• Superior labrum anterior and posterior (SLAP) lesions are a major cause of a dysfunctional throwing shoulder.

• Both indications and surgical techniques for SLAP lesions have evolved over the years.

• There is no clear consensus for the management of SLAP lesions.

• The type of the SLAP lesion (Fig. 7-1) should be determined, with normal anatomic variants kept in mind (Fig. 7-2).

• The side of the glenoid is prepared with a shaver or burr to obtain bleeding bone before anchor placement to promote labral healing (Fig. 7-3). This is best accomplished from a contralateral portal.

• Because anchor placement needs to be somewhat perpendicular to the glenoid to avoid injury to the glenoid cartilage and potential anchor failure, portal placement must be selected meticulously and a new portal created when necessary for ideal anchor placement (Fig. 7-4). A percutaneous anchor placement is necessary to obtain the correct trajectory (Fig. 7-5).

• The Port of Wilmington is ideal for posterosuperior tears, while the “7 o’clock” portal is helpful for posteroinferior lesions.

• Iatrogenic chondrolysis (rapid degeneration of articular cartilage) can be avoided by not using thermal radiofrequency devices or administering anesthetics intra-articularly or by infusion.¹,²,³,⁴

The different techniques initially used for arthroscopic repair of SLAP tears had inconsistent results, especially in young athletes. The rate of successful outcomes ranged significantly from 40% to 94% of patients.⁵,⁶,⁷,⁸,⁹ This wide range was attributed to the huge variability among different techniques and

preferences for SLAP repair. Indeed, a high degree of variability was recorded in numerous issues concerning the repair technique.¹⁰ For example, in one study, the number of anchors used for similarly sized SLAP lesions varied significantly with half of the surgeons using from 1 to 2 anchors vs the other half that used 3-4 anchors. A high degree of variability exists in the use of absorbable suture anchors vs metallic anchors, in the position of the anchors, and in the type and configuration of the knot.¹⁰ As techniques evolved, it was realized that these conflicting data might be due to the fact that early techniques overlooked some basic principles of normal superior labrum anatomy restoration. It was also realized that certain risk factors might contribute to increased failure rate. For example, polylactic acid absorbable suture anchors were associated with an increased risk of failure and reoperation (odds ratio 12.7). Smoking status was also found to be linked with increased failure rate, while age, gender, the presence of rotator cuff pathology, the number of anchors, and the duration of symptoms were not found to be associated with increased failure risk of SLAP tear repair.¹¹