SLAP Repair 29807

CPT	Technique
Indications	Complications
Contraindications	Follow-up Care
Alternatives	Outomes
Pre-op Planning	Review References

SLAP Repair CPT

29807

SLAP Repair Indications

Failure of non-operative management

SLAP Repair Contraindications

Active Infections
Inadequate period of nonoperative treatment (relative)

SLAP Repair Alternatives

Nonoperative treatment: 3 months of physical therapy focusing on strengthening the dynamic stabilizers. If non-op treatment fails to eliminat symptoms arthroscopic repair with suture anchors is indicated.

SLAP Repair Pre-op Planning / Special Considerations

Ensure adequate anchors are available including any instrumentation needed for their insertion. Generally 3.0mm or smaller bioabsorbable or metallic suture anchors are utilized.
Consider concomitant Subacromial decompression. (Coleman SH, AJSM 2007 pending)

SLAP Repair Technique

Pre-operative antibiotics, +/- regional block
General endotracheal anesthesia
position. All bony prominences well padded.
Examination under anesthesia.
Prep and drape in standard sterile fashion.
Perform Shoulder arthroscopy. Note that 73% of shoulders demonstrate some normal anatomic variant to the superior and/or anterior labrum that can be confused with a SLAP tear or anterior labral tear.
Biceps root easily disrupted often into GH joint. Found in anterior and anterior-posterior Type II lesions
Peel-back sign = entire superior BLC will shift medially as the arm is ER while in 70-90 degrees of abduction. Generally found in posterior and combined anterior-posterior Type II lesions. (Burkhart SS, Arthroscopy 1998;14:637)
Drive-through sign = arthroscope can easily be moved through the GH joint from superior to inferior. Found in all Type II lesions
Debride superior glenoid with shaver.
Lightly decorticate the superior glenoid with an arthrscopic SLAP burr.
Place anchors in superior glenoid. At least one suture anchor should be placed beneath biceps root with suture looping through posterior half of the biceps root, elimating peel back sign. Achors should be placed in @ 30° angle in relation to the articular surface for maximal bone support. (Lehtinen JT, AJSM 2003;31:257).
Pass sutures. (Spectrum Suture passer or similar instrument).
Tie arthroscopic knots with the labral side suture as the post.
Posterolateral portal: consider for lesions involving posterosuperior labrum as it is nearly impossible to place an anchor in the round edge of the posterosuperior glenoid. This portal should be used without a cannula, just for drilling and anchor placement.

SLAP Repair Complications

Recurrence / failure, Hardware failure / Anchor pull-out / Synovitis with biodegradable anchors, Infections, Stiffness, CRPS, Fluid Extravasation, Chondrolysis, Hematoma, Chondral Injury / arthritis
Recurrence / failure
Hardware failure / Anchor pull-out / Synovitis with biodegradable anchors.
Infections
Stiffness
CRPS
Fluid Extravasation:
Chondrolysis: though to be related to heat from electo cautery or radiofrequency probes used during capsular release or capsular shrinkage.
Hematoma
Chondral Injury / arthritis

SLAP Repair Follow-up care

Post-Op: Place in sling. Active wrist, hand ROM. Pendelum shoulder exercises. Avoid any active elbow flexion/supination. Keep elbow flexed and humerus internally rotated to avoid tension on biceps.
10 days: Start PT, continue sling for 4 weeks. Avoid any active elbow flexion/supination. Avoid excessive external rotation, especially in abduction to limit shear forces on the repair.
6 weeks: Discontinue sling. Progressive strenghening program.
3-6 months: Sport-specific rehabilitation.
6 months: Return to sport / unrestricted activity
SLAP Repair Rehabilitation Protocol.

SLAP Repair Outcomes

>85% good to excellent results. (Field LD, AJSM 1993;21:783).
92% return to competition for traumatic injuries, 64% for those without an inciting trauma. (Brockmeier SF)

SLAP Repair Review References