LONG-TERM OUTCOME AFTER ARTHROSCOPIC TREATMENT OF SLAP LESOINS: 24 CASES REVIEWED AT MEAN FOUR YEARS FOLLOW-UP

Abstract

Purpose of the study: First described in 1990, superior labral anteroposterior (SLAP) lesions are uncommon and remain a subject of debate. Initially treated by decridement and vivication, indications for reinsertion became increasingly population. The purpose of this study was to evaluate the long-term outcome of arthroscopic treatments.

Material and methods: Isolatd SLAP lesions were treated in 24 patients from 1996 to 2002. This study excluded all patients with rotator cuff tears, glenohumeral instability, a posterosuperior impingement, osteoarthritic degradation, or acromioclavicular pain. Thirteen patients (54.2%) reported that trauma was the triggering factor. Sixteen of the 24 patients practiced sports (seven leisure sports and nine competition sports included two at a high level). The diagnosis of SLAP lesion was suspected preoperative in 15 patients (62.5%) on the basis of clinical and arthroscan findings.

Results: The Snyder classification at arthroscopy was: type I (n=5, 21%), type II (n=17, 71%), type III (n=2, 8%). Debridement avivement was used for type I and III lesions. SLAP II lesions were treated by suture on one or two anchors. There were three complications: one anchor migration and two cases of reflex dystrophy. Twenty cases were reviewed with mean four year follow-up (minimum two years) (ten patients seen at consultation and ten with phone interviews). Only six patients recovered complete shoulder function. Among the ten patients examined, the Constant score improved 18.5 points. 65% of patients were satisfied or very satisfied.

Discussion: The results obtained in this series are in agreement with the literature. Repeated procedures performed in athletes or other professionals favor SLAP lesions. Diagnosis is difficult. Type II SLAP lesions predominate. We did not have any type IV lesions in this series. Adapted surgical treatment enables more or less complete resolution of the symptoms. Resumed physical activity at the same level cannot be guaranteed for the athlete.

Conclusion: SLAP lesions are a rare entity and are difficult to diagnose. Such lesions are a potential diagnosis in the event of posttraumatic painful shoulder or in patients exposed to repeated movements. Arthroscopic treatment is the rule, even though the outcome is uncertain.