Arthroscopic repair of superior glenoid labral detachment (the SLAP lesion)

Abstract

Complete detachment of the glenoid labrum from the superior pole of the glenoid, which is associated with a destabilization of the origin of the long biceps tendon, leads to altered function in the shoulder joint. This is especially noticeable when the shoulder is used in overhead activities. Two operative techniques are described for reattachment of the glenoid labrum to the glenoid. In the first six patients the glenoid labrum was reattached with small cannulated titanium screws. In five patients these screws were inserted under arthroscopic control from a cranial direction. The labrum was always reattached just behind the origin of the long biceps tendon. The most favorable portal was identified by percutaneous probing with a Kirschner wire. If the superior glenoid pole could not be reached via a portal placed anterior or medial to the acromion, a hole was drilled through the acromion, and a transacromial approach was used. The screws were removed by arthroscopy after 3 to 5 months. In the last eight patients, absorbable tacks were used instead of screws. Of 18 patients who showed a complete detachment of the glenoid labrum from the superior pole of the glenoid with destabilization of the attachment of the biceps tendon, 14 underwent reattachment as described previously. The minimum follow-up time was greater than 6 months (mean follow-up time 18 months, maximum follow-up time 30 months). At follow-up, eight patients felt completely rehabilitated and had resumed their previous overhead activities (overhead sports). Four patients believed their conditions were improved. Two patients had not experienced any improvement. Of the patients who had not undergone reattachment and who had undergone shaving of the free margin of the glenoid labrum, only one had experienced improvement, while the other three patients did not report any improvement.