Gazi HURİ, Yoon Suk HYUN, Nickolas G. GARBIS, Edward G. McFARLAND

Treatment of superior labrum anterior posterior lesions: a literature review

Amaç:Superior labrum anterior posterior (SLAP) lezyonlarının tedavisi tartışmalı olmaya devam etmekle birlikte, sütür ankorlarının gelişimiyle bu lezyonların artroskopik ile onarımı kabul görmeye başlamıştır. Bu çalışmanın amacı; biseps tenodezi ve SLAP onarım sonuçlarının karşılaştırılmasına da vurgu yaparak, SLAP lezyonlarının değerlendirilmesi ve tedavisine dair son eğilimleri incelemekti. Çalışma planı: PubMed, Cochrane ve SCOPUS veri tabanlarında yer alan ve biseps tendonları, SLAP lezyonları ile biseps cerrahisi hakkında 1928 ile 2012 yılları arasında yayımlanan tüm İngilizce çalışmalar gözden geçirildi. Literatür incelemesi Düzey 1 çalışmaların eksikliğinden dolayı tablo formunda gerçekleştirildi. Bulgular: Cerrahi onarımlar komplikasyonlarla sonuçlanabileceğinden, baş üstü aktivite gerektiren sporlarla uğraşan sporcuların önceki aktivite seviyelerine geri dönmelerinde engel teşkil edebilirler. SLAP onarımlarında başarısızlık oranı yüksek olduğundan, sporcu olmayan bireylerde ilk girişim olarak biseps tenodezi tercih edilmektedir. SLAP lezyon onarımından sonra semptomları devam eden hastalarda biseps tenodezi, ikinci bir onarım girişiminden daha öngörülebilir bir operasyon seçeneği sunmaktadır. Çıkarımlar: Biseps tenodezi SLAP onarımı için veya SLAP onarımı başarısız olan bazı hastalar için uygun bir tedavi seçeneğidir

Superior labrum anterior posterior lezyonlarının tedavisi: bir literatür incelemesi

Objective:Treatment of superior labrum anterior posterior (SLAP) lesions continues to be controversial, but with the development of suture anchors, it has become acceptable to repair these lesions arthroscopically. The aim of this study was to review recent trends in the evaluation and treatment of SLAP lesions, with particular emphasis on comparing the results of biceps tenodesis and SLAP repair. Methods: All English language publications from the PubMed, Cochrane, and SCOPUS databases between 1928 and 2012 on biceps tendon, SLAP lesions, and biceps surgery were reviewed. Literature was reviewed in table form because of the lack of Level 1 studies. Results: Surgical repair can have complications and may not return overhead athletes to their previous level of activity. Biceps tenodesis has become the preferred primary procedure in non-athletic individuals because of the high failure rate of SLAP repair. In patients with continuing symptoms after SLAP lesion repair, biceps tenodesis offers a more predictable operation than a second repair attempt. Conclusion: Biceps tenodesis may present a viable treatment option for SLAP repair or for failed SLAP repair in some patients.

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1. Andrews JR, Carson WG Jr, McLeod WD. Glenoid la- brum tears related to the long head of the biceps. Am J Sports Med 1985;13:337-41. CrossRef
2. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Fried- man MJ. SLAP lesions of the shoulder. Arthroscopy 1990;6:274-9. CrossRef
3. Maffet MW, Gartsman GM, Moseley B. Superior la- brum-biceps tendon complex lesions of the shoulder. Am J Sports Med 1995;23:93-8. CrossRef
4. Modarresi S, Motamedi D, Jude CM. Superior labral an- teroposterior lesions of the shoulder: part 2, mechanisms and classification. AJR Am J Roentgenol 2011;197:604- 11. CrossRef
5. Kim TK, Queale WS, Cosgarea AJ, McFarland EG. Clinical features of the different types of SLAP lesions: an analysis of one hundred and thirty-nine cases. J Bone Joint Surg Am 2003;85-A:66-71.
6. Meyer AW. Spontaneous dislocation and destruction of the tendon of the long head of the biceps brachii: fifty-nine instances. Arch Surg 1928;17:493-506. CrossRef
7. Cook C, Beaty S, Kissenberth MJ, Siffri P, Pill SG, Hawkins RJ. Diagnostic accuracy of five orthopedic clini- cal tests for diagnosis of superior labrum anterior poste- rior (SLAP) lesions. J Shoulder Elbow Surg 2012;21:13- 22. CrossRef
8. Denard PJ, Lädermann A, Burkhart SS. Long-term out- come after arthroscopic repair of type II SLAP lesions: results according to age and workers’ compensation status. Arthroscopy 2012;28:451-7. CrossRef
9. Hegedus EJ, Goode AP, Cook CE, Michener L, Myer CA, Myer DM, et al. Which physical examination tests provide clinicians with the most value when examining the shoul- der? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med 2012;46:964-78. CrossRef
10. Khazzam M, George MS, Churchill RS, Kuhn JE. Disor- ders of the long head of biceps tendon. J Shoulder Elbow Surg 2012;21:136-45. CrossRef
11. Sayde WM, Cohen SB, Ciccotti MG, Dodson CC. Re- turn to play after Type II superior labral anterior-posterior lesion repairs in athletes: a systematic review. Clin Orthop Relat Res 2012;470:1595-600. CrossRef
12. Schrøder CP, Skare O, Gjengedal E, Uppheim G, Reik- erås O, Brox JI. Long-term results after SLAP repair: a 5-year follow-up study of 107 patients with comparison of patients aged over and under 40 years. Arthroscopy 2012;28:1601-7. CrossRef
13. Weber SC, Martin DF, Seiler JG 3rd, Harrast JJ. Supe- rior labrum anterior and posterior lesions of the shoulder: incidence rates, complications, and outcomes as reported by American Board of Orthopedic Surgery. Part II candi- dates. Am J Sports Med 2012;40:1538-43. CrossRef
14. Paxinos A, Walton J, Rütten S, Müller M, Murrell GAC. Arthroscopic stabilization of superior labral (SLAP) tears with biodegradable tack: outcomes to 2 years. Arthrosco- py 2006;22:627-34. CrossRef
15. Rhee YG, Lee DH, Lim CT. Unstable isolated SLAP le- sion: clinical presentation and outcome of arthroscopic fixation. Arthroscopy 2005;21:1099. CrossRef
16. Becker DA, Cofield RH. Tenodesis of the long head of the biceps brachii for chronic bicipital tendinitis. Long-term results. J Bone Joint Surg Am 1989;71:376-81.
17. Berlemann U, Bayley I. Tenodesis of the long head of bi- ceps brachii in the painful shoulder: improving results in the long term. J Shoulder Elbow Surg 1995;4:429-35.
18. Mazzocca AD, Cote MP, Arciero CL, Romeo AA, Ar- ciero RA. Clinical outcomes after subpectoral biceps tenodesis with an interference screw. Am J Sports Med 2008;36:1922-9. CrossRef
19. Snyder SJ, Banas MP, Karzel RP. An analysis of 140 in- juries to the superior glenoid labrum. J Shoulder Elbow Surg 1995;4:243-8. CrossRef
20. Resch H, Golser K, Thoeni H, Sperner G. Arthroscopic repair of superior glenoid labral detachment (the SLAP lesion). J Shoulder Elbow Surg 1993;2:147-55. CrossRef
21. McFarland EG. Examination of the biceps tendon and su- perior labrum anterior and posterior (SLAP) lesions. In: Kim TK, Park HB, El Rassi G, et al, editors. Examination of the shoulder: the complete guide. New York: Thieme; 2006. p. 213-43.
22. McFarland EG, Kim TK, Savino RM. Clinical assessment of three common tests for superior labral anterior-posteri- or lesions. Am J Sports Med 2002;30:810-5.
23. Guanche CA, Jones DC. Clinical testing for tears of the glenoid labrum. Arthroscopy 2003;19:517-23. CrossRef
24. Tennent TD, Beach WR, Meyers JF. A review of the spe- cial tests associated with shoulder examination. Part II: laxity, instability, and superior labral anterior and posterior (SLAP) lesions. Am J Sports Med 2003;31:301-7.
25. O’Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnor- mality. Am J Sports Med 1998;26:610-3.
26. Kibler WB. Specificity and sensitivity of the anterior slide test in throwing athletes with superior glenoid labral tears. Arthroscopy 1995;11:296-300. CrossRef
27. Kim SH, Ha KI, Han KY. Biceps load test: a clinical test for superior labrum anterior and posterior lesions in shoulders with recurrent anterior dislocations. Am J Sports Med 1999;27:300-3.
28. Liu SH, Henry MH, Nuccion SL. A prospective evalua- tion of a new physical examination in predicting glenoid labral tears. Am J Sports Med 1996;24:721-5. CrossRef
29. Kim SH, Ha KI, Ahn JH, Kim SH, Choi HJ. Biceps load test II: A clinical test for SLAP lesions of the shoulder. Arthroscopy 2001;17:160-4. CrossRef
30. Cheung EV, O’Driscoll SW. The dynamic labral shear test for superior labral anterior posterior tears of the shoulder. Podium presentation at the 76th Annual Meeting of the American Academy of Orthopaedic Surgeons, San Diego (CA), February 14-17, 2007.
31. Oh JH, Kim JY, Kim WS, Gong HS, Lee JH. The evalu- ation of various physical examinations for the diagnosis of type II superior labrum anterior and posterior lesion. Am J Sports Med 2008;36:353-9. CrossRef
32. Ben Kibler W, Sciascia AD, Hester P, Dome D, Jacobs C. Clinical utility of traditional and new tests in the diagno- sis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder. Am J Sports Med 2009;37:1840-7. CrossRef
33. Burkhart SS, Morgan C. SLAP lesions in the overhead athlete. Orthop Clin North Am 2001;32:431-41. CrossRef
34. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology. Part II: evalua- tion and treatment of SLAP lesions in throwers. Arthros- copy 2003;19:531-9. CrossRef
35. Holtby R, Razmjou H. Accuracy of the Speed’s and Yer- gason’s tests in detecting biceps pathology and SLAP le- sions: comparison with arthroscopic findings. Arthros- copy 2004;20:231-6. CrossRef
36. Nakagawa S, Yoneda M, Hayashida K, Obata M, Fuku- shima S, Miyazaki Y. Forced shoulder abduction and el- bow flexion test: a new simple clinical test to detect supe- rior labral injury in the throwing shoulder. Arthroscopy 2005;21:1290-5. CrossRef
37. Nam EK, Snyder SJ. The diagnosis and treatment of supe- rior labrum, anterior and posterior (SLAP) lesions. Am J Sports Med 2003;31:798-810.
38. Myers TH, Zemanovic JR, Andrews JR. The resisted su- pination external rotation test: a new test for the diagnosis of superior labral anterior posterior lesions. Am J Sports Med 2005;33:1315-20. CrossRef
39. Parentis MA, Glousman RE, Mohr KS, Yocum LA. An evaluation of the provocative tests for superior labral ante- rior posterior lesions. Am J Sports Med 2006;34:265-8.
40. Jia X, Yokota A, McCarty EC, Nicholson GP, Weber SC, McMahon PJ, et al. Reproducibility and reliability of the Snyder classification of superior labral anterior poste- rior lesions among shoulder surgeons. Am J Sports Med 2011;39:986-91. CrossRef
41. Gobezie R, Zurakowski D, Lavery K, Millett PJ, Cole BJ, Warner JJP. Analysis of interobserver and intraob- server variability in the diagnosis and treatment of SLAP tears using the Snyder classification. Am J Sports Med 2008;36:1373-9. CrossRef
42. Ide J, Maeda S, Takagi K. Sports activity after arthroscopic superior labral repair using suture anchors in overhead- throwing athletes. Am J Sports Med 2005;33:507-14.
43. Kartus J, Perko M. Arthroscopic repair of a type II SLAP lesion using a single corkscrew anchor. Arthroscopy 2002;18:E10. CrossRef
44. Alpert JM, Wuerz TH, O’Donnell TFX, Carroll KM, Brucker NN, Gill TJ. The effect of age on the outcomes of arthroscopic repair of type II superior labral anterior and posterior lesions. Am J Sports Med 2010;38:2299-303.
45. Brockmeier SF, Voos JE, Williams RJ 3rd, Altchek DW, Cordasco FA, Allen AA. Outcomes after arthroscopic repair of type-II SLAP lesions. J Bone Joint Surg Am 2009;91:1595-603. CrossRef
46. Cohen DB, Coleman S, Drakos MC, Allen AA, O’Brien SJ, Altchek DW, et al. Outcomes of isolated type II SLAP lesions treated with arthroscopic fixation using a bioab- sorbable tack. Arthroscopy 2006;22:136-42. CrossRef
47. Coleman SH, Cohen DB, Drakos MC, Allen AA, Wil- liams RJ, O’Brien SJ, et al. Arthroscopic repair of type II superior labral anterior posterior lesions with and with- out acromioplasty: a clinical analysis of 50 patients. Am J Sports Med 2007;35:749-53. CrossRef
48. Enad JG, Kurtz CA. Isolated and combined Type II SLAP repairs in a military population. Knee Surg Sports Traumatol Arthrosc 2007;15:1382-9. CrossRef
49. Friel NA, Karas V, Slabaugh MA, Cole BJ. Outcomes of type II superior labrum, anterior to posterior (SLAP) re- pair: prospective evaluation at a minimum two-year fol- low-up. J Shoulder Elbow Surg 2010;19:859-67. CrossRef
50. Franceschi F, Longo UG, Ruzzini L, Rizzello G, Maffulli N, Denaro V. No advantages in repairing a type II superior labrum anterior and posterior (SLAP) lesion when associ- ated with rotator cuff repair in patients over age 50: a ran- domized controlled trial. Am J Sports Med 2008;36:247- 53. CrossRef
51. Kartus J, Kartus C, Brownlow H, Burrow G, Perko M. Repair of type-2 SLAP lesions using Corkscrew anchors. A preliminary report of the clinical results. Knee Surg Sports Traumatol Arthrosc 2004;12:229-34. CrossRef
52. Katz LM, Hsu S, Miller SL, Richmond JC, Khetia E, Kohli N, et al. Poor outcomes after SLAP repair: descrip- tive analysis and prognosis. Arthroscopy 2009;25:849-55.
53. Kim SH, Ha KI, Kim SH, Choi HJ. Results of ar- throscopic treatment of superior labral lesions. J Bone Joint Surg Am 2002;84:981-5.
54. Morgan CD, Burkhart SS, Palmeri M, Gillespie M. Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears. Arthroscopy 1998;14:553-65. CrossRef
55. O’Brien SJ, Allen AA, Coleman SH, Drakos MC. The trans-rotator cuff approach to SLAP lesions: technical as- pects for repair and a clinical follow-up of 31 patients at a minimum of 2 years. Arthroscopy 2002;18:372-7. CrossRef
56. Samani JE, Marston SB, Buss DD. Arthroscopic stabili- zation of type II SLAP lesions using an absorbable tack. Arthroscopy 2001;17:19-24. CrossRef
57. Yoneda M, Hirooka A, Saito S, Yamamoto T, Ochi T, Shi- no K. Arthroscopic stapling for detached superior glenoid labrum. J Bone Joint Surg Br 1991;73:746-50.
58. Yung PSH, Fong DTP, Kong MF, Lo CK, Fung KY, Ho EPY, et al. Arthroscopic repair of isolated type II superior labrum anterior-posterior lesion. Knee Surg Sports Trau- matol Arthrosc 2008;16:1151-7. CrossRef
59. Boileau P, Parratte S, Chuinard C, Roussanne Y, Shia D, Bicknell R. Arthroscopic treatment of isolated type II SLAP lesions: biceps tenodesis as an alternative to rein- sertion. Am J Sports Med 2009;37:929-36. CrossRef
60. Neri BR, ElAttrache NS, Owsley KC, Mohr K, Yocum LA. Outcome of type II superior labral anterior posterior repairs in elite overhead athletes: Effect of concomitant partial-thickness rotator cuff tears. Am J Sports Med 2011;39:114-20. CrossRef
61. Branch TP, Lawton RL, Iobst CA, Hutton WC. The role of glenohumeral capsular ligaments in internal and external rotation of the humerus. Am J Sports Med 1995;23:632-7. CrossRef
62. Kuhn JE, Huston LJ, Soslowsky LJ, Shyr Y, Blasier RB. External rotation of the glenohumeral joint: ligament re- straints and muscle effects in the neutral and abducted po- sitions. J Shoulder Elbow Surg 2005;14(1 Suppl S):39S- 48S. CrossRef
63. Berg EE, Ciullo JV. A clinical test for superior glenoid labral or ‘SLAP’ lesions. Clin J Sport Med 1998;8:121-3.
64. Weber SC. Surgical management of the failed SLAP re- pair. Sports Med Arthrosc 2010;18:162-6. CrossRef
65. Schöffl V, Popp D, Dickschass J, Küpper T. Superior labral anterior-posterior lesions in rock climbers-primary double tenodesis? Clin J Sport Med 2011;21:261-3. CrossRef
66. Boileau P, Krishnan SG, Coste JS, Walch G. Arthroscopic biceps tenodesis: a new technique using bioabsorbable in- terference screw fixation. Arthroscopy 2002;18:1002-12.
67. Checchia SL, Doneux PS, Miyazaki AN, Silva LA, Fregoneze M, Ossada A, et al. Biceps tenodesis associated with arthroscopic repair of rotator cuff tears. J Shoulder Elbow Surg 2005;14:138-44. CrossRef
68. Drakos MC, Verma NN, Gulotta LV, Potucek F, Taylor S, Fealy S, et al. Arthroscopic transfer of the long head of the biceps tendon: functional outcome and clinical results. Arthroscopy 2008;24:217-23. CrossRef
69. Franceschi F, Longo UG, Ruzzini L, Papalia R, Riz- zello G, Denaro V. To detach the long head of the biceps tendon after tenodesis or not: outcome analysis at the 4-year follow-up of two different techniques. Int Orthop 2007;31:537-45. CrossRef
70. Koh KH, Ahn JH, Kim SM, Yoo JC. Treatment of biceps tendon lesions in the setting of rotator cuff tears: pro- spective cohort study of tenotomy versus tenodesis. Am J Sports Med 2010;38:1584-90. CrossRef
71. Osbahr DC, Diamond AB, Speer KP. The cosmetic ap- pearance of the biceps muscle after long-head tenotomy versus tenodesis. Arthroscopy 2002;18:483-7. CrossRef
72. Burns JP, Bahk M, Snyder SJ. Superior labral tears: repair versus biceps tenodesis. J Shoulder Elbow Surg 2011;20(2 Suppl):S2-8. CrossRef