The Double-Pulley Anatomic Technique for Type II SLAP Lesion Repair

Abstract

The annual incidence and number of repairs of SLAP lesions in the United States are constantly increasing. Surgical repairs of type II SLAP lesions have overall good success rates. However, a low satisfaction rate and low rate of return to preinjury level of play remain a challenge with elite overhead and throwing athletes. Recent anatomic studies suggest that current surgical techniques over-tension the biceps anchor and the superior labrum. These studies suggest that restoration of the normal anatomy will improve clinical outcomes and sports performance. We present a "double-pulley" technique for arthroscopic fixation of type II SLAP lesions. In this technique the normal anatomy is respected by preserving the mobility of the articular aspect of the superior labrum while reinforcing the biceps anchor and its posterior fibers medially.

Clinical Effect of Suture Anchor and Double-Pulley Technique in the Treatment of Inferior Patellar Fracture

“…Anchor line strength significantly exceeds the general suture; Sasaki et al [17] by comparing the mechanical characteristics of the screws and the anchor lines, it is found that there is no obvious statistical difference in the strength of the two lines, thus ensuring the early functional exercise after the operation. Suture anchor and double-pulley technique are widely used in shoulder surgery, such as bone Bankart injury, remplissage repair of shoulder instability, rotator cuff injury, and SLAP injury [18,19]. It can provide a repair effect in a large range as well as provide a stable internal fixation effect.…”

Primary Double-Pulley SLAP Repair in an Active-Duty Military Population With Type II SLAP Lesions Results in Improved Outcomes and Low Failure Rates at Minimum Six Years of Follow-up

“…The technique used in this study has been previously described in detail and has not changed since its original publication. 22 The double-pulley configuration provides a horizontal repair with large biceps–bone footprint, which improves healing and hopefully avoids strangulation of the superior labrum. 22 , 23 …”

“… 22 The double-pulley configuration provides a horizontal repair with large biceps–bone footprint, which improves healing and hopefully avoids strangulation of the superior labrum. 22 , 23 …”

“…The detailed step-by-step surgical technique and corresponding video are available in our Technical Note article. 22

Fig 2 Right shoulder, glenoid neck debrided to bleeding bone with a 4.5-mm shaver as viewed from the standard posterolateral viewing portal.

Fig 3 Right shoulder, first 1.9-mm double-loaded SUTUREFIX (Smith & Nephew, Andover MA) is placed at the 10-o’clock position as viewed from the anterior–superior portal.

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“…Extrapolating the findings of these authors, in 2015 we published a “double-pulley” technique for anatomic repair of the superior labrum and biceps anchor following a type II SLAP tear. 22 , 23 …”