Burkhart and Morgan describe the peel-back mechanism as a cause of posterior Type II SLAP lesions in throwers. When the arm moves into abduction and external rotation, the biceps vector shifts posteriorly, transmitting torsional force to the posterosuperior labrum. This technical note defines surgical and rehabilitation implications of this mechanism.
Before this paper, SLAP lesion mechanics were attributed primarily to tensile failure at the biceps root (Andrews et al., 1985). Burkhart and Morgan showed that torsional force — not tension — drives posterior Type II lesions, and that this distinction has direct consequences for how you fix and protect the repair.
When you repair a posterior SLAP lesion, place at least one anchor posterior to the biceps at the glenoid corner, inserted at 45°, through a posterolateral (Port of Wilmington) portal. A single anchor anterior to the biceps will not neutralize the torsional vector.
When writing postoperative orders for a posterior SLAP repair, do not default to early external rotation the way you would for a cuff repair. External rotation beyond 0° is held for 3 weeks — because peel-back occurs with external rotation alone, even without abduction.
This paper is foundational for understanding why posterior SLAP rehab is uniquely restrictive, and why anchor position (not just number) determines repair durability in throwers.
Burkhart and Morgan describe the peel-back mechanism as a cause of posterior Type II SLAP lesions in throwers. When the arm moves into abduction and external rotation, the biceps vector shifts posteriorly, transmitting torsional force to the posterosuperior labrum. This technical note defines surgical and rehabilitation implications of this mechanism.
Before this paper, SLAP lesion mechanics were attributed primarily to tensile failure at the biceps root (Andrews et al., 1985). Burkhart and Morgan showed that torsional force — not tension — drives posterior Type II lesions, and that this distinction has direct consequences for how you fix and protect the repair.
When you repair a posterior SLAP lesion, place at least one anchor posterior to the biceps at the glenoid corner, inserted at 45°, through a posterolateral (Port of Wilmington) portal. A single anchor anterior to the biceps will not neutralize the torsional vector.
When writing postoperative orders for a posterior SLAP repair, do not default to early external rotation the way you would for a cuff repair. External rotation beyond 0° is held for 3 weeks — because peel-back occurs with external rotation alone, even without abduction.
This paper is foundational for understanding why posterior SLAP rehab is uniquely restrictive, and why anchor position (not just number) determines repair durability in throwers.