Isolated and combined Type II SLAP repairs in a military population

The study compares the clinical results of isolated arthroscopic repair of Type II SLAP tears with those of combined treatment for Type II SLAP and other associated shoulder conditions. The population was composed of 36 aged-matched active duty males with a mean age of 31.6 years (range 22–41 years); mean follow-up was 29.1 months (range 24–42 months). Eighteen subjects in Group I had isolated Type II SLAP tears. Eighteen subjects in Group II had Type II SLAP tear and concomitant ipsilateral shoulder conditions, including subacromial impingement in six patients, acromioclavicular arthrosis in three patients, subacromial impingement and acromioclavicular arthrosis in four patients, spinoglenoid cyst in four patients, and intra-articular loose bodies in one patient. Arthroscopic SLAP repair was performed with biodegradable suture anchors. Subacromial decompression and spinoglenoid cyst decompression were performed arthroscopically. Distal claviculectomy was performed in open fashion. Loose bodies were removed arthroscopically. At minimum 2-year follow-up, the mean UCLA score for Group I (30.2 ± 3.0 points) was not significantly different from Group II (30.8 ± 2.0 points) (P = 0.48). The mean post-operative ASES score for Group I (84.1 ± 13.4 points) was significantly lower than for Group II (91.8 ± 5.4 points) (P < 0.04). The mean VAS pain score for Group I (1.6 ± 1.3 points) was significantly higher than for Group II (0.7 ± 0.7 points) (P < 0.02). Seventeen of 18 patients (94%) in each group returned to full duty. In a population of active duty males, arthroscopic repair of isolated Type II SLAP had comparable results with a cohort of Type II SLAP repairs treated in combination with other shoulder conditions, with the combined treatment group having significantly better results in two of three parameters measured. Return to duty rates were identical. Therefore, concurrent treatment of other associated extra-articular shoulder conditions improves the overall success of SLAP repair and the presence of these other conditions should be recognized and treated along with the SLAP tears in order to maximize clinical results.     

Outcomes of combined arthroscopic rotator cuff and labral repair

BACKGROUND: Rotator cuff tears, Bankart lesions, and superior labral anterior posterior lesions commonly occur in isolation, but there is a subgroup of patients who experience combined injuries. Prior studies have excluded such patients as confounding groups. HYPOTHESIS: In patients with combined lesions of the labrum and rotator cuff, arthroscopic repair of both lesions will restore range of motion and stability and provide good clinical results. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We retrospectively evaluated the clinical outcomes of a series of patients with combined rotator cuff and labral (Bankart or superior labral anterior posterior) lesions treated arthroscopically. RESULTS: Thirty patients (average age, 47.8 years) with combined rotator cuff and labral lesions were evaluated at a mean follow-up of 2.7 years (range, 24-54 months). Sixteen patients had Bankart lesions and 14 patients had SLAP lesions. Significant improvements in forward flexion (20.5 degrees, P = .005), external rotation (9.0 degrees, P = .008), and internal rotation (2 vertebral levels, P = .016) were observed. The mean L'Insalata and American Society of Shoulder and Elbow Surgeons scores for all patients were 92.9 and 94.3, respectively. Twenty-seven (90%) patients reported satisfaction as good to excellent, and 23 of 30 (77%) returned to their preinjury level of athletics. Two patients suffered recurrent rotator cuff tears. CONCLUSION: In patients with rotator cuff and labral lesions, arthroscopic treatment of both lesions yields good clinical outcomes, restoration of motion, and a high degree of patient satisfaction.     

Arthroscopic repair of isolated type II superior labrum anterior–posterior lesion

The effectiveness of arthroscopic repair of type II superior labrum anterior-posterior lesion (SLAP) was unclear as previous studies examined this treatment with patients of combined types of SLAP lesions. To address this research gap, we evaluated the clinical and functional outcomes of arthroscopic repair for 16 patients (mean=24.2, SD=6.5) with clinical evidence of isolated type II SLAP lesion. After having arthroscopic stabilizations with Bioknotless suture anchors (Mitek), the patients were offered post-operative rehabilitation programs (e.g., physiotherapy) for 6 months. The symptoms of SLAP lesion and the functions of the shoulder were assessed pre-operatively and 28-month post-operatively by O'Brien test, Speed test, Yergason test, and University of California at Los Angeles rating for pain and function of the shoulder. Wilcoxon Signed Ranks test and McNemar test were employed to analyze the difference between assessment in pre-operation and post-operation phases. The result showed that patients' shoulder functions improved (UCLA Shoulder Score), and symptoms of SLAP lesion reduced (O'Brien test, Speed test, and Yergason test) significantly (P<0.05). Time for returning to play with pre-injury level was in average 9.4 months (range 4-24), and no complication or recurrence was detected. We concluded that arthroscopic repair is an effective operation of type II SLAP lesion with good clinical and functional outcomes; however, athletes with high demand of overhead throwing activities are likely to take longer duration of rehabilitation to attain full recovery.     

Clinical and structural results of partial supraspinatus tears treated by subacromial decompression without repair

Patients with primary impingement and articular sided partial tears of the supraspinatus are often treated by subacromial decompression without repair, if the extent of the tear is estimated to be below 50% of tendon thickness. It has been questioned whether repair of these cuff lesions is necessary, because these tears could progress to full thickness tears with deteriorating clinical results. Our hypothesis was that subacromial decompression without repair of the supraspinatus tendon leads to significant clinical improvement for patients with grade I and II articular sided tears without progression to a full thickness tear on a regular basis. 46 consecutive patients (av. Age 59.2 years, range 33–76.6 years) were retrospectively reviewed after an average follow up of 50.3 months (36–86 months). 26 patients (43.5%) had a grade I tear according to Ellman, which was left alone, 20 patients suffered from a grade II tear, which was debrided. Clinical outcome was assessed with the ASES Score and ultrasound evaluation was performed on all patients to detect possible progression to a full thickness tear. The average ASES Score significantly improved from 37.4 to 86.6 points (p < 0.0001). The mean postoperative Constant Score was 87.6 points. Only three patients (6.5%) progressed to a full thickness tear detectable on ultrasound examination. Only one of these patients had a poor result with an ASES Score of 35 points, the other two were very satisfied and had an ASES score above 90 points. 8 patients showed no more signs of partial tearing on ultrasound and these patients had an average ASES Score of 93.1 points. Overall clinical outcome was rated excellent in 35 cases (76.1%), good in 5 (10.9%), average in 2 (4.3%) and poor in 4 (8.7%). Our results indicate that good and excellent results can be achieved mid- to long term by acromioplasty without repair of the rotator cuff in articular sided partial tears grade I and II. These results reach almost 95% of the value of a healthy shoulder. A better result on ultrasound examination was associated with a superior clinical outcome, while progression to a full thickness tear was rare.     

Posterosuperior suture granuloma impingement after arthroscopic SLAP repair using suture anchors: a case report

Arthroscopic refixation of the glenoid labrum has become a standard treatment of type II SLAP lesions although postoperative results are not uniformly good due to factors which are yet unclear. We present the case of an active overhead athlete with an intraarticular posterosuperior impingement syndrome arising from a suture granuloma formation complicating the postoperative course after arthroscopic SLAP repair. The symptoms resolved completely following revision arthroscopy during which the granuloma and the permanent sutures were removed. Implant related complications should be considered when patients present with recurrent pain after arthroscopic SLAP repair using suture anchors, in particular during overhead activity.     

Outcome of the isolated SLAP lesions and analysis of the results according to the injury mechanisms

Superior labral anterior posterior (SLAP) lesions of the shoulder arise from various causes and have some controversies in their treatment. The purpose of this study is to evaluate the outcomes of arthroscopic SLAP repair and the relationship between injury mechanisms and outcomes. We evaluated the clinical results of 24 patients (mean 33 months follow-up) who had an arthroscopic isolated SLAP (type II: 21, type III: 1, type IV: 2 patients) repair with suture anchors. These labral tears were arthroscopically repaired with 1–4 anchors (mean 1.8). All patients were evaluated with University of California, Los Angeles (UCLA) and Visual Analogue Scale (VAS) scores. There were the following injury mechanisms: compression-type, 10; traction-type, 9; combined or other-type, 5 patients. We also compared the clinical results according to the injury mechanisms. Preoperatively, the mean of UCLA and VAS scores were 22.7 and 6.4 points, respectively. At an average of 33 months postoperatively, the mean of UCLA and VAS scores were 29.9 and 2.1 points, respectively. There was statistical improvement in the subjective scores from the pre- to post-operation. UCLA and VAS scores of the pre- and post-operation were not statistically different according to the injury mechanisms. Arthroscopic repair is effective in the treatment of isolated SLAP lesion and injury mechanisms do not affect the clinical outcomes.     

SLAP lesions: a treatment algorithm

Tears of the superior labrum involving the biceps anchor are a common entity, especially in athletes, and may highly impair shoulder function. If conservative treatment fails, successful arthroscopic repair of symptomatic SLAP lesions has been described in the literature particularly for young athletes. However, the results in throwing athletes are less successful with a significant amount of patients who will not regain their pre-injury level of performance. The clinical results of SLAP repairs in middle-aged and older patients are mixed, with worse results and higher revision rates as compared to younger patients. In this population, tenotomy or tenodesis of the biceps tendon is a viable alternative to SLAP repairs in order to improve clinical outcomes. The present article introduces a treatment algorithm for SLAP lesions based upon the recent literature as well as the authors’ clinical experience. The type of lesion, age of patient, concomitant lesions, and functional requirements, as well as sport activity level of the patient, need to be considered. Moreover, normal variations and degenerative changes in the SLAP complex have to be distinguished from “true” SLAP lesions in order to improve results and avoid overtreatment. The suggestion for a treatment algorithm includes: type I: conservative treatment or arthroscopic debridement, type II: SLAP repair or biceps tenotomy/tenodesis, type III: resection of the instable bucket-handle tear, type IV: SLAP repair (biceps tenotomy/tenodesis if >50 % of biceps tendon is affected), type V: Bankart repair and SLAP repair, type VI: resection of the flap and SLAP repair, and type VII: refixation of the anterosuperior labrum and SLAP repair.     

SLAP tears of the glenoid labrum in contact athletes.

OBJECTIVE: To describe the distribution and clinical presentation of labral injuries in rugby players and the time taken for them to return to sports. DESIGN: Retrospective cohort study. SETTING: Busy shoulder practice in the North West of England, treating a large number of professional athletes. PATIENTS: A review of 51 shoulder arthroscopies performed on professional rugby players over a 35 month period. All patients diagnosed with a SLAP lesion at arthroscopy were identified. Eighteen patients had a documented SLAP tear; this group represented our study population. INTERVENTIONS: Arthroscopic debridement and/or stabilization was carried out for all labral injuries using Panaloc anchors and No. 2 PDS via a 2 portal technique. MAIN OUTCOME MEASUREMENTS: Classification of injury, Satisfaction, Time to return to play. RESULTS: The incidence of SLAP tears in our study population was 35%. There were 11 isolated SLAP tears (61%), 3 SLAP tears associated with a Bankart lesion (17%), 2 SLAP tears associated with a posterior labral lesion (11%), and 2 SLAP tears associated with an anterior and posterior labral injuries (11%). Of the 18 SLAP tears, 14 (78%) were type 2, 3 (17%) were type 3, and 1 (5%) was type 4. None of the patients with a SLAP tear presented with symptoms of instability. MR Arthrogram had a 76% sensitivity for detecting SLAP tears. By 6 months postsurgery, 89% of patients were satisfied. Patients with isolated SLAP tears were the quickest to return to sports, at an average of 2.6 months postsurgery. CONCLUSIONS: SLAP tears are a common injury in rugby players. These can often be diagnosed with MR arthrography. Arthroscopic repair is associated with excellent results and early return to sports.     

The partial-thickness rotator cuff tear: is acromioplasty without repair sufficient?

We evaluated the clinical outcome of arthroscopic acromioplasty and debridement in 162 patients who had either normal rotator cuffs, grade 1 (frayed tendon) partial-thickness tears, or grade 2 (less than 50% of the tendon) partial-thickness tears. The mean time from surgery to the response to the L'Insalata outcome questionnaire was 52.7 months (4.5 years) among the 105 respondents (107 shoulders). The mean score was 90 points; eight patients (8%) scored less than 70 points (range, 30 to 65.5), and their treatment failed early on. The patients with grade 2B (bursal) partial-thickness rotator cuff tears had a significantly higher failure rate (38%). Although the clinical outcome of patients with partial-thickness tears of the rotator cuff comprising less than 50% of the tendon (grade 1 and 2) was not significantly different from that of patients without partial rotator cuff tears, the subgroup of patients with grade 2B partial tears had a statistically significantly higher failure rate and may have been better served with primary repair. With follow-up to 10 years, there was no evidence that clinically relevant or symptomatic intrinsic rotator cuff pathologic conditions progress in those patients with partial-thickness tears treated with arthroscopic anterior acromioplasty.     

经肌腱修补法和转化为全层后修补法治疗Ellman 3度冈上肌腱关节侧部分撕裂的临床研究

目的:比较关节镜下经肌腱修补法和转化为全层后修补法治疗冈上肌腱关节侧部分撕裂(PASTA)的临床效果.方法:选取我院2017年1月至2018年12月因PASTA损伤接受手术治疗的患者47例,男31例,女16例,年龄49.7±4.4岁,右肩27例,左肩20例.所选患者均为Ellman 3度,分为经肌腱修补组(24例)和转...     

Rotator Cuff Repair: Is there any role for acromioplasty?

Objectives: Acromioplasty has been one of the most common techniques amongst orthopedic surgeries in the past decade. However, its efficacy in arthroscopic surgeries of rotator cuff repair is still debatable. The purpose of this study is to compare the arthroscopic rotator cuff repair with or without acromioplasty in patients with complete rotator cuff tear.

Methods: In this prospective cohort study, patients with complete rotator cuff tear (acromion type II or III Bigliani) and a history of failure to the conservative treatment for at least 6 months were evaluated for eligibility. Patients, based on the time interval, were placed in one of two groups: arthroscopic rotator cuff repair with (RCR-A group) and without acromioplasty (RCR group). Patients were assessed for two years in term of pain intensity by VAS criteria and shoulder functional status by Quick-DASH, Constant score and simple shoulder test criteria.

Results: In the baseline assessment, RCR-A group (34 patients) and RCR group (33 patients) were similar. Comparing patients in two groups in relation to SST, Quick-DASH and VAS scores preoperatively showed there is no significant difference between the two groups. The SST, Quick-DASH and VAS scores improved significantly in both groups at both the 6-month and 2-year follow-ups (all P < 0.001). The extent of progress in the functional scores was similar in both groups (P > 0.05).

Conclusion: Arthroscopic rotator cuff repair without acromioplasty may be as reliable and useful as conventional rotator cuff repair with acromioplasty. Thus, acromioplasty cannot be recommended as a routine technique in every rotator cuff repair.     

腱固定与盂唇修复治疗肩关节SLAP损伤的系统评价和序贯分析

 目的 比较肱二头肌长头腱固定术(biceps tenodesis,BT)与盂唇修复术(labral repair,LR)在治疗单纯肩关节上盂唇前后向损伤(superior labral anterior posterior lesion,SLAP)中的疗效和潜在风险。方法 基于PubMed、Embase、中国知网、万方、维普、Web of Science和Cochrane Library数据库,检索建库至 2020-10-19的文献,根据预先确定的纳入和排除标准对文献进行筛选,采用Stata 14.0软件进行Meta分析,TSA 0.9.5.10 Beta 软件进行试验序贯分析。结果 共纳入7项研究,涉及279例患者,其中LR组148例,BT组131例。Meta分析结果显示:BT组的患者满意率(OR=0.29,95%CI:0.11~ 0.76)和重返运动率(OR=0.32,95%CI:0.15~0.71)显著高于LR组,美国肩肘外科医师评分(WMD=-0.34,95% CI:-9.59~2.79),加州大学洛杉矶分校评分(WMD=-1.94,95%CI:-5.58~1.70),视觉模拟量表评分(WMD=-0.73,95% CI:-2.01~0.54),并发症发生率(OR= 1.71,95% CI:0.56~5.22)和再手术率(OR=0.98,95%CI:0.33~2.90)两组差异无统计学意义。试验序贯分析表明,患者满意率累积纳入的研究穿过了传统界值和序贯分析界值,表明BT组可提升患者满意率的证据是充分的,而重返运动率累积纳入的研究穿过了传统界值,未穿过序贯分析界值,表明BT组提升重返运动率的证据尚不充分。结论 BT组的患者满意率优于LR组,且具有一定的安全性,但仍需纳入更多高质量的随机对照试验进一步验证。     

Shoulder injuries in overhead athletes. The "dead arm" revisited

The following statements summarize this article: Three distinct categories of Type 2 SLAP lesions exist: (1) anterior, (2) posterior, and (3) combined anteroposterior. Posterior Type 2 SLAP lesions have distinct clinical and anatomic features that distinguish them from anterior Type 2 SLAP lesions. Posterior and combined Type 2 SLAP lesions can be disabling to overhead-throwing athletes because of posterosuperior instability and anteroinferior pseudolaxity. The Jobe relocation test is positive with posterosuperior pain in patients with posterior or combined anterior-posterior Type 2 SLAP lesions and is negative in patients with anterior Type 2 SLAP lesions. Rotator cuff tears are frequently associated with posterior or combined anterior-posterior SLAP lesions, are lesion-location specific, and typically begin from inside the joint as undersurface tears. Repair of posterior SLAP lesions can return overhead-throwing athletes to full overhead athletic functioning. The peel-back mechanism is a likely cause of posterior Type 2 SLAP lesions. To securely repair the posterosuperior labrum to resist torsional peel-back, sulure anchors must be placed posterior to the biceps at the corner of the glenoid. The repair must be protected against external rotation past 0 degree for 3 weeks to avoid undue premature torsional stresses on the repair from the peel-back mechanism. A tight posteroinferior capsule predisposes to Type 2 SLAP lesions in overhead athletes. Shoulders at risk for the dead arm syndrome have a marked loss of internal rotation caused by contracture of the posteroinferior capsule such that less than a 180 degrees arc of rotation is achieved with the arm abducted 90 degrees (the 180 degrees rule). Type 2 SLAP lesions that cause the dead arm syndrome in overhead-throwing athletes are most likely acceleration injuries that occur in late cocking rather than deceleration injuries in follow-through. Rehabilitation of athletes with the dead arm syndrome must include the entire kinetic chain. The root cause of the dead arm syndrome is the Type 2 SLAP lesion.     

Superior labrum anterior posterior lesions of the shoulder: Operative techniques of management

Since the advent of shoulder arthroscopy, pathology of the superior glenoid labrum and biceps anchor has been increasingly recognized as a source of shoulder pain and disability. Additional biomechanical testing has substantiated the role of the superior labrum and biceps anchor in glenohumeral stability. The diagnosis of superior labral injury such as the superior labrum anterior posterior (SLAP) lesion remains difficult, as the history, clinical examination, and radiographic evaluation can only raise suspicion. The ultimate diagnosis of the SLAP lesion can only be made with a well-directed diagnostic glenohumeral arthroscopy. The treatment of SLAP lesions depends on the type of SLAP lesion encountered at arthroscopy. This includes debridement of most type I and III lesions, and repair of type II and many type IV SLAP lesions. In this report, we will present our basic approach towards evaluation and treatment of SLAP lesions at the Southern California Orthopedic Institute.     

Arthroscopic release of the long head of the biceps tendon: functional outcome and clinical results

BACKGROUND: Treatment of chronic, refractory biceps tendinitis remains controversial. The authors sought to evaluate clinical and functional outcomes of arthroscopic release of the long head of the biceps tendon. HYPOTHESIS: In specific cases of refractory biceps tendinitis, site-specific release of the long head of the biceps tendon may yield relief of pain and symptoms. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Fifty-four patients diagnosed with biceps tendinitis underwent arthroscopic release of the long head of the biceps tendon as an isolated procedure or as part of a concomitant shoulder procedure over a 2-year period. Patients were not excluded for concomitant shoulder abnormality, including degenerative joint disease, rotator cuff tears, Bankart lesions, or instability. Nine of 40 patients had an isolated arthroscopic release of the biceps tendon. At a minimum of 2 years, the American Shoulder and Elbow Surgeons; the University of California, Los Angeles; and the L'Insalata shoulder questionnaires as well as ipsilateral and contralateral metrics were used for evaluation. RESULTS: The L'Insalata; University of California, Los Angeles; and American Shoulder and Elbow Surgeons scores were 77.6, 27.6, and 75.6, respectively. Seventy percent had a Popeye sign at rest or during active elbow flexion; 82.7% of men and 36.5% of women had a positive Popeye sign (P < .05); 68% were rated as good, very good, or excellent. No patient reported arm pain at rest distally or proximally; 38% of patients complained of fatigue discomfort (soreness) isolated to the biceps muscle after resisted elbow flexion. CONCLUSION: Arthroscopic release of the long head of the biceps tendon is an appropriate and reliable intervention for patients with chronic, refractory biceps tendinitis. Cosmetic deformity presenting as a positive Popeye sign and fatigue discomfort were the primary complaints. CLINICAL RELEVANCE: Although tenotomy is not the ideal intervention for patients of all ages with various shoulder abnormalities, data suggest that it may be an acceptable surgical intervention for a specifically selected cohort of individuals.     

Arthroscopic subacromial decompression. An anatomical study

Anterior acromioplasty as described by Neer has been an effective procedure for shoulder impingement syndrome. Recent presentations by Ellman suggest that an effective acromioplasty may be performed arthroscopically. These clinical reports have not been supported by any laboratory experience. The purpose of our study was to examine the feasibility and attempt to quantitate the results of arthroscopic subacromial decompressions. Six acromioplasties were performed according to the recommended technique of Dr. Neer to create a standard for comparison. Fourteen fresh postmortem specimens were studied. In seven shoulders a standard acromioplasty was performed with an osteotome. In seven shoulders an acromioplasty was performed using standard arthroscopic approaches and motorized instruments. In five shoulders an isolated division of the coracoacromial ligament was performed arthroscopically. The coracoacromial ligament was completely divided in all five cases. In the osteotome group adequate bone was resected in 75% (21/28) measured locations. In the arthroscopic group adequate bone was removed at 86% (24/28) location. This difference is not statistically significant. In the cadaver, anterior acromioplasty was performed effectively and predictably with arthroscopic instruments. This compared favorably to a conventional osteotome acromioplasty. It was concluded that coracoacromial ligament division can be accomplished.     

Influence of SLAP lesions on chondral lesions of the glenohumeral joint

From 2004 to 2008 we evaluated 431 SLAP lesions during 3,395 shoulder arthroscopies and compared two groups of patients, one with SLAP lesion as group I and one without SLAP lesions as group II. Exclusion of type I SLAP lesions, rotator cuff tears and history of dislocation of the shoulder in both groups left 182 cases in group I, and additionally, exclusion of all-type SLAP lesions left 251 patients in group II. In group I, SLAP lesion-associated chondral lesions were present in 20% at the humerus (4% group II, p = 0.005), 18% at the glenoid (5% in group II, p = 0.05) and 14% glenohumeral (3% group II, p = 0.04). We observed a pattern of typical localization of SLAP-associated chondral lesions at the humerus underneath the biceps tendon (78%) and at the anterior half of the glenoid (63%) in group I in contrast to the central region of the humerus (82%) and the central region at the glenoid (55%) in group II. The association of SLAP and chondral lesions was not influenced by the presence of trauma or age of the patients. SLAP lesions seem to be a risk factor for subsequent early onset of osteoarthritis either caused by a bicipital chondral print or glenohumeral instability or a combination of both.     

Diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior lesions of the shoulder

OBJECTIVE: The purpose of this study was to evaluate the diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior (SLAP) lesions of the shoulder with emphasis on the classification of SLAP lesions. MATERIALS AND METHODS: Two hundred sixty-five MR arthrograms including 68 MR arthrograms of patients with arthroscopically proven SLAP lesions of the shoulder and 197 MR arthrograms of patients with an intact superior labrum and biceps anchor were retrospectively reviewed in random order. MR arthrography was performed using triplanar T1-weighted spin-echo sequences and a coronal oblique T2-weighted fast spin-echo sequence. MR arthrograms were evaluated by two radiologists with agreement by consensus, and the results were compared with arthroscopic findings. RESULTS: Of 68 SLAP lesions, seven (10%) were arthroscopically classified as type I, 41 (60%) as type II (including 20 type II lesions with coexisting Bankart lesions [29%]), 14 (21%) as type III, and six (9%) as type IV. Compared with arthroscopy as the gold standard, MR arthrography showed a sensitivity of 82% and a specificity of 98% for the overall detection of SLAP lesions. MR arthrographic grading and arthroscopic grading were concurrent in 45 (66%) of 68 arthroscopic diagnoses. Of the surgically confirmed SLAP lesions, involvement of the biceps insertion and SLAP type II lesions with coexisting Bankart lesions were assessed correctly in 75% and 95% of cases, respectively. CONCLUSION: MR arthrography is a highly effective method for the detection of SLAP lesions, but this technique is limited in the classification of different types of SLAP lesions. However, for preoperative planning MR arthrography provides accurate information about the stability of the biceps insertion and the presence of associated anteroinferior labral injuries.     

Schultergelenkverletzungen bei Überkopfsportarten

Overhead sport places great demands on the shoulder joint. Shoulder pain in overhead athletes and throwers can in the majority of cases be attributed to lesions resulting from chronic overuse of tendons and capsuloligamentous structures or to sequels of microinstability and secondary impingement. Due to its great impact on therapeutic decisions, imaging in athletes with unclear shoulder pain is a challenge. In this connection, magnetic resonance (MR) arthrography represents the cross-sectional imaging modality of first choice, as it allows depiction and exclusion of pathologic alterations of all relevant joint structures with sufficient confidence. This article reviews the biomechanical and clinical aspects and MR arthrographic features of the most common shoulder pathologies in overhead athletes, including biceps tendinopathy, superior labral anterior-posterior (SLAP) lesions, rotator cuff lesions, as well as extrinsic and intrinsic impingement syndromes.