Snyder et al. retrospectively reviewed more than 700 shoulder arthroscopies to identify and classify a previously undescribed superior labral injury pattern involving the biceps anchor. The study asks: what are the clinical features, mechanisms, and arthroscopic subtypes of this injury — and how should each type be treated? 27 cases were identified, and a four-type classification system was proposed to guide arthroscopic management.
In 1990, superior labral tears involving the biceps anchor had no name, no classification, and no treatment framework. Surgeons encountering this pattern at arthroscopy had no guidance on what they were seeing or what to do about it.
This paper gives you the vocabulary and the decision tree. When you see a SLAP lesion at arthroscopy, your first job is to identify the type — because treatment is entirely type-driven. Debride Type I. Reattach Type II. Excise the flap in Type III. In Type IV, resect the split biceps tendon; if more than 50% of the tendon is torn and the patient has biceps symptoms, perform tenodesis.
Two practical points to carry into the OR: always inspect the rotator cuff when you find a SLAP lesion (26% have a concomitant partial tear), and do not rely on preoperative MRI to rule it out. Arthroscopy remains the diagnostic standard. MR arthrography with gadolinium had only just begun to show promise at the time of this paper, and even now, SLAP lesion diagnosis is confirmed on the table.
Snyder et al. retrospectively reviewed more than 700 shoulder arthroscopies to identify and classify a previously undescribed superior labral injury pattern involving the biceps anchor. The study asks: what are the clinical features, mechanisms, and arthroscopic subtypes of this injury — and how should each type be treated? 27 cases were identified, and a four-type classification system was proposed to guide arthroscopic management.
In 1990, superior labral tears involving the biceps anchor had no name, no classification, and no treatment framework. Surgeons encountering this pattern at arthroscopy had no guidance on what they were seeing or what to do about it.
This paper gives you the vocabulary and the decision tree. When you see a SLAP lesion at arthroscopy, your first job is to identify the type — because treatment is entirely type-driven. Debride Type I. Reattach Type II. Excise the flap in Type III. In Type IV, resect the split biceps tendon; if more than 50% of the tendon is torn and the patient has biceps symptoms, perform tenodesis.
Two practical points to carry into the OR: always inspect the rotator cuff when you find a SLAP lesion (26% have a concomitant partial tear), and do not rely on preoperative MRI to rule it out. Arthroscopy remains the diagnostic standard. MR arthrography with gadolinium had only just begun to show promise at the time of this paper, and even now, SLAP lesion diagnosis is confirmed on the table.