Arthroscopic SLAP repair is a minimally invasive keyhole procedure to repair the torn labrum at the top of the shoulder joint (biceps anchor). Patients wear a sling for six weeks and start therapy two weeks after surgery. Strengthening and training for your sport commences at 3 months; full unrestricted contact sport is possible at 4-6 months after surgery.
An arthroscopic SLAP repair is a surgical procedure where small keyhole incisions are used to access the shoulder using specialised instruments. For most patients who sustain shoulder injury and a SLAP tear that requires surgical repair, we are able to undertake this utilising an arthroscopic technique.
Using a minimally invasive approach means faster recovery time, minimal blood loss, and fewer complications from surgery. An arthroscopic SLAP repair is a common procedure and is done either as a day only case or with an overnight stay in hospital. The results are excellent and most patients return to their previous level of function.
In most cases, the MRI scan will demonstrate whether this is an isolated SLAP tear or tear extension (either anterior and/or posterior). The MRI will also provide a guide as to the grade of the SLAP tear (ie the severity). It is also important to look at the quality of the biceps tendon and the rotator cuff on the MRI. All of these features will guide the best treatment around your SLAP tear and repair.
The primary aim of a SLAP repair is to repair the superior labrum where the biceps tendon attaches to the glenoid (socket). At the time of surgery, if significant damage is found to the biceps tendon then it may be best to not complete a SLAP repair but instead re-anchor the biceps tendon out of the shoulder joint (this procedure is called a biceps tenodesis).
If there is a labrum tear that extends anterior or posterior then this may also need to be repaired at the time of surgery. All of this can be performed by keyhole at the same time.
Watch a surgical animation demonstrating how Dr Pant performs a Shoulder SLAP Repair.
There are three essential components to a good outcome from surgery:
Post-operative physiotherapy
Dr Pant utilises the JPL pathway for most patients and this will form the basis of your rehabilitation after surgery; it will be modified to suit your individual circumstance.
The JPL pathway allows for self-directed, early passive shoulder range of movement:
Therapy overview
After the surgery you will be in a sling to protect your shoulder and allow the SLAP repair to heal. At two weeks after the surgery Dr Pant will see you at your review appointment and discuss the JPL rehabilitation protocol with you. This JPL physiotherapy protocol will commence two weeks after your surgery.
The therapy program will focus on flexibility and range of motion exercises initially. These gentle stretches will improve your range of motion and prevent shoulder stiffness. As the SLAP repair begins to heal you will be able to progress to exercises that strengthen your shoulder muscles. Shoulder strengthening is commenced at 12 weeks post SLAP repair surgery.
Sling
The type of sling is selected specific to you and your shoulder surgery
When can I drive?
Showering and getting dressed
Sleeping after Shoulder Surgery
Elbow and hand movement
Surgery is a carefully choreographed process and you are being treated by a sub-specialist shoulder surgeon and a highly experienced team; however, all surgeries inherently carry some risk of complications.
The risk of complications after SLAP repair surgery (shoulder and biceps stabilisation) are less than 1% in the Sydney Shoulder Unit experience. General risks include:
Frozen shoulder (5% risk)
Improves over 3-6 months and will generally not affect your outcome or need further surgery.
Reoperation and failure of surgery
When performing a shoulder reconstruction, your surgeon is using your own tissue to repair what is damaged. The weakest point in the repair is your own tissue. The longer the history of damage and frequency of dislocations/instability prior to surgery, the more likely the tissue quality is poor.
Bone-Anchor interface
The anchors today are very high in quality and usually do not fail; sometimes if your bone is soft (older patients), the anchor may pull out of the bone.
Anchor-Suture interface
This area is typically very strong and not a source of common failure
Suture-Tissue interface
This is the weakest point and the most common reason for failure of surgery (usually due to poor tissue quality). There are special techniques in tissue management and suture choice to reduce failure rates.
Delays/Inability to return to previous level of sport
Patients who smoke, use tobacco products, have diabetes, or elderly are at higher risk of complications both during and after surgery. They are also more likely to have problems with wound and bone healing.
Most healthy patients, however, cope well with keyhole shoulder surgery and are unlikely to have complications.
SLAP repair surgery is a minimally invasive procedure that repairs the torn labrum at the top of the glenoid. It is a successful operation (>90% satisfaction) when undertaken for the correct indications. Younger patients, acute tears, higher grade SLAP tears and anterior/posterior tear extension are good indications for surgery and result in more reliable outcomes.
Dr Sushil Pant is a leading Australian trained orthopaedic shoulder surgeon. He is the founder and medical director of the Sydney Shoulder Unit; and is a Shoulder Surgeon at Sydney Sports Medicine Centre at Sydney Olympic Park.
This 19 year old tennis player sustained shoulder trauma with an instability episode. Over the following weeks, he was unable to play tennis and presented with night pain and difficulty undertaking overhead tasks.
His examination findings were consistent with a SLAP tear and this was confirmed to be a high-grade tear on MRI. Given his young age, functional demands, overhead sport, and high-grade SLAP tear surgery was the prefered option.
He underwent an Arthroscopy and SLAP repair. At the time of surgery anterior labral extension was noted and repaired at the same time. He used the JPL method for shoulder rehabilitation. At six weeks he had full range of motion and commenced strengthening at 3 months. He returned to playing tennis at five months pain-free with full shoulder function.
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Dr Sushil Pant is a leading Australian trained Orthopaedic Shoulder Surgeon. He is the founder and medical director of the Sydney Shoulder Unit; and is a Shoulder Surgeon at Sydney Sports Medicine Centre at Sydney Olympic Park.
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