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SLAP Repair

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Updated June 30, 2013

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A SLAP repair, a surgical procedure performed for treatment of a SLAP tear, is considered for patients who do not improve following nonsurgical treatments. In patients with a SLAP tear that's causing pain, surgical treatment may be an option.

A SLAP tear is a specific type of labral tear within the shoulder joint. SLAP tears occur where the biceps tendon attaches to the labrum on the top of the shoulder socket. When surgery is considered for a SLAP tear, there are several options for how to address the problem.

  • SLAP Debridement:
    A SLAP debridement simply removes any excess or damaged tissue that causes symptoms of catching and pain in the shoulder. In some people, the damage is minimal, and removing the torn tissue may be adequate to address the cause of the pain.
  • SLAP Repair:
    A SLAP repair is performed to surgically repair the tear within the labrum. Usually, a SLAP repair is performed using sutures to reattach the damaged labrum to the bone of the shoulder socket.
  • Biceps Tenodesis or Tenotomy:
    A biceps tenodesis or tenotomy may be considered when the SLAP tear cannot be repaired, or if the biceps tendon is significantly damaged.

SLAP Repair Surgery

A SLAP repair is an arthroscopic shoulder surgery using sutures to reattach the torn labrum back to the bone of the shoulder socket. During the shoulder arthroscopy, other injuries may be detected that can also be treated, including bursal inflammation, rotator cuff tears, and cartilage damage. Therefore, a SLAP repair may be just a part of the surgery to fix shoulder pain. The steps of a SLAP repair are:
  • 1. The SLAP tear is identified and excess/damaged tissue is removed.
  • 2. A small hole is drilled into the bone where the labrum has torn away from the socket.
  • 3. An anchor is placed into this hole; attached to the anchor is a strong suture.
  • 4. The suture is used to tie the torn labrum snuggly against the bone.
  • 5. Additional anchors are placed as needed to secure to the torn labrum.

SLAP Repair vs. Biceps Tenodesis

Advantages of SLAP repair:
  • A SLAP repair restores the normal anatomy of the shoulder by reattaching the labrum in its normal position.
  • Once healed, the SLAP repair allows normal function of the previously damaged labrum and biceps attachment.

Advantages of biceps tenodesis:

  • The rehabilitation is often not as restrictive as is the case with a SLAP repair.
  • The results of surgery are usually more predictable, as healing of a SLAP repair may not be as reliable.

Rehab After Surgery

Rehabilitation after a SLAP repair varies depending on factors such as the strength of the repair and the preference of the surgeon. Most often, a period of time of restricted motion is maintained for about six weeks following a SLAP repair. During this first phase of rehabilitation, some passive motion is allowed to prevent shoulder stiffness. In the first phase, the torn labrum is healing to the bone in its proper position.

Once healed, patients enter the second phase of rehabilitation and can begin more motion at about six weeks. Physical therapy continues to help maintain motion and regain strength of the shoulder. The third phase of rehabilitation involves more active strengthening of the muscles that surround the shoulder joint. The final phase is geared towards restoration of full athletic activities, and full recovery is expected between 4-6 months.

Sources:

Kim TK, et al. "Clinical features of the different types of SLAP lesions" Journal of Bone Joint Surgery Am. 2003 Jan;85-A(1):66-71.

Choi NH, Kim SJ. "Avulsion of the superior labrum"Arthroscopy. 2004 Oct;20(8):872-4.

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