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Arthroscopic SLAP repair (Superior Labral Repair)

This is a keyhole operation  performed under general anaesthesia and regional nerve block.  Tiny (<1cm) incisions allow introduction of the arthroscope, instruments and implants.

A tear in the superior labrum is often called a SLAP tear.  This term stands for  'Superior Labrum Anterior and Posterior (to Biceps tendon)'.  The injury tends to occur from a sudden traction injury to your shoulder; a direct blow to your shoulder (landing heavily on your side); or after repeated twisting motions from overhead sports (tennis, throwing etc).  

The superior labrum and the origin of the long head of your biceps tendon are intimately related, so the symptoms of both can overlap, and sometimes a tear of the superior labrum is best treated by disconnecting the long head of the biceps tendon from the glenoid socket. 

Your pattern of superior labral injury is assessed to decide which treatment option is best for you:

  1. SLAP Repair (indicated for certain patterns of injury in younger (<35 years) patients
  2. Biceps tenodesis (for different patterns of injury and in patients >35 years old
  3. Debridement of the SLAP (trim ragged tissue – best for degenerate tears and fraying)

SLAP Repair

The torn superior labrum is mobilised from scar tissue.  The exposed upper glenoid bone is prepared to optimise healing using a rasp or a burr and your superior labrum is reattached to bone using suture anchors (as shown below).

Arthroscopic image of a repaired SLAP tear.  Two anchors have been used to fix the tear and stabilise the biceps tendon (just out of shot anterior to the right-hand anchor).  Mr Granville-Chapman uses knotless suture anchors to minimise the risk of abrasion of the suture material against the cartilage and rotator cuff.  An illustration of the same technique is shown below.


Superior labrum is repaired to the glenoid using suture anchors 

What is my recovery after surgery?

You will usually go home on the same day as your operation.  Please take your painkillers regularly for the first few days and begin them before your nerve block wears off. 

You will need to wear a sling six weeks.  Your physiotherapist will guide you through your rehabilitation.  After 6 weeks you will progress to active shoulder motion and you will begin to strengthen from 10 weeks. All restrictions will be removed by 6 months.

You can take down bulky padded dressings on day 2 after surgery, but keep your wound dry and covered with your waterproof dressings for 12 days. You can shower from 4 days with waterproof dressings on.

Patients vary in their symptoms after surgery, but in general you can expect to return to:

Office work after two weeks or so (in a sling)
Light physical work after twelve weeks
Heavier labour may take 5-6 months
Contact or overhead sport usually takes six months
Driving is allowed once you are confident and competent to control a car both for routine and emergency manoeuvres.  It will probably take about eight weeks for you to be ready.  

By six months, 85% of patients will feel their shoulder is better. You may notice some stiffness in your shoulder, but this is usually improves over the first year from your operation. 

When will I be followed up?

You will be seen at two weeks after your operation.  Depending on your progress, your on-going follow up will vary, but many patients can be discharged between six months and twelve months after surgery

What can go wrong?

Keyhole Shoulder surgery is generally very safe, but specific risks of Superior Labral Repair surgery

Persistent stiffness (5%), rarely needs surgery, but occasionally requires arthroscopic capsular release 

Failure of healing/re-tear (<15%). This may require further surgery, normally a biceps tenodesis

Occasionally (10%) patients notice on-going pain in their shoulder and a cause for this is not always found