Failed Arthroscopic SLAP Repair in 35-Year-Old Male Police Officer

Abstract

Superior labral anterior to posterior (SLAP) tears can cause persistent pain and disability, often with vague clinical presentation. SLAP tears represent a detachment of the labrum from anterior to posterior, with or without involvement of the anchor of the long head of the biceps tendon. Synder et al. first described a classification system, which was later expanded upon by Maffet et al., classifying lesions based on their stability and location (Maffet, Gartsman, Moseley. Am J Sports Med 23:93–98, 1995; Snyder, Karzel, Del Pizzo, Ferkel, Friedman. Arthroscopy 6:274–279, 1990). SLAP tears result from traction or compression injuries or with repetitive overhead activity. If nonoperative management fails, multiple surgical treatment options are available, including simple debridement, stabilization of the biceps-labrum complex with repair, biceps tenotomy, or biceps tenodesis (Chalmers, Monson, Frank, et al. Knee Surg Sports Traumatol Arthrosc 24:3870–76, 2016; Ek, Shi, Tompson, Freehill, Warner. J Shoulder Elb Surg 23:1059–1065, 2014; Werner, Brockmeier, Miller. J Am Acad Orthop Surg 22:554–65, 2014).

With the increasing incidence and operative management of primary SLAP lesions, failed arthroscopic SLAP repair has become increasingly described (Provencher, McCormick, Dewing, McIntire, Solomon. Am J Sports Med 41:880–6, 2013). In a retrospective study of the New York Statewide Database, Mollon et al. found that in an 11-year time span, with 2524 identified cases of isolated arthroscopic SLAP repair, there was a 10.1% incidence of a subsequent surgery (Mollon, Mahure, Ensor, Zuckerman, Kwon, Rokito. Arthroscopy 32:1954–62 e1951, 2016). Numerous factors may contribute to a failed SLAP repair, and literature on management is varied. Neuman et al. and others have reported less reliable outcomes after SLAP repair in overhead athletes (Neuman, Boisvert, Reiter, Lawson, Ciccotti, Cohen. Am J Sports Med 39:1883–8, 2011; Park, Chung, Jeon, Lee, Oh. Am J Sports Med 41:1372–79, 2013; Yung, Fong, Kong, et al. Knee Surg Sports Traumatol Arthrosc 16:1151–1157, 2008). Frank et al. also reported increased revision rates with overhead athletes and patient aged less than 20 at time of initial repair (Frank, Nho, McGill, et al. Adv Orthop 2013:125960, 2013). Others have reported increased failure rates related to age or presence of a concomitant rotator cuff tear (Abbot, Li, Busconi. Am J Sports Med 37:1358–62, 2009; Erickson, Lavery, Monica, Gatt, Dhawan. Am J Sports Med 43:1274–82, 2015; Franceschi, Longo, Ruzzini, Rizzello, Maffulli, Denaro. Am J Sports Med 36:247–53, 2008; Neri, Vollmer, Kvitne. Am J Sports Med 37:937–42, 2009). Additional diagnoses or pathology and postoperative stiffness have been suggested as the most common reasons for revision (Katz, Hsu, Miller, et al. Arthroscopy 25:849–55, 2009; Mollon, Mahure, Ensor, Zuckerman, Kwon, Rokito. Arthroscopy 32:1954–62 e1951, 2016).

Factors that may contribute to failure include the inherent poor blood supply of the labrum, improper immobilization protocol, or possible overtreatment (McCormick, Nwachukwu, Solomon, et al. Am J Sports Med 42:820–5, 2014). Other intraoperative complications may occur including suture pullout, suture anchor pullout, suture reaction or granuloma formation, synovitis, chondrolysis, or long head of the biceps delamination (McCormick, Nwachukwu, Solomon, et al. Am J Sports Med 42:820–5, 2014). This case-based discussion will focus on a case of a failed SLAP repair, presenting with a repeat injury, to highlight the assessment, diagnosis, management, and outcomes of failed SLAP repairs.