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.

Purpose of the study: This retrospective study was conducted to analyze the mid-term effect of damage to the anteroinferior rim of the glenoid cavity in failed arthroscopic stabilization of the shoulder.

Material and methods: From 1999 to 2001, 54 patients underwent surgery performed by the same operator. Full data were available for analysis for 46 patients. Mean age was 28 years and mean follow-up four years. A pre-operative scan was available for all patients to analyze the bone lesions. The same technique was used for all shoulders: three or four suture points using resorbable thread attached to a Panolok anchor with a north-south retension effect. The Duplay score was noted at last follow-up. Experimental work by Gerber, which demonstrated that the anti-dislocation resistance decreased as a function of the ratio (x) between the length of the anteroinferior glenoid defect and its maximal antero-posterior diameter, was used to assess resistance to dislocation. This resistance decreased 30% when x=0.5 and 50% when x=0.75.

Results: The Duplay score at 47 months was 83.3. The rate of recurrence was 13% (n=6). Age, sex, and number of episodes of instability had little effect on outcome. The rate of recurrence (38%) in patients with a significant damage (x> 0.5) was much higher than in patients with minimal damage (x< 0.5) (2.2%). The difference was statistically significant (p< 0.01). The Duplay score (63.8 points) in patients with significant damage (x> 0.5) was significantly lower (p=0.01) than in patients (91 points) with minimal damage (x< 0.05).

Discussion: The presence of bony lesions of the anterior glenoid rim appears to be one of the most important prognostic factors of recurrence. Considering the high frequency of these lesions in our series (54%), this element deserves careful analysis which would require computed tomographic reconstruction in the sagittal plane to obtain a precise assessment of the loss of articular surface. The statistical analysis demonstrated that patients with important loss of articular surface (x> 0.5) had a significantly higher risk of recurrent instability (p< 0.01).

Conclusion: Arthroscopic stabilization of the shoulder joint yields results similar to those obtained with more conventional techniques. Our study confirmed this notion showing a rate of recurrence of 13% which could be reduced to less than 3% with careful preoperative assessment of glenoid articular surface loss on the preoperative scan.