Published online Oct 18, 2015. doi: 10.5312/wjo.v6.i9.660
Peer-review started: February 9, 2015
First decision: March 6, 2015
Revised: July 18, 2015
Accepted: August 4, 2015
Article in press: August 7, 2015
Published online: October 18, 2015
Surgical treatment of superior labral anterior posterior (SLAP) lesion becomes more and more frequent which is the consequence of evolving progress in both, imaging and surgical technique as well as implants. The first classification of SLAP lesions was described in 1990, a subdivision in four types existed. The rising comprehension of pathology and pathophysiology in SLAP lesions contributed to increase the types in SLAP classification to ten. Concerning the causative mechanism of SLAP lesions, acute trauma has to be differed from chronic degeneration. Overhead athletes tend to develop a glenohumeral internal rotation deficit which forms the basis for two controversial discussed potential mechanisms of pathophysiology in SLAP lesions: Internal impingement and peel-back mechanism. Clinical examination often remains unspecific whereas soft tissue imaging such as direct or indirect magnetic resonance arthrography has technically improved and is regarded to be indispensable in detection of SLAP lesions. Concomitant pathologies as Bankart lesions, rotator cuff tears or perilabral cysts should be taken into consideration when planning a personalized therapeutic strategy. In addition, normal variants such as sublabral recess, sublabral hole, Buford complex and other less common variants have to be distinguished. The most frequent SLAP type II needs a sophisticated approach when surgical teatment comes into consideration. While SLAP repair is considered to be the standard operative option, overhead athletes benefit from a biceps tenodesis because improved patient-reported satisfaction and higher rate of return to pre-injury level of sports has been reported.
Core tip: Superior labral anterior posterior (SLAP) lesions often lead to painful shoulder impairment and especially in overhead athletes to restriction in sport specific activity. In the context of diagnostic examination, magnetic resonance arthrography is of particular importance, not only in detection of SLAP lesions and concomitent pathologic findings but also in differentiation from normal anatomic variants. Therapeutic options include-besides conservative treatment- arthroscopic SLAP repair and biceps tendon tenodesis. Decision-making in SLAP lesions remains challenging and requires a distinct evaluation of individual patient history, accurate examination and detailed analysis of imaging to meet the requirements of a personalized treatment.