Superior Labral Repair

Abstract

Advances in shoulder arthroscopy have led to a greater understanding of the importance of lesions of the superior labrum and biceps tendon complex. Diagnosis of superior labrum anterior to posterior tears requires a high index of suspicion and is made by careful attention to the history, physical examination, and magnetic resonance arthrography. The diagnosis is confirmed with arthroscopy. The form of treatment is dependent on the type of tear and the stability of the superior labrum and biceps anchor. Appropriate treatment of the tear and any associated pathologies should lead to reliable improvements in the patient's symptoms. The purpose of this review article is to describe the anatomy, pathophysiology, classification, indications, and surgical technique of arthroscopic repair of superior labral tears. The surgical technique we present involves using 1 anchor with 2 sutures to anchor the superior labrum anterior to posterior tear to the superior glenoid tubercle.

Injury of the suprascapular nerve during arthroscopic repair of superior labral tears: An anatomic study

“…8 We know through previous anatomic studies that the suprascapular nerve and its branches track close to the glenoid rim; some research has shown this distance to be quite short, with a mean distance of 20 mm. 1,2,15 However, little research has been conducted into the risk of neurovascular injury from the ''blind'' drilling, that is, drilling where the surgeon is unable to directly visualize the drill path to create holes for the placement of suture anchors.…”

Disorders of the Proximal and Distal Aspects of the Biceps Muscle

“…In patients undergoing repair, some authors advocate the use of two anchors, one anterior and one posterior to the biceps anchor, whereas others advocate a single double-loaded anchor, with sutures passed in a similar fashion. Alternatively, many advocate a single point of fixation posterior to the biceps anchor 25,56,57 . For posterior lesions, a shift to an anterior viewing portal and deployment of the shaver via the posterior portal may assist with debridement 57 .…”

“…Alternatively, many advocate a single point of fixation posterior to the biceps anchor 25,56,57 . For posterior lesions, a shift to an anterior viewing portal and deployment of the shaver via the posterior portal may assist with debridement 57 . Suture anchors are placed at the superior glenoid articular cartilage margin at a 45°angle for maximum anchor security.…”

“…Type-III SLAP lesions are treated by resection of buckethandle tears or by repair of the middle glenohumeral ligament when its insertion is compromised 57 . Treatment of type-IV SLAP lesions depends on the amount of tendon involvement.…”

Glenohumeral joint instability

“…11) (20, 78, 81, 103, 109). Differentiating this type of injury from labral detachments may imply changes in the surgical technique (109). However, the imaging differentiation between these lesions can be difficult.…”