013 Jul;5(4):367-76
references.pmid: 24459557
references.citation: Am J Sports Med. 2009 May;37(5):929-36
references.pmid: 19229046
references.citation: AJR Am J Roentgenol. 2011 Sep;197(3):604-11
references.pmid: 21862802
references.citation: Am J Sports Med. 2008 Feb;36(2):247-53
references.pmid: 17940144
references.citation: Am J Sports Med. 2014 Apr;42(4):820-5
references.pmid: 24519182
references.citation: Am J Orthop (Belle Mead NJ). 2015 Nov;44(11):491-4
references.pmid: 26566547
references.citation: J Bone Joint Surg Am. 2009 Jul;91(7):1595-603
references.pmid: 19571081
references.citation: Arthroscopy. 2008 May;24(5):500-5
references.pmid: 18442680
references.citation: Am J Sports Med. 2010 Nov;38(11):2299-303
references.pmid: 20739578
references.citation: Am J Sports Med. 2011 Sep;39(9):1883-8
references.pmid: 21737836
references.citation: J Bone Joint Surg Am. 2003 Apr;85-A(4):653-9
references.pmid: 12672841
references.citation: Knee Surg Sports Traumatol Arthrosc. 2004 May;12 (3):229-34
references.pmid: 14712345
references.citation: J Shoulder Elbow Surg. 2014 Jul;23(7):1059-65
references.pmid: 24388713
references.citation: Arthroscopy. 2003 May-Jun;19(5):517-23
references.pmid: 12724682
references.citation: Arthroscopy. 1998 Sep;14(6):637-40
references.pmid: 9754487
references.citation: Orthop J Sports Med. 2015 Aug 14;3(8):2325967115599154
references.pmid: 26535389
references.citation: Am J Sports Med. 2005 Apr;33(4):507-14
references.pmid: 15722289
references.citation: Am J Sports Med. 1993 May-Jun;21(3):425-30; discussion 430-1
references.pmid: 8346758
references.citation: Am J Sports Med. 2015 May;43(5):1274-82
references.pmid: 24961444
references.citation: Arthroscopy. 2012 Apr;28(4):451-7
references.pmid: 22264832
references.citation: Am J Sports Med. 2013 Apr;41(4):880-6
references.pmid: 23460326
references.citation: Acta Orthop Traumatol Turc. 2014;48(3):290-7
references.pmid: 24901919
references.citation: Int J Shoulder Surg. 2015 Jul-Sep;9(3):74-80
references.pmid: 26288536
references.citation: Arthroscopy. 2008 Mar;24(3):311-7
references.pmid: 18308183
references.citation: Am J Sports Med. 2014 Aug;42(8):1904-10
references.pmid: 24890780
references.citation: Am J Sports Med. 1985 Sep-Oct;13(5):337-41
references.pmid: 4051091
references.citation: J Shoulder Elbow Surg. 1995 Jul-Aug;4(4):243-8
references.pmid: 8542365
references.citation: Knee Surg Sports Traumatol Arthrosc. 2016 Dec;24(12 ):3870-3876
references.pmid: 26328801
references.citation: J Orthop Sports Phys Ther. 2009 Feb;39(2):71-80
references.pmid: 19194018
references.citation: Am J Sports Med. 1991 Sep-Oct;19(5):428-34
references.pmid: 1962705