Management of type II superior labrum anterior posterior lesions: a review of the literature

  • Xinning Li | xinning.li@gmail.com University of Massachusetts Medical Center, Worcester, MA, United States.
  • Timothy Lin University of Massachusetts Medical School, Worcester, MA, United States.
  • Marcus Jager University of Duesseldorf Medical School, Germany.
  • Mark D. Price University of Massachusetts Medical Center, Worcester, MA, United States.
  • Nicola Deangelis University of Massachusetts Medical Center, Worcester, MA, United States.
  • Brian D. Busconi University of Massachusetts Medical Center, Worcester, MA, United States.
  • Michael Brown University of Massachusetts Medical Center, Worcester, MA, United States.

Abstract

Superior labrum anterior and posterior lesions were first described in 1985 by Andrews et al. and later classified into four types by Synder et al. The most prevalent is type II which is fraying of the superior glenoid labrum with detachment of the biceps anchor. Superior labrum anterior posterior (SLAP) lesions can also be associated with other shoulder pathology. Both MRI and MRA can be utilized in making the diagnosis with the coronal images being the most sensitive. The mechanism of injury can be either repetitive stress or acute trauma with the superior labrum most vulnerable to injury during the late cocking phase of throwing. A combination of the modified dynamic labral shear and O’Brien test can be used clinically in making the diagnosis of SLAP lesion. However, the most sensitive and specific test used to diagnosis specifically a type II SLAP lesion is the Biceps Load Test II. The management of type II SLAP lesions is controversial and dependent on patient characteristics. In the young high demanding overhead athlete, repair of the type II lesion is recommended to prevent glenohumeral instability. In middle-aged patients (age 25-45), repair of the type II SLAP lesion with concomitant treatment of other shoulder pathology resulted in better functional outcomes and patient satisfaction. Furthermore, patients who had a distinct traumatic event resulting in the type II SLAP tear did better functionally than patients who did not have the traumatic event when the lesion was repaired. In the older patient population (age over 45 years), minimum intervention (debridement, biceps tenodesis/tenotomy) to the type II SLAP lesion results in excellent patient satisfaction and outcomes.

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Author Biographies

Xinning Li, University of Massachusetts Medical Center, Worcester, MA
Department of Orthopaedic Surgery
Marcus Jager, University of Duesseldorf Medical School
Professor of Orthopaedics
Brian D. Busconi, University of Massachusetts Medical Center, Worcester, MA
Associate Professor and Chief of the Division of Sports Medicine
Published
2010-02-15
Info
Issue
Section
Reviews
Keywords:
SLAP Lesions, Type II, Management, Classification, Shoulder
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How to Cite
Li, X., Lin, T., Jager, M., Price, M., Deangelis, N., Busconi, B., & Brown, M. (2010). Management of type II superior labrum anterior posterior lesions: a review of the literature. Orthopedic Reviews, 2(1), e6. https://doi.org/10.4081/or.2010.e6