Is timing of superior labrum anterior to posterior (SLAP) repair important?

Is timing of superior labrum anterior to posterior (SLAP) repair important?

A cohort study evaluating the effect of the duration of symptoms prior to surgery on the outcomes of patients who underwent type II SLAP repair


First described by Andrews et al., superior labrum anterior to posterior (SLAP) tears are a cause of significant pain and disability.¹ The Snyder classification system categorises SLAP tears based on the degree of labral tearing and bicipital tendon involvement. Type II tears are the most common. They involve fraying of the superior labrum and the detachment of the biceps anchor from the superior glenoid.² ⁴ A period of 3–6 months of non-operative treatment is often advocated for SLAP lesions.⁵ ⁶

In a prospective case series of 46 patients, Shin et al. found that three months of non-operative treatment improved patient’s American shoulder and elbow surgeons (ASES) scores and Constant scores from baseline by two years after commencement of non-operative treatment.⁷ Similarly, Edwards et al., in a case series of 19 patients, found that 3–6 months of non-operative treatment significantly improved patient ASES scores compared with prior to treatment.⁸ However, in both studies, several patients (15% and 51%, respectively) still required surgery after this period of non-operative treatment.⁷ ⁸

SLAP repair is a commonly advocated surgical treatment for SLAP tears. It involves the reattachment of the superior labra to the glenoid rim. SLAP repair results have generally been reported as significantly improving patients shoulder function and reduce pain.⁴ ⁹ ¹⁰ In recent times, several studies have questioned the efficacy of this surgery.¹¹ ¹² To our knowledge, there has been no study that has analysed if the duration of time from symptom onset to surgery affects patient outcomes. The purpose of this current study therefore was to determine the benefit or not of having an early SLAP repair. We hypothesised that early SLAP repairs would be associated with improved functional outcomes.


Earlier superior labral (SLAP) repairs do better than those that waited more than 6 months

Overall shoulder satisfaction in SLAP repair patients who had surgery within six months of symptom onset and those that did not. Analysed with a Student’s t test. *p