Arthroscopic surgery for the slap lesion
Superior labral antero posterior lesion with significant symptoms such as pain, clicking, catching, grinding will necessitate arthroscopic surgery to treat the lesion.
Nature of the procedure
Arthroscopic surgery gives a chance to visualise the shoulder joint thoroughly. The labrum can be seen for obvious tears and can also be probed to identify if there are subtle tears. A dynamic assessment is possible so that the shoulder joint movements are reproduced passively and the hidden presence of any unstable tears can be detected. Some tears can be just fraying then they need debridement. But if the tear is full and if the labrum has avulsed from the glenoid then it needs to be fixed back by stitching the labrum with strong fibrewires and anchoring it to glenoid rim. This gives sound possibility for the lesion to heal.
Steps of the Surgery
The procedure is done under anaesthesia. Two or three tiny incisions are made around the shoulder joint. A tube like arthroscopic camera is introduced into the shoulder joint. Thorough assessment of the labrum all around the ring is performed. The diagnosis of the SLAP lesion will be confirmed. Then the tear is mobilized so that it can be attached back into the glenoid. A miniature drill is introduced to reach the glenoid margin and an absorbable screw with strong fibrewire is anchored to the glenoid margin. The fibrewire is then passed through the labrum and arthroscopic knots are applied to hold the labrum tight to the glenoid margin. Depending on the length of the labral tear there may be a necessity of two or three stitches. The arthrosocopy incisions in the skin will be closed with one or two stitches. There will not be any pain during the procedure as it is done with anaesthesia. Because the arthrosocpic surgery itself is done through tiny incisions the pain after the surgery is minimal.
A sling will be given to rest the arm for 4 weeks. A systematic physiotherapy programme will be implemented with the help of a trained physiotherapist. This will help you to get the pain free range of movements back. To get back to sports level activities it could sometimes take up to 3 to 4 months. The labrum that is reattached takes about 3 – 4 months to heal.
Success and complications
The procedure is safe and the success rate is high.
The complications are minimal. Infection, stiffness, chondral damage are rare possibilities.