Abstract
Purpose
The purpose of this study was to meticulously observe the structures around the origin of the long head of the biceps tendon (LHB) in order to propose a method of anatomical superior labrum anterior and posterior repair.
Methods
Twenty-eight shoulders of 16 cadavers with intact LHB origin were macroscopically investigated. Among them, 20 shoulders with an intact superior labrum were additionally observed, to determine whether the anterior edge of LHB on the labrum (point ‘A’) was anterior to the supraglenoid tubercle. Serial sections vertical to LHB were observed using ordinary light and polarized microscopy in three glenoids and scanning acoustic microscopy in one.
Results
The labrum had a meniscal appearance, and no LHB fibre was sent anterior to the anterior edge of the supraglenoid tubercle. ‘A’ was not located more posterior than the supraglenoid tubercle. All specimens had the so-called ‘the sheet-like structure’, in which the portion closer to the LHB origin tends to be stiffer. Fibres of the sheet-like structure ran vertically to LHB.
Conclusion
Fibre orientation and the stiffness of the sheet-like structure suggest its support of LHB. As LHB fibres do not anteriorly cross over ‘A’, ‘A’ could be a landmark for the anterior border of LHB, independent from the sheet-like structure. Considering a previous report mentioning that the horizontal mattress suture maintains the meniscus-like structure which might be sufficient for proper motion of the normal superior labrum, the horizontal mattress suture not crossing over ‘A’ should be recommended from the viewpoint of functional anatomy.
Similar content being viewed by others
References
Andrews J, Carson WJ, McLeod W (1985) Glenoid labrum tears related to the long head of the biceps. Am J Sports Med 13:337–341
Arai R, Kobayashi M, Toda Y, Nakamura S, Miura T, Nakamura T (2012) Fiber components of the shoulder superior labrum. Surg Radiol Anat 34:49–56
Boileau P, Parratte S, Chuinard C, Roussanne Y, Shia D, Bicknell R (2009) Arthroscopic treatment of isolated type II SLAP lesions: biceps tenodesis as an alternative to reinsertion. Am J Sports Med 37:929–936
Bradbury S, Hoshino K (1978) An improved embalming procedure for long-lasting preservation of the cadaver for anatomical study. Acta Anat 101:97–103
Burkhart S, Morgan C (1998) The peel-back mechanism: its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation. Arthroscopy 14:637–640
Denard PJ, Ladermann A, Burkhart SS (2012) Long-term outcome after arthroscopic repair of type II SLAP lesions: results according to age and workers’ compensation status. Arthroscopy 28:451–457
Dines JS, Elattrache NS (2008) Horizontal mattress with a knotless anchor to better recreate the normal superior labrum anatomy. Arthroscopy 24:1422–1425
Domb B, Ehteshami J, Shindle M, Gulotta L, Zoghi-Moghadam M, MacGillivray J, Altchek D (2007) Biomechanical comparison of 3 suture anchor configurations for repair of type II SLAP lesions. Arthroscopy 23:135–139
Gorantla K, Gill C, Wright R (2010) The outcome of type II SLAP repair: a systematic review. Arthroscopy 26:537–545
Hagiwara Y, Saijo Y, Ando A, Onoda Y, Suda H, Chimoto E, Hatori K, Itoi E (2012) Comparison of articular cartilage images assessed by high-frequency ultrasound microscope and scanning acoustic microscope. Int Orthop 36:185–190
Hagiwara Y, Saijo Y, Chimoto E, Akita H, Sasano Y, Matsumoto F, Kokubun S (2006) Increased elasticity of capsule after immobilization in a rat knee experimental model assessed by scanning acoustic microscopy. Upsala J Med Sci 111:303–313
Hozumi N, Yamashita R, Lee CK, Nagao M, Kobayashi K, Saijo Y, Tanaka M, Tanaka N, Ohtsuki S (2004) Time-frequency analysis for pulse driven ultrasonic microscopy for biological tissue characterization. Ultrasonics 42:717–722
Huber W, Putz R (1997) Periarticular fiber system of the shoulder joint. Arthroscopy 13:680–691
Kim TK, Queale WS, Cosgarea AJ, McFarland EG (2003) Clinical features of the different types of SLAP lesions: an analysis of one hundred and thirty-nine cases. J Bone Joint Surg Am 85-A:66–71
Morse A (1945) Formic acid-sodium citrate decalcification and butyl alcohol dehydration of teeth and bones for sectioning in paraffin. J Dent Res 24:143–153
Pal G, Bhatt R, Patel V (1991) Relationship between the tendon of the long head of biceps brachii and the glenoidal labrum in humans. Anat Rec 229:278–280
Snyder S, Karzel R, Pizzo W, Ferkel R, Friedman M (1990) SLAP lesions of the shoulder. Arthroscopy 6:274–279
Vangsness C Jr, Jorgenson S, Watson T, Johnson D (1994) The origin of the long head of the biceps from the scapula and glenoid labrum. An anatomical study of 100 shoulders. J Bone Joint Surg Br 76-B:951–954
Walch G, Nove-Josserand L, Levigne C, Renaud E (1994) Tears of the supraspinatus tendon associated with “hidden” lesions of the rotator interval. J Shoulder Elbow Surg 3:353–360
Werner A, Mueller T, Boehm D, Gohlke F (2000) The stabilizing sling for the long head of the biceps tendon in the rotator cuff interval. A histoanatomic study. Am J Sports Med 28:28–31
Yoo J, Ahn J, Lee S, Lim H, Choi K, Bae T, Lee C (2008) A biomechanical comparison of repair techniques in posterior type II superior labral anterior and posterior (SLAP) lesions. J Shoulder Elbow Surg 17:144–149
Acknowledgments
The authors thank Masatoshi Hagiwara M.D., PhD. for supervision of cadaver management.
Conflict of interest
There is no conflict of interest regarding this study, and it is not financially supported by any person or institute.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Arai, R., Kobayashi, M., Harada, H. et al. Anatomical study for SLAP lesion repair. Knee Surg Sports Traumatol Arthrosc 22, 435–441 (2014). https://doi.org/10.1007/s00167-013-2385-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-013-2385-3