J Korean Orthop Assoc.  2017 Oct;52(5):385-391. 10.4055/jkoa.2017.52.5.385.

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

• Park JY
• Lee JH
• Lee JG

• KMID: 2393510
• DOI: http://doi.org/10.4055/jkoa.2017.52.5.385

Abstract

Stiffness and pain are major causes of failed superior labral anterior to posterior (SLAP) repair. The term, "˜failed SLAP repair', can be defined as stiffness or pain without rotator cuff tears, acromio-clavicular pathology, arthritis, impingement syndrome, and other shoulder diseases. Moreover, it does not respond to conservative management. Generally, for failed SLAP repair, the initial conservative management includes physical therapy, strengthening exercise, oral medications, and injections. In addition, with failed conservative treatment, surgical intervention can be carried out. Surgical indications must be in consideration with patients' age, mechanism of injury, stability of the lesion, activity, former history of sports activity, and types of sports. Surgical treatments include debridement, SLAP repair, biceps tenodesis and tenotomy. However, each type of surgical method is controversial on both indications and prognosis. Surgical treatment on SLAP lesion is increasing, and studies on failed SLAP repair are expanding. The recommended first line therapy for failed SLAP lesion is conservative management, and with limited and thorough indications, surgical treatment yields good results, depending on concurrent lesions. However, authors recommend that it is important to seek for adjacent lesions prior to the initial SLAP repair to decrease failed SLAP repair.

Keyword

superior labral anterior to posterior; failed superior labral anterior to posterior repair; tenotomy; tenodesis

MeSH Terms

Arthritis
Debridement
Methods
Pathology
Problem Solving*
Prognosis
Rotator Cuff
Shoulder
Sports
Tears
Tenodesis
Tenotomy

Figure

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  Figure 1 Magnetic resonance angiography finding of the re-torn site after superior labrum repair; a contrast material leakage in superior labrum and showing high signal intensity between superior labrum and superior glenoid.

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  Figure 2 Loose stitch after failed superior labral anterior to posterior repair.

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  Figure 3 Removal of loose stitch.

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  Figure 4 Complete removal of the loose stitch and insertion of suture anchor after decortication of the superior glenoid.

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  Figure 5 Arthroscopic finding after repair of failed superior labral anterior to posterior lesion.

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