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<v ->Dr P. here, we're talking treatment of SLAP lesions,

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which is going to depend on the functionality of the patient

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and their age.

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So let's start out with the fibrillated fissured SLAP one.

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Usually nothing is done with those.

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They're left alone, especially in older people

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but even in younger ones

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where load to go in and repair those.

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SLAP two. There are two choices.

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In a younger individual,

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you're going to repair them with anchors and sutures.

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You're going to sew that closed.

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In younger individuals, you may leave it alone.

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Sometimes you'll actually, if it undercuts the biceps,

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here's the biceps taking off,

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So the biceps becomes hypermobile or loose

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because what it's attached to is detached,

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then you might even resect this or tenodese it.

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So there are some different options.

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They depend upon age and function and symptoms.

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Surprisingly, and unlike the knee,

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the bucket handle tear in the shoulder

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is more often resected than repaired.

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In the knee, whenever you can, you always repair.

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So this would be taken down

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in the majority of cases,

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SLAP three, the bucket handle tear.

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SLAP four.

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There are several options available here,

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including depending upon what the person does.

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If they're a high performance athlete,

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you'd certainly shoot for a repair,

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both a repair of the biceps,

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which is involved longitudinally,

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as well as repair of the bucket handle tear,

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or, in a different setting,

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you might choose to resect this fragment

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and take down the biceps and tenodese it

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in front of the upper humerus at the level

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of the humeral neck.

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The SLAP five, that one's pretty self-explanatory.

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That one will get treated with a Bankart repair.

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What you do with the upper portion of a labrum

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really depends on the age of the patient

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and their overhead status.

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You may try and sew this closed,

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or you may just leave it alone,

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and repair and stabilize

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the antero, mid, and inferior aspect

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of the shoulder with capsular imbrication

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and typical Bankart repair.

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SLAP six. These are pretty easy.

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They're resected.

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The flaps are taken down, much like you would do

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for an unstable flap tear in the knee.

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SLAP seven, the one that goes

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into the middle glenohumeral ligament,

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might be left alone or might be imbricated with sutures,

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and then sewn closed like you would a SLAP two.

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Another option for these is to imbricate this,

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and then take the biceps down.

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And tenodese it at the level of the humeral neck.

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SLAP eight.

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These are most commonly seen

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in young weightlifter people

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that do a lot of bench pressing and military pressing.

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They can be rather annoying.

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And when they are very small, without major cysts,

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if the person refrains from that activity,

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these will often seal shut.

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But if they don't refrain from that activity

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or they're wide, or they have cysts,

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or they're signs of instability on MRI,

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for instance the glenoid is lurching posteriorly

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when the patient lies down,

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then you'll have to take down the cyst

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and then repair the posterior labrum.

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In fact, the entire posterior labral rim.

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Now, most surgeons are low to do this

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because one thing that happens

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when you mess around with the posterior labrum

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is the shoulder and shoulder capsule becomes tight

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and loss of flexibility is really taboo

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for any overhead performance athletes.

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You've got to choose very wisely there.

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SLAP nine.

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I see this most commonly in, I wouldn't say elderly.

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That's probably too harsh a word,

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but people over the age of 50.

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And I often see it in patients

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with chronic degenerative disease.

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The classic SLAP nine is about 270 degrees,

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and in my experience,

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it often spares the most inferior axillary aspect

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of the glenoid.

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But you may have to tack it down all the way around

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because the shoulder often experiences some degree

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of microinstability.

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These people are usually not frank dislocators, however,

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but they have shoulder pain and their function is limited.

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And then we have the SLAP 10,

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where we have a gap superior labral tear

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that extends into the SGHL,

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or superior glenohumeral ligament and rotator interval.

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These are tricky ones to mess with.

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You may have to imbricate the rotator interval.

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Sometimes the superior labrum is taken down

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along with the biceps

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and the biceps is tenodesed once again to the humeral neck.

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So these are a little bit harder to treat

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and depend heavily on what the patient's activity level is

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and their age.

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So that concludes our discussion of SLAP lesions.

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We talked about the different subtypes,

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their clinical implication,

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some key findings that you have to hone in on,

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as it relates to depth, and quadrant, and length,

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and degree of gapping or separation,

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whether the lesions are primary and isolated

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or collision lesions,

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and the treatment that each one generates.

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Thanks and have a great day.

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Dr. P out.