This is the foundational 1995 paper that established the SLAP classification system in clinical practice. Snyder et al. reviewed 140 arthroscopically confirmed SLAP lesions from 2375 shoulder procedures and characterized lesion type distribution, associated pathology, and early surgical outcomes. The paper also documents the failure of bioabsorbable tack fixation and proposes the suture anchor technique that became standard care.
Every SLAP repair you perform traces back to this paper. Before 1990, superior labral injuries had no systematic classification and no consensus on repair vs. Debridement. Snyder's group named the lesion, defined its four types, and established the operative logic that still governs management.
When you scope a shoulder and find labral pathology at the biceps anchor, the first question is: which type? Type I gets debridement. Type II needs fixation. Type III gets the bucket-handle excised. Type IV depends on how much biceps tendon is split — debride or repair if less than 50% involved, tenodesis if more than 50%.
Do not anchor your diagnostic confidence to MRI. This paper showed MRI sensitivity of only 26% for SLAP lesions. If clinical suspicion is high. Pain with mechanical catching, positive biceps tension test, history of a fall onto an outstretched arm. Go to the OR.
The paper also explains why bioabsorbable implants fell out of favor for labral fixation: loose fragments requiring reoperation in 5 cases are not acceptable for a non-oncologic shoulder procedure.
This is the foundational 1995 paper that established the SLAP classification system in clinical practice. Snyder et al. reviewed 140 arthroscopically confirmed SLAP lesions from 2375 shoulder procedures and characterized lesion type distribution, associated pathology, and early surgical outcomes. The paper also documents the failure of bioabsorbable tack fixation and proposes the suture anchor technique that became standard care.
Every SLAP repair you perform traces back to this paper. Before 1990, superior labral injuries had no systematic classification and no consensus on repair vs. Debridement. Snyder's group named the lesion, defined its four types, and established the operative logic that still governs management.
When you scope a shoulder and find labral pathology at the biceps anchor, the first question is: which type? Type I gets debridement. Type II needs fixation. Type III gets the bucket-handle excised. Type IV depends on how much biceps tendon is split — debride or repair if less than 50% involved, tenodesis if more than 50%.
Do not anchor your diagnostic confidence to MRI. This paper showed MRI sensitivity of only 26% for SLAP lesions. If clinical suspicion is high. Pain with mechanical catching, positive biceps tension test, history of a fall onto an outstretched arm. Go to the OR.
The paper also explains why bioabsorbable implants fell out of favor for labral fixation: loose fragments requiring reoperation in 5 cases are not acceptable for a non-oncologic shoulder procedure.