Combined posterior and posterior-superior (PPS) labral injuries dominate the disabled throwing shoulder, yet their biomechanics and ideal repair were undefined. This cadaveric study measured how PPS injury and two repair strategies affect glenohumeral kinematics and joint contact during simulated deceleration and follow-through. It asks whether repair should stop at the rip stop or extend a superior anchor to 11:00.
The clinical rule this paper supports: in a symptomatic thrower with a PPS labral tear, repair the immobile inferior labrum from 6:30 up to the rip stop at 10:30 and stop there.
Adding a superior anchor at 11:00 to "fix everything you see" tethers the mobile superior segment that needs freedom for external rotation and biceps tension band function. The result is nonphysiologic anterior and inferior humeral head translation. This is a mechanistic explanation for why traditional SLAP-style repairs and Type VIII repairs perform poorly in pitchers (70% vs 95% return to play).
Remember the two-organ model: superior labrum as the mobile organ of tension, inferior labrum as the fixed organ of compression, meeting at the rip stop.
As a cadaveric quasi-static study with 10 male shoulders, no scapular motion, and only the deceleration/follow-through phase tested, it defines mechanics rather than clinical outcomes. Its recommendation is strengthened by clinical data showing better results with posterior versus posterior-superior repair.
Combined posterior and posterior-superior (PPS) labral injuries dominate the disabled throwing shoulder, yet their biomechanics and ideal repair were undefined. This cadaveric study measured how PPS injury and two repair strategies affect glenohumeral kinematics and joint contact during simulated deceleration and follow-through. It asks whether repair should stop at the rip stop or extend a superior anchor to 11:00.
The clinical rule this paper supports: in a symptomatic thrower with a PPS labral tear, repair the immobile inferior labrum from 6:30 up to the rip stop at 10:30 and stop there.
Adding a superior anchor at 11:00 to "fix everything you see" tethers the mobile superior segment that needs freedom for external rotation and biceps tension band function. The result is nonphysiologic anterior and inferior humeral head translation. This is a mechanistic explanation for why traditional SLAP-style repairs and Type VIII repairs perform poorly in pitchers (70% vs 95% return to play).
Remember the two-organ model: superior labrum as the mobile organ of tension, inferior labrum as the fixed organ of compression, meeting at the rip stop.
As a cadaveric quasi-static study with 10 male shoulders, no scapular motion, and only the deceleration/follow-through phase tested, it defines mechanics rather than clinical outcomes. Its recommendation is strengthened by clinical data showing better results with posterior versus posterior-superior repair.