AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-SLAP Repair-Justin W. Griffin, M.D.

SLAP Repair-Justin W. Griffin, M.D.

Pdf Summary

Dr. Justin W. Griffin’s 2020 presentation at the AANA Fellows Course addresses the complex management of Superior Labrum Anterior to Posterior (SLAP) lesions in overhead athletes. SLAP tears involve the biceps-labral complex and present diagnostic and treatment challenges. The key questions are who requires SLAP repair versus biceps tenodesis, how to optimally perform these procedures, the biceps’ role in shoulder stability, and strategies for managing surgical failures.<br /><br />SLAP lesions stem from mechanisms such as eccentric overload, peel back during throwing, and kinetic chain dysfunction, causing pain without necessarily producing mechanical instability. The biceps tendon-labrum complex acts as a secondary stabilizer but may contribute to pain. There are 10 recognized SLAP types; Type II is the most common labral pathology requiring surgery. Clinical evaluation includes physical tests (O’Brien’s, Speed’s, Yergason’s) and imaging, with special attention to age, activity level, and symptoms such as deep or bicipital groove pain.<br /><br />Decision-making hinges on distinguishing normal anatomical variants from pathologic tears that cause pain and dysfunction. For younger overhead athletes (<40) with acute symptoms, knotless arthroscopic SLAP repair is favored. Technical considerations include secure anchor placement, avoiding over-constraint of the biceps, and ensuring a biologic healing environment. Knotless suture anchors with tape constructs offer biomechanical advantages, lower profile, and reduced risk of chondral abrasion.<br /><br />In older patients or those with clear biceps-related symptoms, biceps tenodesis—subpectoral or suprapectoral—is often preferred. Failure rates for SLAP repair are significant in overhead athletes, and tenodesis after failed repair can lead to better return-to-play outcomes (~77% in overhead athletes). Overall, the trend is to reduce unnecessary SLAP repairs, favor knotless techniques, and personalize treatment based on patient age, symptoms, and activity demands.<br /><br />In summary, 2020 SLAP repair concepts emphasize selective repair, improved fixation techniques, and judicious use of tenodesis to optimize function and return to sport in overhead athletes.

Keywords

SLAP lesions

Superior Labrum Anterior to Posterior

overhead athletes

biceps tenodesis

knotless arthroscopic SLAP repair

biceps-labral complex

shoulder stability

surgical failure management

SLAP tear diagnosis

return to play outcomes