Superior Labrum Anterior – Posterior (SLAP) Lesion: Consideration and Controversies

SLAP tears are a common pathology, observed in 26% of patients undergoing shoulder arthroscopy. First described by Andrews et al, SLAP tears were then further subclassified by Snyder et al. The variable relationship between the anterosuperior labrum and the glenohumeral ligaments has important implications for the evaluation and treatment of SLAP lesions. These normal variants include a sublabral recess / foramen (3.3%), a sublabral foramen with a cord-like MGHL (8.6%) and an absent anterosuperior labrum with a cord-like MGHL (i.e. Buford complex, 1.5%). Frequently accepted mechanisms of injury include forceful traction loads to the arm, direct compression loads, and repetitive overhead throwing activities. SLAP lesions are difficult to examine accurately, because that most SLAP lesions occur concomitantly with other shoulder injuries (e.g. glenohumeral instability, rotator cuff tears, biceps tendon ruptures), and they typically have no specific associated pain pattern. Several provocative tests for SLAP tears have been described, however, none of these tests has been found to be highly accurate for diagnosis of SLAP tears. The definitive diagnosis of SLAP lesions is best made through diagnostic arthroscopy. Treatment of these lesions is directed according to its type. Treatment ranges from non-operative management to surgical management including SLAP repair, biceps tenotomy, and biceps tenodesis. The management of Type-II SLAP (most common) of the shoulder remains a controversial topic. Whether to repair a shoulder SLAP lesion or perform a biceps tenodesis depends on a multitude of factors: patient age, activity or work level, type of SLAP tear, location of SLAP tear, and quality of labral tissue. Determining which procedure to perform does not have such a simple, one-size-fits-all solution.