Superior labral anterior posterior lesions of the shoulder: Current diagnostic and therapeutic standards

Table 1 Superior labral anterior posterior classification, adapted from ref. [77]

SLAP type	Location (o'clock)	Description	Comments
Snyder et al[1]
I	11-1	Fraying with intact biceps tendon	More significant in young people with repetitive overhead motion or patients with degenerative change
II	11-1	Tear of BLC and biceps tendon stripping	Most common SLAP type, associated with repetitive overhead motion
III	11-1	Bucket-handle tear of superior labrum with biceps tendon intact	Associated with fall on outstretched hand
IV	11-1	Bucket-handle tear of superior labrum extension to biceps tendon	Associated with fall on outstretched hand
Morgan et al[32]
IIA	11-3	Tear of BLC with more anterior extension
IIB	9-11	Tear of BLC with more posterior extension	Associated infraspinatus tendon tear may be present
IIC	9-3	Tear of BLC with anterior and posterior extension	Associated infraspinatus tendon tear may be present
Maffet et al[31]
V	11-5	Bankart lesion in continuity with type II SLAP tear	Can result from anterior shoulder dislocation
VI	11-1	Anterior or posterior flap tear of the superior labrum with biceps tendon stripping	Probably represents a bucket-handle tear (SLAP III/IV) with tear of the handle
VII	11-3	Tear extends into MGHL	Can result from acute trauma with anterior dislocation
Powell et al[78]
VIII	7-1	Superior labral tear with posteroinferior labral tear	Associated with posterior shoulder dislocation
IX	7-5	Superior labral tear with extensive anterior and posterior extension	Global labral abnormality, probably secondary to trauma
X	11-1	Superior labral tear with extension to the rotator interval	Involving the rotator interval structures including SGHL, long head biceps tendon and CHL

BLC: Bicipito-labral complex; MGHL: Middle glenohumeral ligament; SGHL: Superior glenohumeral ligament; CHL: Coraco-humeral ligament; SLAP: Superior labral anterior posterior.

Table 2 Traditional superior labral anterior posterior tests, adapted from ref. [37]

SLAP test	Sensitivity (95%CI)	Specificity (95%CI)	PPV (95%CI)	NPV (95%CI)	OR (95%CI)
O'Brien	0.67 (0.51, 0.80)	0.37 (0.22, 0.54)	1.06 (0.90, 1.25)	0.89 (0.67, 1.20)	1.19 (0.76, 1.86)
Speed	0.20 (0.05, 0.53)	0.78 (0.58, 0.90)	0.90 (0.43, 1.90)	1.03 (0.86, 1.23)	0.87 (0.35, 2.55)
Anterior slide	0.17 (0.03, 0.55)	0.86 (0.81, 0.89)	1.20 (0.22, 6.51)	0.97 (0.96, 1.36)	1.24 (0.16, 9.47)
Crank	0.34 (0.19, 0.53)	0.75 (0.65, 0.83)	1.36 (0.84, 2.21)	0.88 (0.69, 1.12)	1.54 (0.75, 3.18)
Yergason	12.4 (6.60, 20.6)	95.3 (90.6, 98.1)	2.49 (0.97, 6.40)	0.91 (0.84, 0.99)	2.67 (0.99, 7.73)
Relocation	51.6 (41.2, 61.8)	52.4 (44.0, 60.6)	1.13 (0.88, 1.45)	0.93 (0.72, 1.20)	1.23 (0.72, 2.11)
Biceps palpation	38.6 (26.0, 52.4)	66.7 (52.9, 78.6)	1.06 (0.66, 1.68)	0.95 (0.74, 1.22)	1.13 (0.51, 2.50)
Compression rotation	24.5 (13.8, 38.3)	78.0 (72.9, 82.5)	2.81 (0.20, 39.70)	0.87 (0.66, 1.16)	3.39 (0.15, 74.78)

PPV: Positive predictive value; NPV: Negative predictive value; OR: Odds ratio; SLAP: Superior labral anterior posterior.

Table 3 Outcomes after repair of superior labral anterior posterior tears, adapted from ref. [77]

Ref.	Study design	No. of patients	Repair techniques	Outcome summary
Morgan et al[32]	Retrospective	102	Type II repair, sture anchor	83% excellent overall; 87% excellent results in 53 overhead athletes
Friel et al[70]	Prospective cohort	48	Suture anchor fixation	54% returns to previous level of sport
Sayde et al[72]	Systematic review	506	Suture anchor, bioabsorbable tacks, staples	63% return to previous level of play
Snyder et al[53]	Retrospective	140	Type I: debridement, 56% type II: debridement, 44% suture fixation	N/A
Cohen et al[74]	Retrospective	39	Biodegradable tacks	27/39 G-E results; 14/29 return to play at preinjury level at 3.7 yr follow-up
Funk et al[11]	Retrospective	18	Suture anchor fixation	89% satisfaction rate; 95% return to play at preinjury level
Enad et al[71]	Retrospective	27	Suture anchor fixation	24/27 G-E results
Coleman et al[79]	Retrospective	± 50 acromioplasties	Biodegradable tacks	65% G-E results at 3.4 yr follow-up
Brockmeier et al[80]	Prospective cohort	47	Suture anchor fixation	41/47 G-E results at 2.7 yr follow-up
O'Brien et al[73]	Retrospective	31	Biodegradable tacks	22/31 G-E results at 3.9 yr follow-up
Kim et al[75]	Retrospective	34	Suture anchor fixation	31/34 return to play at preinjury level
Boileau et al[68]	Prospective cohort	25 (2 groups)	Suture anchor fixation (SLAP repair) vs interference screw (biceps tenodesis)	4/10 satisfied in SLAP repair group; 13/15 satisfied in tenodesis group
Schöffl et al[9]	Prospective cohort	6 (rock climbers only)	Mini-open biceps tenodesis	96.8% satisfaction, 100% return to preinjury level of climbing
Voos et al[81]	Retrospective	34 SLAP + RCR; 28 RCR alone	Suture anchor fixation for RCR ± SLAP	90% G-E results, 77% return to play at preinjury level
Youm et al[82]	Retrospective	10 SLAP + spinoglenoid cyst	SLAP repair, no cyst treatment	8/10 resolution of cyst and labral healing in MRI

G-E: Good to excellent; RCR: Rotator cuff repair; SLAP: Superior labral anterior posterior; N/A: Not available; MRI: Magnetic resonance imaging.