Morgan et al. analyzed 102 arthroscopically treated type II SLAP lesions, excluding all cases with Bankart pathology or anterior instability. The study asks whether distinct anatomic subtypes exist and defines each subtype's physical exam signature, associated rotator cuff pathology, and instability pattern.
Before this paper, type II SLAP lesions were treated as a single entity with a single anterosuperior location, based on the original Snyder description. Posterior and combined subtypes were not systematically recognized, and the Port of Wilmington did not exist as a named portal.
When you see a drive-through sign at arthroscopy but find no Bankart tear and no anterior-inferior labral pathology, look posterosuperiorly. You are dealing with a posterior or combined type II SLAP lesion producing anterior pseudolaxity through the labral circle concept. Repair the posterior component through the Port of Wilmington (1 cm anterior and 1 cm lateral to the posterior acromial angle) — the standard anterosuperior portal cannot achieve the required angle.
Use physical exam to guide your index of suspicion preoperatively: Speed and O'Brien positivity points anterior; Jobe relocation positivity (posterosuperior pain relieved by posterior pressure on the humeral head) points posterior. A mixed picture means a combined lesion requiring both portals.
When you find a rotator cuff tear alongside a type II SLAP lesion, repair the SLAP as well. The authors argue the labral instability is primary and the cuff tear is secondary, meaning leaving the SLAP unrepaired leaves the cause in place.
Morgan et al. analyzed 102 arthroscopically treated type II SLAP lesions, excluding all cases with Bankart pathology or anterior instability. The study asks whether distinct anatomic subtypes exist and defines each subtype's physical exam signature, associated rotator cuff pathology, and instability pattern.
Before this paper, type II SLAP lesions were treated as a single entity with a single anterosuperior location, based on the original Snyder description. Posterior and combined subtypes were not systematically recognized, and the Port of Wilmington did not exist as a named portal.
When you see a drive-through sign at arthroscopy but find no Bankart tear and no anterior-inferior labral pathology, look posterosuperiorly. You are dealing with a posterior or combined type II SLAP lesion producing anterior pseudolaxity through the labral circle concept. Repair the posterior component through the Port of Wilmington (1 cm anterior and 1 cm lateral to the posterior acromial angle) — the standard anterosuperior portal cannot achieve the required angle.
Use physical exam to guide your index of suspicion preoperatively: Speed and O'Brien positivity points anterior; Jobe relocation positivity (posterosuperior pain relieved by posterior pressure on the humeral head) points posterior. A mixed picture means a combined lesion requiring both portals.
When you find a rotator cuff tear alongside a type II SLAP lesion, repair the SLAP as well. The authors argue the labral instability is primary and the cuff tear is secondary, meaning leaving the SLAP unrepaired leaves the cause in place.