• Journal of the Korean Arthroscopy Society
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• v.12 no.2
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• pp.134-138
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• 2008

SLAP(Superior labrum anterior to posterior) lesion is found in superior labrum injury alone and also combined with extension of the Bankart lesion(anteroinferior labral tear) in recurrent shoulder dislocation patients and rarely accompanied by the posterior Bankart lesion. There have been reports about SLAP lesions associated with various lesions, however, posterior type II SLAP lesion associated with posterior Bankart lesion has been rarely reported. In such a case, there are important technical tips in inserting anchors and suturing during arthroscopic repair. We experienced a rare case of posterior type II SLAP lesion associated with posterior Bankart lesion, occurred not after repetitive throwing(common mechanism) but after trauma in slipping down with the arm stretched during riding a bicycle. The satisfactory result was obtained after arthroscopic repair in this case.

• Clinics in Shoulder and Elbow
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• v.21 no.1
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• pp.37-41
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• 2018

Background: The purpose of this study is to evaluate results of superior labrum anterior to posterior (SLAP) repairs and debridement of type II SLAP lesions combined with Bankart lesions. Methods: Between 2010 and 2014, total 58 patients with anterior shoulder instability due to a Bankart lesion combined with a type II SLAP lesion were enrolled. Patients were divided into two groups: group C consisted of 30 patients, each with a communicated Bankart and type II SLAP lesion and group NC consisted of 28 patients, each with a non-communicated Bankart and type II SLAP lesion. Bankart repairs were performed for all patients. SLAP lesions were repaired in group C and debrided in group NC. Clinical results were analysed to compare groups C and NC by using the visual analogue scale pain score, American Shoulder and Elbow Surgeons score, Constant scores, Rowe score for instability and range of motion assessments. Results: The clinical scores were improved in both groups at final follow-up. Also, there were no differences between two groups. No significant difference was found in terms of the range of motion measured at the last follow-up. The number of suture anchors used was significantly higher in group C than in group NC (5.6 vs. 3.8; p=0.021). Conclusions: In this study, it is considered that Bankart repair and SLAP debridement could be a treatment option in patients with a non-communicated type II SLAP lesion combined with a Bankart lesion (study design: IV, therapeutic study, case series).

• Clinics in Shoulder and Elbow
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• v.2 no.2
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• pp.115-119
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• 1999

Purpose: We reviewed the SLAP lesions and associated injuries, also evaluated a hypothesis that the type II posterior SLAP lesion is related with posterior rotator cuff tear and gives rise to the postero-superior instability. Materials and Methods: The patient recording papers, MRI, video and operation sheets were reviewed with the 28 SLAP lesions confirmed by the arthroscopy among 242 cases. Among these SLAP lesions, type II was 22 cases and classified to the anterior, posterior(16 cases), combined subtype(6 cases) based on the main anatomic location. There were 14 cases of the type II accompanying rotator cuff tear. The average follow-up(13 months) results were evaluated with the ASES and Rowe rating score after repair or debridement of the SLAP lesions. Results: In the type II lesions accompanying the rotator cuff tears(14 cases), the posterior(l0 cases) and combined type(4 cases), cuff lesions were all existed posteriorly. Also We could confirm the drive-through sign in the eleven cases, though did not check the disappearance of this sign after repair because of retrospective study. We could followed up the 22 cases, 18 cases(77%) were excellent or good, fair 3 cases(14%) and poor 1 case(4%). Also, type II lesions with the rotator cuff tear(14 cases) were showed better results in the repair(8 cases) than the debridement(6 cases) of the unstable type II with the cuff repair. Conclusion: The type II lesions were frequently associated with the cuff tear in the specific location. We could presume the possibility of postero-superior instability in the SLAP lesion with the cuff injuries. Also, satisfactory results could be experienced when the unstable SLAP lesions with the cuff tear were repaired at the same time.

• Clinics in Shoulder and Elbow
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• v.18 no.1
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• pp.36-42
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• 2015

Background: Repair of superior labral anterior to posterior (SLAP) lesion in patients older than 40 years is controversial. The purpose of this study was to evaluate clinical outcomes of arthroscopic repair of SLAP lesions between younger and older patient groups. Methods: We reviewed 50 patients with isolated type II SLAP lesions who underwent arthroscopic repair. Patients were divided into 2 groups: group 1 included 20 patients aged <40 years, and group 2 included 30 patients aged ${\geq}40years$. Functional outcome at the final follow-up was assessed using a visual analog scale for pain and satisfaction, American Shoulder and Elbow Surgeons form, Constant score, University of California at Los Angeles score, and periodic change in range of motion (ROM). Anatomical outcome was evaluated using computed tomography (CT) arthrography at least 1 year after surgery. Results: No significant differences in functional scores or postoperative ROM were observed between the 2 groups. In group 2, later recovery of ROM (forward flexion, p=0.025; internal rotation, p=0.034) and lower satisfaction score (p=0.06) were observed for atraumatic patients (n=16) compared to patients with traumatic injury (n=14). Fifteen patients in group 1 (15/17, 88%) and 21 patients in group 2 (21/26, 81%) demonstrated a healed labrum on postoperative CT arthrography, and this difference was not significant. Conclusions: The results of this study suggest that arthroscopic repair of type II SLAP lesions can yield good functional and anatomical outcomes regardless of age, if patient selection is adequate. However, the delay in ROM recovery and lower satisfaction, particularly in older patients without traumatic injury, should be considered.

• Clinics in Shoulder and Elbow
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• v.13 no.2
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• pp.244-249
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• 2010

Purpose: Our goal of this study was to compare the mechanism of injury and the clinical outcomes between the non-traumatic and traumatic type II SLAP lesions. Materials and Methods: From January 2007 to May 2009, the sunjects of this study were 27 patients who had undergone operations for isolated type II SLAP lesions. The lesions were classified according to Burkhart's method. The lesions that were located on the anterior-superior labrum were classified as type I, those lesions located on the posterior-superior labrum were classified as type II and those lesions located on the anterior-posterior labrum were classified as type III. The clinical outcomes were evaluated by the UCLA score and the KSS score preoperatively and postoperatively. Results: Of the 27 cases, 16 cases were traumatic and eleven cases were non-traumatic. In the traumatic group, there were 12, 2 and 2 cases of type I, type II and type III, respectively (p=0.013). In non-traumatic group, there were 2, 6 and 3 cases of type I, type II and type III (p=0.026). Anterior lesions were more frequent in the traumatic group and posterior lesions were more frequent in the non-traumatic group. For the clinical outcomes, the mean preoperative UCLA score and KSS score were 18 (range: 14~23) and 48 (range: 32~76), respectively, and the postoperative UCLA score and KSS score were 32 (range: 28~33) and 86 (range: 71~92), respectively, in the traumatic group, and the preoperative UCLA score and KSS score were 21 (18~25) and 58 (41~68), respectively, and the postoperative UCLA score and KSS score were 29 (26~31) and 81 (68~89), respectively in the non-traumatic group. There was no significant statistical difference of clinical outcomes between the two groups (p=0.317, 0.405). Conclusion: In this study, the anatomical feature of type II SLAP lesion was associated with a trauma mechanism. Therefore, a trauma mechanism must be considered when planning the surgical treatment for type II SLAP lesions.

• Clinics in Shoulder and Elbow
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• v.10 no.2
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• pp.175-182
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• 2007

Purpose: This study compared the SLAP lesions caused by a sports-induced injury with those caused by a non-sports-induced injury. Materials and Methods: The study was performed on 54 patients who had undergone arthroscopic surgery for a SLAP lesion. There were 21 sports-induced-injury patients (group I) and 36 non-sports-induced injury patients (group II). The mean age of the men was 36 years and that of the women was 48 years. In both groups, the frequency of a concomitant injury and the clinical outcomes at the last follow-up was evaluated using the UCLA score, Rowe score, and the ASES score. Results: According to their injury mechanism, , there were 14 cases (67%) of repeated microtrauma injury in group I and 25 cases (75%) of compression injury type in group II. As a concomitant pathology, there was 11 cases of shoulder instability and 5 cases of a rotator cuff tear in group I, and 23 cases of rotator cuff tears and 14 cases of shoulder instability in group II. At the last follow up, group I showed slightly better clinical satisfaction (P>0.05). Conclusion: The possibility of a SLAP lesion accompanying other diseases is high. Therefore, an accurate assessment of concomitant injury lesions before surgery is important for the treatment outcome.

• Clinics in Shoulder and Elbow
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• v.19 no.3
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• pp.155-162
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• 2016

Background: The study aimed to determine the type of capsular insertion and the extent of capsular elongation in anterior shoulder instability by quantitatively evaluating their computed tomography arthrographic (CTA) findings, and to investigate the correlation of these parameters with surgical outcomes. Methods: We retrospectively reviewed 71 patients who underwent CTA and arthroscopic capsulolabral reconstruction for anterior shoulder instability between April 2004 and August 2008. The control group comprised 72 patients diagnosed as isolated type II superior labrum anterior to posterior (SLAP) lesion during the period. Among the 143 patients, 71 were examined with follow-up CTA at an average 13.8 months after surgery. It was measured the capsular length and cross-sectional area at two distinct capsular regions: the 4 and 5 o'clock position of the capsule. Results: With regards to the incidence of the type of anterior capsular insertion, type I was more common in the control group, whereas type III more common than in the instability group. Anterior capsular length and cross-sectional area were significantly greater in the instability group than in the control group. Among patients of the instability group, the number of dislocations and the presence of anterior labroligamentous periosteal sleeve avulsion lesion were significantly associated with anterior capsular redundancy. Postoperatively, recurrence was found in 3 patients (4.2%) and their postoperative capsular length and cross-sectional area were greater than those of patients without recurrence. Conclusions: Capsular insertion type and capsular redundancy derived through CTA may serve as important parameters for the management of anterior shoulder instability.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 1997.05a
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• pp.164-166
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• 1997

MR arthrography is a useful modality for evaluating the labrocapsular ligamentous complex(LOLC) of the shoulder. This study was performed to describe normal anatomic variations and pitfalis in image interpretation related to evaluation of the LOLC. MR Arthrogram of 56 shoulders in 41 asymptomatic young, active volunteers were prospectively reviewed to evaluate the labral shapes. capsular insertions and images which may mimic the lesions of glenohumoral instability. The anterior and posterior parts of the labra. respectively. varied in shape: triangular$(72\%,\; 36\%)$. round $(13\%,\; 35\%)$. cleaved$(8\%,\; 1\%)$. notched$(2\%,\; 0\%)$. flat$(5\%,\; 24\%)$ and absent$(0\%,\; 4\%)$. The anterior and posterior capsular insertions. respectively. varied in sites: Mosely and Oevergaard type I$(82\%,\;62\%)$, type II$(13\%,\; 3\%)$ and type III $(5\%,\; 2\%)$. A number of pitfalls in image interpretation were discovered. Articular cartilage undercutting the labrum$(29\%)$ and middle glenohumoral ligament in proximity to anterior labrum $(5\%)$ simulated a labral tear. Joint fluid interposed in the central. superior portion of the sublabral sulci$(25\%)$ simulated a SLAP lesion. Synovial fold$(38\%)$ in axillary pouch resembled a loose body. Knowledge of normal variations and pitfalls in MR arthrogram image interpretation of labral capsular - ligamentous complex will help the orthopedist to accurately detect debilitating derangements associated with the glenohumeral instability.