SLAP II REPAIR - NEW TECHNIQUES, COMPLICATIONS AND CLINICAL OUTCOMES
DOI:
https://doi.org/10.31435/ijitss.1(49).2026.5679Keywords:
SLAP II Lesion, Arthroscopic Repair, Knotless Anchor, Double-Pulley Repair, Biceps Tenodesis, Clinical OutcomesAbstract
Superior labrum anterior to posterior (SLAP) type II lesions represent a clinically significant source of shoulder pain and dysfunction, particularly in young athletes and individuals engaged in repetitive overhead activities. Detachment of the superior labrum and biceps anchor disrupts glenohumeral biomechanics, potentially leading to instability, mechanical symptoms and impaired athletic performance. Although arthroscopic repair remains the standard surgical approach, optimal management strategies continue to evolve in response to variable return-to-sport rates and procedure-related complications observed with traditional techniques.
Contemporary surgical concepts emphasize anatomic restoration of the labral-biceps complex while minimizing implant-related morbidity. Innovations such as anatomic double-pulley constructs aim to distribute fixation forces more evenly and reduce peel-back stress during overhead motion. Knotless anchor systems and low-profile suture-tape constructs have been developed to eliminate intra-articular knots, decrease chondral irritation and facilitate smoother rehabilitation. In parallel, single-portal approaches seek to reduce soft-tissue disruption without compromising biomechanical stability. For selected patients particularly those with degenerative labral tissue or advanced age, biceps-based alternatives such as tenodesis provide a viable strategy with comparable functional outcomes and potentially earlier pain relief.
Early and mid-term results of these contemporary techniques demonstrate meaningful improvements in pain, shoulder function and patient satisfaction. Nevertheless, postoperative stiffness, persistent discomfort and incomplete return to high-demand activity remain clinically relevant challenges. Careful patient selection, meticulous surgical execution and individualized rehabilitation protocols are essential for optimizing outcomes. Further long-term, high-quality studies are required to refine treatment algorithms and establish durable, evidence-based recommendations.
References
Andrews, J. R., Carson, W. G., & McLeod, W. D. (1985). Glenoid labrum tears related to the long head of the biceps. The American Journal of Sports Medicine, 13(5), 337–341. https://doi.org/10.1177/036354658501300508
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: The Journal of Arthroscopic & Related Surgery, 14(6), 637–640. https://doi.org/10.1016/S0749-8063(98)70065-9
Chia, M. R., & Hatrick, C. (2015). Simplified knotless mattress repair of type II SLAP lesions. Arthroscopy Techniques, 4(6), e763–e767. https://doi.org/10.1016/j.eats.2015.07.024
Clark, J. M., & Harryman, D. T. (1992). Tendons, ligaments, and capsule of the rotator cuff: Gross and microscopic anatomy. The Journal of Bone and Joint Surgery. American Volume, 74(5), 713–725.
Cooper, D. E., Arnoczky, S. P., O’Brien, S. J., Warren, R. F., DiCarlo, E., & Allen, A. A. (1992). Anatomy, histology, and vascularity of the glenoid labrum: An anatomical study. The Journal of Bone and Joint Surgery. American Volume, 74(1), 46–52.
Corpus, K. T., Camp, C. L., Dines, D. M., Altchek, D. W., & Dines, J. S. (2016). Evaluation and treatment of internal impingement of the shoulder in overhead athletes. World Journal of Orthopedics, 7(12), 776–784. https://doi.org/10.5312/wjo.v7.i12.776
Cuéllar, R., Ruiz-Ibán, M. A., & Cuéllar, A. (2017). Anatomy and biomechanics of the unstable shoulder. The Open Orthopaedics Journal, 11, 919–933. https://doi.org/10.2174/1874325001711010919
De Maeseneer, M., Van Roy, F., Lenchik, L., Shahabpour, M., Jacobson, J., Ryu, K. N., Handelberg, F., & Osteaux, M. (2000). CT and MR arthrography of the normal and pathologic anterosuperior labrum and labral-bicipital complex. RadioGraphics, 20(suppl_1), S67–S81. https://doi.org/10.1148/radiographics.20.suppl_1.g00oc03s67
Dean, R. S., Onsen, L., Lima, J., & Hutchinson, M. R. (2023). Physical examination maneuvers for SLAP lesions: A systematic review and meta-analysis of individual and combinations of maneuvers. The American Journal of Sports Medicine, 51(11), 3042–3052. https://doi.org/10.1177/03635465221100977
Erickson, B. J., Jain, A., Abrams, G. D., Nicholson, G. P., Cole, B. J., Romeo, A. A., & Verma, N. N. (2016). SLAP lesions: Trends in treatment. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 32(6), 976–981. https://doi.org/10.1016/j.arthro.2015.11.044
Liu, F., Cheng, X., Dong, J., Zhou, D., Sun, Q., Bai, X., & Wang, D. (2019). Imaging modality for measuring the presence and extent of the labral lesions of the shoulder: A systematic review and meta-analysis. BMC Musculoskeletal Disorders, 20(1), 487. https://doi.org/10.1186/s12891-019-2876-6
Liu, Z., Wang, Y., Liu, P., Chen, W., & Du, C. (2024). A single-portal arthroscopic technique for type II SLAP lesions in the beach chair position. Arthroscopy Techniques, 13(2), 102859. https://doi.org/10.1016/j.eats.2023.10.002
Luime, J., Koes, B., Hendriksen, I., Burdorf, A., Verhagen, A., Miedema, H., & Verhaar, J. (2004). Prevalence and incidence of shoulder pain in the general population: A systematic review. Scandinavian Journal of Rheumatology, 33(2), 73–81. https://doi.org/10.1080/03009740310004667
Maffet, M. W., Gartsman, G. M., & Moseley, B. (1995). Superior labrum-biceps tendon complex lesions of the shoulder. The American Journal of Sports Medicine, 23(1), 93–98. https://doi.org/10.1177/036354659502300116
Mercouris, P., & Mercouris, M. (2023). Superior labrum anterior to posterior lesions: Part 1—Imaging and anatomy with arthroscopic classification. SA Journal of Radiology, 27(1), 2706. https://doi.org/10.4102/sajr.v27i1.2706
Mitchell, C., Adebajo, A., Hay, E., & Carr, A. (2005). Shoulder pain: Diagnosis and management in primary care. BMJ, 331(7525), 1124–1128. https://doi.org/10.1136/bmj.331.7525.1124
Morgan, C., Burkhart, S., Palmeri, M., & Gillespie, M. (1998). Type II SLAP lesions: Three subtypes and their relationships to superior instability and rotator cuff tears. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 14(6), 553–565. https://doi.org/10.1016/S0749-8063(98)70049-0
Mostello, A. J., Caldwell, P. E., & Pearson, S. E. (2020). Arthroscopic low-profile knotless repair of SLAP tears with suture tape. Arthroscopy Techniques, 9(10), e1505–e1509. https://doi.org/10.1016/j.eats.2020.06.010
Nosratpour, M., Zarei, H., Zaker Moshfegh, M., Mahdavi, M., Moteshakereh, S. M., Shirvani, P., Azizi, M., Parvandi, A., Kazemi, S. M., Sobhani, A., Farrokhi, M., & Amiri, S. (2025). Diagnostic accuracy of magnetic resonance imaging for detecting superior labrum anterior to posterior lesions: A systematic review and meta-analysis. JSES International, 9(6), 1972–1987. https://doi.org/10.1016/j.jseint.2025.05.023
Parnes, N., Ciani, M., Carr, B., & Carey, P. (2015). The double-pulley anatomic technique for type II SLAP lesion repair. Arthroscopy Techniques, 4(5), e545–e550. https://doi.org/10.1016/j.eats.2015.05.009
Powell, S. E., Nord, K. D., & Ryu, R. K. N. (2004). The diagnosis, classification, and treatment of SLAP lesions. Operative Techniques in Sports Medicine, 12(2), 99–110. https://doi.org/10.1053/j.otsm.2004.07.001
Snyder, S. J., Karzel, R. P., Pizzo, W. D., Ferkel, R. D., & Friedman, M. J. (1990). SLAP lesions of the shoulder. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 6(4), 274–279. https://doi.org/10.1016/0749-8063(90)90056-J
Song, Y., Wu, Z., Wang, M., Liu, S., Cong, R., & Tao, K. (2022). Arthroscopic modified double-row biceps tenodesis versus labral repair for the treatment of isolated type II SLAP lesions in non-overhead athletes. Orthopaedic Surgery, 14(7), 1340–1349. https://doi.org/10.1111/os.13229
Stetson, W. B., Polinsky, S., Morgan, S. A., Strawbridge, J., & Carcione, J. (2019). Arthroscopic repair of type II SLAP lesions in overhead athletes. Arthroscopy Techniques, 8(7), e781–e792. https://doi.org/10.1016/j.eats.2019.03.013
Thayaparan, A., Yu, J., Horner, N. S., Leroux, T., Alolabi, B., & Khan, M. (2019). Return to sport after arthroscopic superior labral anterior-posterior repair: A systematic review. Sports Health, 11(6), 520–527. https://doi.org/10.1177/1941738119873892
Wilk, K. E., Macrina, L. C., Cain, E. L., Dugas, J. R., & Andrews, J. R. (2013). The recognition and treatment of superior labral (SLAP) lesions in the overhead athlete. International Journal of Sports Physical Therapy, 8(5), 579–600.
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Copyright (c) 2026 Michalina Adamczyk, Aleksandra Lisowska, Pola Sitek, Dariusz Szołtys, Karolina Zygoń-Komendarczyk, Katarzyna Oberska, Sandra Olewińska, Tola Kotkiewicz, Hanna Grygorcewicz, Yelyzaveta Petrenko

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