Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2015; 6(9): 660-671
Published online Oct 18, 2015. doi: 10.5312/wjo.v6.i9.660
Superior labral anterior posterior lesions of the shoulder: Current diagnostic and therapeutic standards
Dominik Popp, Volker Schöffl
Dominik Popp, Volker Schöffl, Section of Sportsorthopedics, Sportsmedicine, Sportstraumatology, Shoulder and Elbow Surgery, Department for Orthopedics and Traumatology, Sozialstiftung Bamberg, Klinikum am Bruderwald, 96049 Bamberg, Germany
Author contributions: Popp D and Schöffl V contributed equally to this paper.
Conflict-of-interest statement: The authors declare not to have any competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dominik Popp, MD, Section of Sportsorthopedics, Sportsmedicine, Sportstraumatology, Shoulder and Elbow Surgery, Department for Orthopedics and Traumatology, Sozialstiftung Bamberg, Klinikum am Bruderwald, Buger Str. 80, 96049 Bamberg, Germany. dominik.popp@sozialstiftung-bamberg.de
Telephone: +49-951-50315552
Received: February 8, 2015
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.

Keywords: Superior labral anterior posterior lesion, Tenodesis, Superior labral anterior posterior repair, Shoulder arthroscopy, Biceps tendon

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.