ANTERIOR SUPERIOR INSTABILITY WITH ROTATOR CUFF TEARING: SLAC LESION

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MATERIALS AND METHODS

Forty consecutive patients with the diagnosis of anterior superior instability were evalu-ated in this study. The average age was 43 (range, 18 to 71). In 30 patients, the dominant shoulder was involved. The nondominant shoulder was involved in 10 patients. The average duration of symptoms before presentation to the clinic was 10.6 months with a range of 1 to 80 months. The mechanism of injury was overhead sports in 9 patients, overhead work in 10 patients, motor vehicle accident in 6 patients,

CLINICAL EXAMINATION

The initial diagnosis of anterior superior instability was made by physical examination in all 40 patients. The load and shift testing (Fig. 1) (39 or 40 patients) and/or anterior superior SLAP test results (Fig. 2) (38 or 40 patients) were most often positive in this patient group. Kibbler testing results for anterior superior labral pathology was positive in 37 of the 40 patients. O'Brien's8 active compression test was positive in 35 to 40 patients. Jobe's relocation test was negative or only

DIAGNOSTIC STUDIES

Thirty patients had MRI testing, 10 of these with saline or gadolinium injection. Nine of the 20 patients (48% with standard magnetic resonance imaging [MRI]) had signal change in both the anterior superior labrum and supraspinatus. Six patients had positive findings in either the labrum (2 patients) or rotator cuff (4 patients). Nine of the 10 patients with gadolinium or saline MR arthrograms had findings of both anterior superior labral pathology and undersurface supraspinatus tearing. One

SURGICAL FINDINGS

All patients had evidence (glenoid chondromalacia, labral fraying, and/or detachment) of anterior superior instability. Thirty-seven of the 40 patients had obvious partial undersurface tearing of the supraspinatus tendon. The size of the tear was usually 1 cm in width anterior to posterior, 9 to 12 mm in length (medial to lateral) and 3 to 4 mm in depth. Three patients had intact undersurface capsule that, on minimal debridement, revealed tearing of the supraspinatus tendon (Fig. 4).

Thirty-nine

Subjective Evaluation

Thirty-nine of 40 patients were satisfied with the procedure, and 1 was very dissatisfied. One of the 39 satisfied patients, although saying he was satisfied, thought the results from the surgery should have been better.

VAS (Visual Analog Scale)

On the VAS, 30 patients reported no pain in the operative shoulder. Seven patients reported occasional pain at a 1 to 2 level, and 2 patients reported a fairly regular ache of 1 to 3 (on a scale of zero to 10). None of these patients required medication or reoperation. One

DISCUSSION

Originally, labral detachment and fraying above the equator of the shoulder were not thought to be significant. The anatomic variation of the labrum and normal labral sulcus in this area make the diagnosis and management difficult. Additionally, age related clefts between the labrum and glenoid, stretching of the rotator interval, and degeneration of the rotator cuff might further confuse the examining physician.7, 12, 13

To be considered a true pathologic entity, there must be a mechanism of

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Address reprint requests to Felix H. Savoie, III, MD, 1325 East Fortification Street, Jackson, MS 39202

This article was originally published in the July 2000 issue of Operative Techniques in Sports Medicine.

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Upper Extremity Service, Mississippi Sports Medicine & Orthopaedic Center; Department of Orthopaedic Surgery, University of Mississippi School of Medicine, Jackson, Mississippi; and the Department of Orthopaedics, Louisiana State University Medical Center, Shreveport, Louisiana

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