Summary

Superior labrum anterior-posterior tears may be related to injury of the superior glenoid humeral ligament and may cause rupture and displacement of the labral ring, leading to anterior instability. This type of injury needs to be distinguished from previous injuries and treated accordingly

Abstract

Background

Superior labrum anterior-posterior (SLAP) lesions are common shoulder injuries. The 10-type classification system has been widely used to diagnose SLAP lesions since it was proposed. However, growing evidence from arthroscopic studies indicates the existence of many SLAP lesions, especially those associated with superior glenoid humeral ligament (SGHL) injuries, that were not included in the initial classification.

Purpose

To introduce a SLAP classification associated with SGHL injury based on arthroscopic views and discuss the injury mechanism and corresponding treatment options.
Study Design: Case series study

Methods

Patients were included in our analysis. A total of 828 patients with SLAP lesions underwent shoulder arthroscopic surgical treatment from June 2011 to January 2017 in six level-I centers were evaluated in this study. Preoperative radiographs and MRI scans were used to diagnose SLAP lesions, and arthroscopic views from the standard posterior portal were recorded. The traditional 10-type classification system for SLAP was used to classify these cases. A classification method for SLAP lesions associated with SGHL injury was introduced. This classification system was investigated by 4 observers to evaluate inter- and intraobserver reliability (kappa coefficient, ?).

Results

A total of 828 patients were included in our analysis. 61 patients (7.3%) could not be classified by the 10-type traditional classification. Forty-four patients (5.3%) had SGHL lesions. A novel classification for 3 subtypes of SLAP with SGHL lesions was introduced. The mean ? value of the interobserver reliability for the classification approach was 0.796 (range, 0.678 to 0.854), indicating substantial agreement. The mean ? value for the intraobserver reliability was 0.883, indicating excellent agreement (range, 0.799 to 0.964).

Conclusions

Our study demonstrates a novel classification system for SLAP lesions associated with SGHL injury introduced a series of cases with characteristics that showed high inter- and intraobserver reliability. Such cases have not been reported before, and the classification correlates with surgical treatment. This classification may be used as a supplement to the traditional 10-type classification.