SLAP stands for superior labrum anterior and posterior, meaning there’s a tear from front to back on the top of the glenoid labrum of the shoulder. The glenoid labrum is a fibrocartilagenous structure that helps to deepen the socket of the glenoid. When a person has a SLAP lesion, the shoulder joint becomes unstable and develops pain, popping and clicking with certain movements.
The SLAP surgical options examined
New research from New York University says:
- of 2,524 patients who had a SLAP lesion surgical repair, after 3 to 11 years of follow-up, 10% of patients (254 of 2,524) underwent repeat surgical intervention on the same shoulder as the initial SLAP repair.
- The average time to that repeat shoulder surgery was a little more than 2 years later
- Subsequent procedures included:
- subacromial decompression a procedure that cuts ligaments and shaves down bone spurs on the acromion bone (35%),
- debridement, a “power washing” of the debris and damaged tissue in the shoulder (26.7%).
- repeat SLAP repair (19.7%),
- and biceps tenodesis or tenotomy (13.0%). This is a more radical procedure usually reserved for aging patients and involves cutting the tendon attachment of the bicep to the shoulder labrum and attaching it to the humerus bone (upper arm).
- After isolated SLAP repair (where only the SLAP lesion was arthroscopically repaired), patients aged 20 years or younger were more likely to undergo arthroscopic Bankart repair
- Patients over 30 were at risk for subsequent acromioplasty and distal clavicle resection
- The need for a subsequent procedure was significantly associated with Workers’ Compensation cases.2
In a combined study from University of Minnesota and German researchers, doctors found that if conservative treatment fails, successful arthroscopic repair of symptomatic SLAP lesions could be achieved. However what was the measurement of success? If it was return to sport, or function in older patients, it was not that successful.
- the results of arthroscopic repair in throwing athletes are less successful with a significant amount of patients who will not regain their pre-injury level of performance.
- The clinical results of SLAP repairs in middle-aged and older patients are mixed, with worse results and higher revision rates as compared to younger patients.
These doctors also looked at the problem of “normal variations and degenerative changes” in the SLAP complex that need to be distinguished from “true”SLAP lesions in order to improve results and avoid overtreatment.” Possibly avoid a surgery based on the wrong recommendation.3
Surgery as diagnostic tool causes concern
In a recent review of SLAP lesion repair surgeries, one author, Stephen C. Weber, MD, noted the rise in both the number of repair surgeries and complications associated with them.This study looked at the American Board of Orthopedic Surgery database for SLAP lesion repairs.
- With 4,975 repairs in the database, only 26.3% of the patients reported a complete resolution of pain.
- Worse, only 13.1% of them reported normal function.
The author expressed concern over the number of young orthopedic surgeons performing SLAP lesion repairs and also the number of middle-aged and elderly patients receiving them given the complications associated.
He concluded that there should be a greater focus on educating young orthopedic surgeons so that they can recognize and treat SLAP lesions appropriately with the hopes of decreasing the amount of surgical repairs performed.4
Four years later researchers suggests the best diagnostic tool is still surgery and doing some repair while you are in there.
- Doctors in the United Kingdom say: magnetic resonance arthrography while having a high diagnostic accuracy for labral tears and Hill-Sachs lesions, is controversial. Arthroscopic diagnosis remains the gold standard. 5
- University researchers in Turkey say “Although MRI is a good diagnostic tool for SLAP lesions, its use for the classification is limited.”6
“36.8% of these surgeries were considered a “failure” and 28% had to be redone”
“Arthroscopic revision type II SLAP repairs yield worse results than primary repairs as reported in the literature, with workers’ compensation patients and overhead athletes doing especially worse.”
The above recent study published in the American Journal of Sports Medicine analyzed the post-surgical outcomes of athletes with SLAP lesions (superior labrum anterior to posterior tears).3
One hundred seventy nine military athletes were used in the study, all of which underwent surgery to fix an existing SLAP lesion. Out of all the operations, 36.8% of these surgeries were considered a “failure” and 28% had to be redone. That means that 66 individuals had a failed surgery and 51 had to go back into the operating room.
At two to five year follow-ups, a significant amount of these athletes still had decreased range of motion in the affected shoulder. Researchers concluded that an age greater than 36 years old was the factor that was associated with an increased chance of surgery failure. Other studies have shown similar statistics with many participants unable to ever return to their previous pre-surgery activity level.
Alternative to arthroscopic surgery for slap lesions of the shoulder
It’s interesting that we keep coming across research studies that show very few patients with long-term pain relief from joint surgery. It’s even more interesting that researchers are recommending a decrease in the number of joint surgeries performed.
Most joint surgeries can be avoided with Prolotherapy, and surgical SLAP lesion repair is no exception.
The typical program involves three to six visits receiving Prolotherapy for Shoulder Pain. In our experience, tissues such as a labrum can heal faster with Platelet Rich Plasma (PRP). PRP involves extracting platelets and growth factors from the patent’s blood and injecting those substances into and around the injured area to repair the structures of the joint.
In some cases, cellular Prolotherapy or Stem Cell Therapy may be more advantageous. This involves extracting cells from your blood, fat, or bone marrow and using them to help tissue proliferation in and around the joint.
The average “shoulder patient” in our office usually needs about four treatments to make a full recovery, although this number can range anywhere from two-10 depending on the severity of the case. Treatments are spaced about four to six weeks apart and patients are given specific rehab instructions to optimize healing.
1 Fedoriw WW, Ramkumar P, McCulloch PC, Lintner DM. Return to play after treatment of superior labral tears in professional baseball players. Am J Sports Med. 2014 May;42(5):1155-60. [Pubmed] [Google Scholar]
2 Mollon B, Mahure SA, Ensor KL, Zuckerman JD, Kwon YW, Rokito AS. Subsequent Shoulder Surgery After Isolated Arthroscopic SLAP Repair. Arthroscopy. 2016 Oct;32(10):1954-1962.e1. [Pubmed] [Google Scholar]
4 Weber, SC, et al. Superior Labrum Anterior and Posterior Lesions of the Shoulder: Incidence Rates, Complications, and Outcomes as Reported by American Board of Orthopedic Surgery Part II Candidates. Am J Sports Med. 2012 May 24. [AAOS]
5 Saqib R, Harris J, Funk L. Comparison of magnetic resonance arthrography with arthroscopy for imaging of shoulder injuries: retrospective study. Ann R Coll Surg Engl. 2017 Apr;99(4):271-274. doi: 10.1308/rcsann.2016.0249. [Pubmed] [Google Scholar]
6. Yıldız F, Bilsel K, Pulatkan A, Uzer G, Aralaşmak A, Atay M. Reliability of magnetic resonance imaging versus arthroscopy for the diagnosis and classification of superior glenoid labrum anterior to posterior lesions. Arch Orthop Trauma Surg. 2017 Feb;137(2):241-247. [Pubmed] [Google Scholar]