The Snyder Classification of Superior Labrum Anterior and Posterior (SLAP) Lesions

Ahsan, Zahab S.; Hsu, Jason E.; Gee, Albert O.

doi:10.1007/s11999-016-4826-z

Cited by 11 publications

(10 citation statements)

References 28 publications

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“…It may be difficult to identify lesions of the labrum correctly, such as Bankart, as literature shows discrepancies in defining lesions according to the clockface-method [ 47 , 48 ]. The Snyder classification is used to evaluate SLAP lesions but shows high inter-observer and intra-observer variability, even between experience specialists [ 49 ]. Lastly, the Outerbridge classification is used for the classification of chondral lesions but studied only limited times in small populations [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

Recurrence in traumatic anterior shoulder dislocations increases the prevalence of Hill–Sachs and Bankart lesions: a systematic review and meta-analysis

Rutgers

Verweij²,

Priester-Vink³

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose The extent of shoulder instability and the indication for surgery may be determined by the prevalence or size of associated lesions. However, a varying prevalence is reported and the actual values are therefore unclear. In addition, it is unclear whether these lesions are present after the first dislocation and whether or not these lesions increase in size after recurrence. The aim of this systematic review was (1) to determine the prevalence of lesions associated with traumatic anterior shoulder dislocations, (2) to determine if the prevalence is higher following recurrent dislocations compared to first-time dislocations and (3) to determine if the prevalence is higher following complete dislocations compared to subluxations. Methods PubMed, EMBASE, Cochrane and Web of Science were searched. Studies examining shoulders after traumatic anterior dislocations during arthroscopy or with MRI/MRA or CT published after 1999 were included. A total of 22 studies (1920 shoulders) were included. Results The proportion of Hill–Sachs and Bankart lesions was higher in recurrent dislocations (85%; 66%) compared to first-time dislocations (71%; 59%) and this was statistically significant (P < 0.01; P = 0.05). No significant difference between recurrent and first-time dislocations was observed for SLAP lesions, rotator-cuff tears, bony Bankart lesions, HAGL lesions and ALPSA lesions. The proportion of Hill–Sachs lesions was significantly higher in complete dislocations (82%) compared to subluxations (54%; P < 0.01). Conclusion Higher proportions of Hill–Sachs and Bankart were observed in recurrent dislocations compared to first-time dislocations. No difference was observed for bony Bankart, HAGL, SLAP, rotator-cuff tear and ALPSA. Especially when a Hill–Sachs or Bankart is present after first-time dislocation, early surgical stabilization may need to be considered as other lesions may not be expected after recurrence and to limit lesion growth. However, results should be interpreted with caution due to substantial heterogeneity and large variance. Level of evidence IV.

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Section: Discussionmentioning

confidence: 99%

Recurrence in traumatic anterior shoulder dislocations increases the prevalence of Hill–Sachs and Bankart lesions: a systematic review and meta-analysis

Rutgers

Verweij²,

Priester-Vink³

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…29 The literature addressing modes of management regarding this topic has escalated within the past 10 years to provide appropriate indications for the management of all types of SLAP tears. 2 This is most appreciable by the finding that patients older than 40 years have the fastest rising incidence of BT. SLAP repair still remains the preferred option for younger patients, but it is important to note the decreasing incidence of this procedure for isolated tears.…”

Section: Discussionmentioning

confidence: 99%

Trends in the Management of Isolated SLAP Tears in the United States

Cvetanovich

Gowd

Agarwalla

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background:The management of superior labrum anterior and posterior (SLAP) tears remains controversial, with surgical treatment options including SLAP repair, debridement, and open or arthroscopic biceps tenodesis (BT), based on patient factors and the type of tear.Hypothesis:We hypothesized that SLAP repair has become less frequently performed over time, while BT is more frequently performed, particularly in patients ≥ 40 years.Study Design:Descriptive epidemiology study.Methods:A retrospective query was performed using the Humana insurance database from years 2007 to 2016. For the management of a SLAP tear diagnosis (International Classification of Diseases–Ninth Edition [ICD-9] code: 840.7), independent and exclusive cohorts were formed using Current Procedural Terminology (CPT) codes for debridement (29822, 29823), SLAP repair (29807), open or arthroscopic BT (29828, 23430), and SLAP repair combined with BT (29828 OR 23430 AND 29807).Results:Of 46,650 diagnoses of a SLAP tear, there were 3347 patients who underwent operative management for an isolated SLAP tear from 2007 to 2016. There was a linear increase of SLAP tear diagnoses per year (r 2 = 0.800, P < .001) during this period. Overall, SLAP repair was performed in 1629 patients (48.7%), debridement was performed in 1076 patients (32.1%), BT was performed in 552 patients (16.5%), and combined SLAP repair and BT was performed in 90 patients (2.7%). There was a 69.3% decrease in isolated SLAP repair from 2007 to 2016 (r 2 = 0.882, P < .001). BT for the diagnosis of an isolated SLAP tear increased by 370.0% over the same period (r 2 = 0.800, P < .001). SLAP repair had an equivalent percentage of being performed in patients both older and younger than 40 years (P = .218). There was a 1500.0% increase in BT performed in patients older than 40 years during the study period. There were no statistical differences in the postoperative incidence of stiffness, surgical site infections, and reoperations between all surgical treatment groups (P > .05).Conclusion:An analysis of a large private-payer database revealed that surgical treatment of isolated SLAP tears in the United States has shifted from 2007 to 2016, with an increase in the frequency of BT and a decline in the frequency of SLAP repair, particularly in patients older than 40 years.

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“…1 Subsequently, several authors have described additional variations resulting in 10 subtypes of slap tears based on their location and morphology. 1,2,8 This video will focus on the type VIII slap tear, which is characterized by posterior extension of a type II tear to include the posterior labrum and the insertion of the posterior inferior glenohumeral ligament. 1,2,7,8…”

Section: Video Transcriptmentioning

confidence: 99%

Arthroscopic Repair of a Type VIII Superior Labrum Anterior Posterior Tear

Nammour

Arner

Murray

et al. 2023

Video Journal of Sports Medicine

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Background: Type VIII superior labrum anterior posterior (SLAP) tears are described as SLAP type II tears with posterior extension to the posterior inferior glenohumeral ligament. These tears are a common source of pain, instability, and decreased function in active individuals, particularly overhead or throwing athletes. Indications: Type VIII SLAP tears can cause pain and loss of sports performance, especially in a throwing athlete. This patient is a quarterback and pitcher who had magnetic resonance imaging and arthroscopic evidence of a type VIII SLAP tear with pain and inability to throw at his preinjury level. Technique Description: In the lateral decubitus position, a standard posterior portal is established along with anterior and accessory lateral portals. A type VIII SLAP tear is identified and the arm is taken out of balanced suspension traction and placed in abduction and external rotation which shows displacement of the posterior labrum and peelback of the superior labrum indicating pathologic labral instability. The labrum is then elevated and glenoid prepared to achieve healthy bleeding bone. Tape sutures are then passed around the labrum and placed into a glenoid anchor starting superiorly and continuing the repair posteroinferiorly. Three anchors were placed in the superior labrum using a percutaneous technique, with 2 more placed from the posterior portal to complete the 5-anchor repair. The posterior portal is then closed with a single monofilament suture to prevent a potential stress riser in the capsule. Results: The literature suggests that athletes with type VIII SLAP tears can expect improved functional outcomes and high return to play rates (>90%); however, only 50% to 70% of throwing athletes return to the same level of play. Discussion/Conclusion: Type VIII SLAP tears are an important cause of shoulder pain and dysfunction, particularly in overhead athletes. Arthroscopic repair of type VIII SLAP tears can improve functional outcomes and ability to return to sport; however, throwing athletes experience lower rates of return to previous level. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

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The Snyder Classification of Superior Labrum Anterior and Posterior (SLAP) Lesions

Cited by 11 publications

References 28 publications

Recurrence in traumatic anterior shoulder dislocations increases the prevalence of Hill–Sachs and Bankart lesions: a systematic review and meta-analysis

Recurrence in traumatic anterior shoulder dislocations increases the prevalence of Hill–Sachs and Bankart lesions: a systematic review and meta-analysis

Trends in the Management of Isolated SLAP Tears in the United States

Arthroscopic Repair of a Type VIII Superior Labrum Anterior Posterior Tear

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