Evolution of Technology

Suture Anchor

Suture anchors are the technology of choice when performing labral repair. A variety of suture anchor types exist, each with their own benefits and limitations. Suture anchors contain three components: the anchor, the eyelet and the suture. The anchor can be a screw mechanism, or an interference fit.

Materials used for anchors include various metals or bioabsorbable composites. The eyelet is a loop in the anchor through which the suture passes. Finally, the suture is what connects the under-repair tissue to the anchor. Suture can be absorbable or permanent, and varies in strength and elasticity. The ideal anchor when performing a labral repair is low profile, to eliminate the possibility of the anchor violating the glenoid cartilage, and provides excellent pullout strength.

Evolution of Procedure

SLAP Repair

Treatment of SLAP tears varies based on a variety of factors. Patient age, activity level and the anatomy of the tear all portend differing treatment strategies. Repair of the SLAP tear is the preferred treatment in the overhead athlete, and can allow for predictable return to sport with no loss of shoulder strength or stability.

A SLAP repair is performed through an arthroscopic approach to the shoulder. Utilizing suture anchors, surgeons reattach the torn aspect of the labrum to the glenoid. Caution is taken to ensure that suture anchors are not placed too fare anteriorly in order to avoid overtightening the shoulder. In older patients with SLAP tears, biceps tenodesis (detachment and reattachment) of the biceps tendon has more predictable outcomes.

Stiffness is a common complication following SLAP repair, so consistent post-operative rehabilitation is a mainstay of treatment. Most athletes return to sport at the 6-month mark post-operatively. Research has shown that immediate post-operative passive and active assisted flexion in the scapular plan helps to prevent stiffness and allow for more predictable return to sport and activity.

Evolution of Diagnosis

Superior Labral From Anterior to Posterior (SLAP) Tear

A superior labral tear from anterior to posterior (SLAP) tear is a specific injury to the glenoid labrum that commonly affects overhead athletes. A SLAP tear occurs to the superior aspect of the labrum. Unlike anterior or posterior labral tears, which confer a high degree of instability, SLAP tears commonly cause progressive and debilitating pain, especially in overhead athlete.

They also commonly cause impingement and a catching sensation in the shoulder, which can lead to decreased pitching velocity and control. Typically, these injuries involve the area where the biceps tendon attaches to the labrum. As a result, patients will often have pain with elbow flexion and supination.

Research has shown that pitches suffering from glenohumeral internal rotation deficiency (GIRD) are predisposed to SLAP tears. The harbinger of these injuries is often a painful “popping” sensation in the shoulder during overhead activity or a traumatic event (i.e. descending during pullups). Overall these are rare injuries, which account for only 5% of all shoulder injuries.