SLAP and Bankart Repair

what is the function of the labrum?

deepens the glenoid cavity, attachment site for GH ligaments

what is the ABER view for shoulder imaging?

abducted and externally rotated (throwing position)

what happens when you overcome the attachment of the labrum to the glenoid?

you lose tension on the GH ligaments and dislocate

primary restraint to ER at 90 degrees ABD (prevents dislocation)

anterioinferior GH ligament

what is a soft tissue bankart?

labrum torn off but periosteum/bone/articular cartilage are ok

what is a bony bankart?

bone of glenoid breaks

what is an ALPSA

anterior labrum periosteal sleeve avulsion- bone/labrum intact but periosteum is stripped ofc the bone which disrupts tension

what is a perthes lesion

tissue stripped off and sits next to proper spot- can sometimes heal with proper therapy

what is a GLAD lesion

perthes lesion with additional loose piece of cartilage disrupted

why is instability a big deal?

arthropathy (arthritis)- affects 18% of patients with single dislocation and 39% of those with reoccurance

what is the chance of reoccurrence in pediatric shoulder dislocation?

70%

how is reoccurrence after dislocation prevented?

arthroscopic bankart repair

1st step of a bankart repair

use elevator to strip periosteum off the glenoid

what is used to fix a bankart lesion

suture anchors

a defect on the humeral head that occurs when the shoulder dislocates forward from contact w/ the glenoid

hill sachs lesion

a bankart lesion repair _________ the GH ligamnets

retensions

how long does recovery after labral repair take?

about 5 months

what percent of athletes return to play w/o further dislocations following a bankart repair?

90%

surgically stabilized shoulders are _______ to complete the following season without recurrence than non-operative

5.8x more likely

is long term prognosis improved with a bankart repair?

yes

what is a bankart lesion?

a tear of the anteroinferior glenoid labrum

what is a SLAP tear?

superior labrum tear anterior to posterior

simple fraying of the superior labrum

Type 1 SLAP tear

superior labrum tear with the biceps anchor detached

type 2 SLAP tear

labrum detached and displaced with biceps anchor stable (bucket handle)

Type 3 SLAP tear

labrum displaced and tear extends into biceps tendon

Type 4 SLAP tear

what types of SLAP tears are almost always treated surgically

types 3 and 4

what types of SLAP tears are typically treated nonsurgically

type 1

what types of SLAP tears are controversial in what treatment is best (surgical vs nonsurgical)

Type 2

what is the anchoring point for the long head of the biceps tendon

superior labrum

difference in symptoms of SLAP tear and bankart lesion

bankart lesions cause instability while SLAP tears do not but are painful

caused by the undersurface of RC tendon bumping against the glenoid rim

internal impingement

series of events that often lead to SLAP tear by pathologic internal impingement

posterior capsule tigthness→ AC attenuation→ microinstability→repetitive microtrauma to the undersurface of RC and labrum

what further accentuated pathological internal impingement?

scapular dyskinesis/protraction

steps for slap tear repair

remove damaged labral tissue from the bone and create bleeding bed for healing, insert suture anchors and tie down the tissue on each side of the labrum

goal fro the first month after a labrum repair

Protection in a sling (to not pull the repair off)

what population is return to sport less likely for after SLAP repair?

throwers

what is the long term prognosis for type II slap surgical vs. nonsurgical

no difference b/w groups

what is suggested as treatment order for type 2 slap?

try PT first for at least 6 months before considering surgery