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Rehabilitation After Labral / SLAP Repair

Phased rehabilitation protocols after arthroscopic labral / SLAP repair. Protection phase, loading restrictions, return-to-overhead timelines. Modifications for combined nerve decompression.

Overview

Arthroscopic treatment of SLAP tears yields predictably good functional results and an acceptable rate of return to sport and/or work [18]. Long-term outcomes after isolated labral repair for SLAP lesions are good and independent of age [1]. Arthroscopic type 2 SLAP repair induces good short- and long-term clinical outcomes, return to overhead activities, and subjective satisfaction in the general population, regardless of age [15]. Predictable short-term surgical results and return to activity can be expected after repair of type II SLAP lesions in patients younger than 50 years who have coexistent rotator cuff tear [2].

SLAP repair should continue to be considered as an option for SLAP tear treatment only after nonsurgical management has failed [23]. Nonoperative treatment of SLAP tears in athletes can be successful, especially in the subset of patients who are able to complete their rehabilitation program before attempting a return to play [3]. In a young active population, primary arthroscopic biceps tenodesis is a viable surgical alternative to labral repair for type II SLAP lesions [4].

Surgical positioning for arthroscopic posterior shoulder labral repair did not affect postoperative clinical and patient-reported outcomes [11]. In patients with rotator cuff and labral lesions, arthroscopic treatment of both lesions yields good clinical outcomes, restoration of motion, and a high degree of patient satisfaction [13]. Following arthroscopic repair, patients with Type V SLAP tears had a similar overall rate of return to play when compared directly to a control group of patients who underwent arthroscopic Bankart repair alone [12]. In a population of active duty males, arthroscopic repair of isolated Type II SLAP had comparable results with a cohort of Type II SLAP repairs treated in combination with other shoulder conditions, with the combined treatment group having significantly better results in two of three parameters measured [10]. Both arthroscopic-assisted subpectoral biceps tenodesis combined with anterior labral repair and arthroscopic SLAP repair led to statistically and clinically significant increases in outcome scores, marked improvements in pain, and high rates of return to unrestricted active duty in military patients with type V SLAP lesions [7].

Anatomy & Pathophysiology

Kinematics and Biomechanics

Rotator Cuff Integrity: Three-dimensional shoulder kinematics normalize after rotator cuff repair [30]. Observed changes in scapular kinematics are associated with an increased overall range of motion and suggest restored function of shoulder muscles [30]. The supraspinatus cord, and not the coracohumeral ligament, is the key structure responsible for the transmission of anterior shoulder abduction force [40]. Load transmission via the supraspinatus cord prevents muscle fatty degeneration [40]. Disruption of the anterior–posterior rotator cuff force balance alters joint function and leads to joint damage [45]. Joint imbalance is a mechanical mechanism for joint damage, demonstrating the importance of preserving rotator cuff balance when treating active cuff tear patients [45]. Surgical techniques should be tailored to optimize residual cuff activation to restore balanced shoulder mechanics [32]. Optimum restoration of shoulder function requires activation of all kinetic chain segments to re-establish the interactions that existed before injury [35].

Subacromial Dynamics: Subacromial pressures are significantly altered by arm position, increasing during abduction, flexion, and internal rotation, and decreasing during external rotation [36].

Superior Capsular Reconstruction (SCR): Shoulder superior capsular reconstruction using xenograft shows no deterioration in functional improvement at 5-year follow-up [19]. No correlations between functional outcomes and radiographic shoulder findings at mid-term were identified for shoulder superior capsular reconstruction [19]. Superior capsular reconstruction may not depress the humeral head during functional abduction [31]. Postoperative improvements in subjective and clinical outcomes following superior capsular reconstruction may be affected by mechanisms other than changes in shoulder kinematics [31].

Rotator Cuff Repair Techniques: Additional biomechanical and clinical investigations are needed for the low-profile Roman bridge technique for knotless double-row repair of the rotator cuff [33].

Shoulder Arthroplasty: Shoulder arthroplasty leads to some degree of strength improvement across all planes of motion, but the magnitude is modest and may not be perceptible to patients [34].

Osseous and Glenoid Morphology

Glenoid Defects: The all-arthroscopic modified Eden-Hybinette procedure using iliac crest autograft and double-pair button fixation restores glenoid bone defects and preserves normal shoulder anatomy [41]. Glenoid morphology can be normalized during the intermediate to long-term postoperative period, even in shoulders with a smaller fragment [37].

Critical Shoulder Angle (CSA): Analyzing critical shoulder angle on plain radiographs may help manage functional expectations in patients with cuff tear arthropathy [38]. Neither higher critical shoulder angle nor acromion index impaired clinical results over time after arthroscopic supraspinatus tendon repair [39].

Ligamentous and Instability

Proprioception: Five years after surgical repair for shoulder instability, joint position sense improved significantly to a level of normal, healthy shoulders [43].

Clinical Considerations for Specific Pathologies

Throwers with SLAP Tears: Proper treatment of throwers with SLAP tears requires a thorough understanding of the altered biomechanics and the indications for nonoperative management and arthroscopic treatment of these lesions [42].

Postoperative Motion Loss: Most shoulders with early motion loss after rotator cuff repair recover motion and rarely require capsular release [44].

Classification

Snyder: The Snyder classification is a reliable system for identifying SLAP lesions among experienced shoulder surgeons [53].

Clinical Presentation

Long-term outcomes after isolated labral repair for SLAP lesions are good and independent of age [1]. Arthroscopic type 2 SLAP repair induces good short- and long-term clinical outcomes, return to overhead activities, and subjective satisfaction in the general population, regardless of age [15]. Predictable short-term surgical results and return to activity can be expected after repair of type II SLAP lesions in patients younger than 50 years who have coexistent rotator cuff tear [2]. In a young active population, primary arthroscopic biceps tenodesis is a viable surgical alternative to labral repair for type II SLAP lesions [4].

In 87% of cases, a good or excellent functional outcome can be anticipated after arthroscopic repair of type II SLAP lesions with the described techniques [5]. Arthroscopic repair of isolated type II SLAP lesions with suture anchors leads to a satisfactory functional outcome and return to pre-injury sports levels, with delayed, but significant pain relief observed 6 months after surgery [16]. In a population of active duty males, arthroscopic repair of isolated Type II SLAP had comparable results with a cohort of Type II SLAP repairs treated in combination with other shoulder conditions, with the combined treatment group having significantly better results in two of three parameters measured [10].

Nonoperative treatment of SLAP tears in athletes can be successful, especially in the subset of patients who are able to complete their rehabilitation program before attempting a return to play [3]. Nonsurgical treatment can resolve pain effectively and restore function in patients with SLAP tears or biceps lesions [9].

Concomitant shoulder pathology should be treated at the time of SLAP repair [6]. In patients with rotator cuff and labral lesions, arthroscopic treatment of both lesions yields good clinical outcomes, restoration of motion, and a high degree of patient satisfaction [13]. In patients over the age of 45 years with a minimally retracted rotator cuff tear and associated SLAP lesion, arthroscopic repair of the rotator cuff with combined debridement of the type II SLAP lesion may provide greater patient satisfaction and functional outcome in terms of pain relief and motion [46].

Surgical positioning for arthroscopic posterior shoulder labral repair did not affect postoperative clinical and patient-reported outcomes [11]. Both arthroscopic-assisted subpectoral biceps tenodesis combined with anterior labral repair and arthroscopic SLAP repair led to statistically and clinically significant increases in outcome scores, marked improvements in pain, and high rates of return to unrestricted active duty in military patients with type V SLAP lesions [7]. Combined posterior labral and SLAP repair led to statistically and clinically significant increases in outcome scores and high rates of return to active-duty military service that did not differ significantly from the results after isolated posterior labral repair [17]. Arthroscopic evaluation and repair of posterior labral lesions resulted in 93% of patients returning to sport and 82% returning without any limitations [21].

Patients who underwent SLAP repair were associated with a higher risk of revision surgery and subsequent rotator cuff strain diagnosis [8]. There is a 10.1% incidence of subsequent surgery after isolated SLAP repair, often related to an additional diagnosis [14]. Glenoid bone loss was identified as a significant prognostic factor for patients not returning to sport following arthroscopic labral repair [22]. A significant tear of the infraspinatus in combination with glenohumeral internal rotation deficit and SLAP tears in the throwing athlete results in a guarded prognosis in return to play at the same level [49].

Investigations

Plain radiography: Radiographic greater tuberosity spurs and narrow acromiohumeral intervals are associated with advanced retraction of the supraspinatus tendon in patients with symptomatic rotator cuff tears [61]. When patients with clinical suspicion of rotator cuff tear present with these findings, a prompt MRI examination and referral to a shoulder specialist are recommended [61].

MRI: The position of the musculotendinous junction with respect to the glenoid face is a reliable, identifiable marker on MRI scans that can be predictive of healing [76]. Postoperative MR arthrogram features did not predict functional outcome or recurrent instability 6 months after arthroscopic Bankart repair [66].

CT: A contrast-filled gap between the labrum and glenoid on neutral CT arthrography after SLAP repair is frequently observed even in patients with satisfactory clinical outcomes [47].

Other Considerations: Long-term outcomes after isolated labral repair for SLAP lesions are good and independent of age [1]. Predictable short-term surgical results and return to activity can be expected after repair of type II SLAP lesions in patients younger than 50 years who have coexistent rotator cuff tear [2]. In 87% of cases, a good or excellent functional outcome can be anticipated after arthroscopic repair of type II SLAP lesions with the described techniques [5]. Arthroscopic repair of isolated type II SLAP lesions with suture anchors leads to a satisfactory functional outcome and return to pre-injury sports levels [16], with delayed, but significant pain relief observed 6 months after arthroscopic isolated type II SLAP repair [16]. Arthroscopic evaluation and repair of posterior labral lesions resulted in 93% of patients returning to sport [21], with 82% returning to sport without any limitations [21]. Arthroscopic repair of subscapularis lesions shows good clinical and radiological results, with a classification system applicable during imaging workup showing differences in results between lesion types [24]. Glenoid bone loss is a significant prognostic factor for patients not returning to sport following arthroscopic labral repair [22]. Nearly a quarter of athletes were unable to return to play after arthroscopic superior labral repair [25]. Arthroscopic SLAP repairs show favorable clinical and radiological outcomes, but return to play may still be problematic in elite baseball players [67]. Concomitant shoulder pathology should be treated at the time of SLAP repair [6]. Patients who underwent SLAP repair were associated with a higher risk of revision surgery and subsequent rotator cuff strain diagnosis [8]. There is a 10.1% incidence of subsequent surgery after isolated SLAP repair, often related to an additional diagnosis [14]. Nonsurgical treatment can resolve pain effectively and restore function in patients with SLAP tears or biceps lesions [9]. No correlations between functional outcomes and radiographic shoulder findings were identified at mid-term follow-up for shoulder superior capsular reconstruction using xenograft [19]. Surgeons should be cautious of restoring labral height at the inferior glenoid location for successful arthroscopic Bankart repair [77]. Image-guided PRP treatment on 2 occasions does not improve early tendon-bone healing or functional recovery after arthroscopic supraspinatus tendon repair [56].

Treatment

Non-Operative

Nonsurgical treatment effectively resolves pain and restores function in patients with SLAP tears or biceps lesions [9]. Nonoperative management is often an appropriate and effective initial treatment for superior labral injuries, unless there are obvious pathologic changes altering the mechanics of the glenohumeral joint or other associated injuries [50]. An initial trial of nonoperative management may be considered in young active patients with isolated SLAP tear [48]. Nonoperative treatment of SLAP tears in athletes can be successful, especially in the subset of patients who are able to complete their rehabilitation program before attempting a return to play [3]. SLAP repair should continue to be considered as an option for SLAP tear treatment only after nonsurgical management has failed [23].

Operative

Indications: In a young active population, primary arthroscopic biceps tenodesis is a viable surgical alternative to labral repair for type II SLAP lesions [4]. Arthroscopic treatment of both rotator cuff and labral lesions yields good clinical outcomes, restoration of motion, and a high degree of patient satisfaction [13].

Surgical Approach / Technique: Both arthroscopic-assisted subpectoral biceps tenodesis combined with anterior labral repair and arthroscopic SLAP repair led to statistically and clinically significant increases in outcome scores, marked improvements in pain, and high rates of return to unrestricted active duty in military patients with type V SLAP lesions [7]. In a population of active duty males, arthroscopic repair of isolated Type II SLAP had comparable results with a cohort of Type II SLAP repairs treated in combination with other shoulder conditions, with the combined treatment group having significantly better results in two of three parameters measured [10]. The authors present an effective arthroscopic technique for managing combined anterior shoulder instability and type IV SLAP lesions by repairing all pathoanatomy present, including the superior labrum and biceps tendon split [20]. Surgical positioning for arthroscopic posterior shoulder labral repair did not affect postoperative clinical and patient-reported outcomes [11]. The detailed approach described allows the arthroscopist access to the entire glenohumeral joint and transforms repair of complex intra-articular pathology into simple exercises in arthroscopic surgical technique [52].

Implant Selection: Implant related complications should be considered when patients present with recurrent pain after arthroscopic SLAP repair using suture anchors, in particular during overhead activity [28]. It is anatomically possible that suprascapular nerve could sustain iatrogenic injury during labral anchor placement during SLAP repair [72].

Pain Management: Management through the PRP based on scientific evidence in the strategy of postoperative rehabilitation of patients with ARCR is effective for pain intensity, ROM, and shoulder function [70]. Patients who were prescribed NSAIDs as part of a postoperative pain management regimen following primary arthroscopic labral repair for glenohumeral instability had similar patient-reported outcomes, revision rates, and rates of return to preinjury activities compared to those who were not prescribed NSAIDs [71]. Multimodal pain therapy after rotator cuff repair provided at least equivalent pain relief compared to opioid analgesia, and standardized prescription protocols can decrease opioid consumption without reducing patient satisfaction [63]. It remains a safe and effective analgesia method during rotator cuff repair surgery to use periarticular corticosteroid injections [57].

Other Considerations: Long-term outcomes after isolated labral repair for SLAP lesions are good and independent of age [1]. In 87% of cases, a good or excellent functional outcome can be anticipated after arthroscopic repair of type II SLAP lesions with the described techniques [5]. Arthroscopic type 2 SLAP repair induced good short- and long-term clinical outcomes, return to overhead activities, and subjective satisfaction in the general population, regardless of age [15]. SLAP repair in throwing athletes should be approached with caution [75]. Surgeons should be aware of the uncommon cause of shoulder pain from new SLAP lesion development after arthroscopic, isolated decompression of ganglion cyst of the shoulder and perform careful capsulotomy with minimal resection to prevent labral damage [73].

Postoperative Rehabilitation and Pain Management

There is no clear consensus regarding optimal post-operative rehabilitation following arthroscopic shoulder stabilisation [69].

Return to Sport Criteria

Criteria for determining successful return to sport and return to preinjury level after superior labral pathophysiology treatment were not reported by most studies [74].

Complications

Subsequent Surgery: SLAP repair is associated with an increased rate of subsequent rotator cuff diagnoses [8] and an increased rate of revision surgery [8]. The incidence of subsequent surgery after isolated SLAP repair is 10.1% [14], and this subsequent surgery is often related to an additional diagnosis [14]. Outcomes after surgical management of failed SLAP repair are inferior to those of primary repair [90].

Implant-Related Complications: Implant-related complications, such as suture granuloma impingement, should be considered when patients present with recurrent pain after arthroscopic SLAP repair using suture anchors, particularly during overhead activity [28].

Other Considerations: The presence of concurrent glenohumeral osteoarthritis is associated with a significant increase in the odds of both short- and longer-term complications following arthroscopic rotator cuff repair [94]. Coronary artery disease significantly increases the risk of rotator cuff retear at 6 months, 1 year, and 4 years following primary arthroscopic rotator cuff repair [95]. Peripheral artery disease significantly increases the risk of rotator cuff retear at 6 months, 1 year, and 4 years following primary arthroscopic rotator cuff repair [95]. Coronary artery disease significantly increases the risk of postoperative complications within 90 days following primary arthroscopic rotator cuff repair [95]. Peripheral artery disease significantly increases the risk of postoperative complications within 90 days following primary arthroscopic rotator cuff repair [95]. Acromioplasty does not meaningfully reduce re-tear rates in rotator cuff repair [29]. Pooled analysis of long-term outcomes for arthroscopic and open/mini-open rotator cuff repairs demonstrates a substantial retear rate in both groups [81]. The substantial retear rate in rotator cuff repair is associated with inferior shoulder function [81].

Recovery

Long-term outcomes after isolated labral repair for SLAP lesions are good and independent of age [1]. Predictable short-term surgical results and return to activity can be expected after repair of type II SLAP lesions in patients younger than 50 years who have coexistent rotator cuff tear [2]. Recent outcomes studies have shown predictably good functional results and an acceptable rate of return to sport and/or work with arthroscopic treatment of SLAP tears [18]. Good to excellent results and high return to prior level of activity can be expected for the majority of properly indicated patients who undergo isolated type II superior labral anterior posterior repairs, regardless of age [62]. Arthroscopic repair of isolated type II SLAP lesions with suture anchors leads to a satisfactory functional outcome and return to pre-injury sports levels, with delayed, but significant pain relief observed 6 months after surgery [16].

Concomitant shoulder pathology should be treated at the time of SLAP repair [6]. In a young active population, primary arthroscopic biceps tenodesis is a viable surgical alternative to labral repair for type II SLAP lesions [4]. Arthroscopic revision type II SLAP repairs yield worse results than primary repairs, with workers' compensation patients and overhead athletes doing especially worse [60]. Patients requiring rotator cuff repair with simultaneous biceps tenodesis have lower baseline ASES function and earlier postoperative plateaus in pain relief and motion improvement following surgery [84].

Nonoperative treatment of SLAP tears in athletes can be successful, especially in the subset of patients who are able to complete their rehabilitation program before attempting a return to play [3]. Nonsurgical treatment can resolve pain effectively and restore function in patients with SLAP tears or biceps lesions [9]. Participants with microtraumatic posterior shoulder instability demonstrated significant improvements in patient-reported outcome measures and high rates of return to sport following a 24-week conservative rehabilitation program [68]. Many patients with rotator cuff tendinitis, impingement, and partial- and full-thickness tears can return to full activity by means of a complete rehabilitation program [65]. Specific exercises for scapular control can be used as part of a comprehensive rehabilitation program for restoration of shoulder function [64].

Following arthroscopic repair, patients with Type V SLAP tears had a similar overall rate of return to play when compared directly to a control group of patients who underwent arthroscopic Bankart repair alone [12]. Overall, nearly a quarter of athletes were unable to return to play after arthroscopic superior labral repair [25]. Studies reviewed reported moderate return to play and return to previous level of performance rates following SLAP repairs in competitive overhead athletes [78]. Undergoing repair of the throwing or trail batting shoulder can delay return to sport by several months, though pitching workload returns to baseline by the second season postoperatively [58].

Criteria-based return-to-sport testing helps identify functional deficits in young athletes following posterior labral repair, but may not reduce recurrence or increase return to play [80]. Two-thirds of athletes who underwent criteria-based return-to-sport testing after posterior labral repair failed at least 1 section, indicating some functional deficit [80]. Anterior shoulder stabilization procedures lead to high, though varied, reported return to sport and return to preinjury rates across all studied cohorts [27].

Arthroscopic repair of rotator cuff lesions gives very good results in terms of functional recovery, with recovery as early as 3 months, further improvement over the first year, and subsequent stabilization [83]. At 3 months, approximately 75% of pain relief and 50% of functional recovery can be expected after arthroscopic rotator cuff repair, with larger tears having a slower speed of recovery [26]. Immediate self-rehabilitation after open Latarjet procedures enables recovery of preoperative shoulder mobility at 3 months [51]. Immediate self-rehabilitation after open Latarjet procedures enables recovery of preoperative shoulder mobility at 3 months with no adverse events related to self-rehabilitation [55]. The patient returned with full function and subjective assessment showing excellent results 22 years postoperatively after open repair for a large cuff tear [54].

Key Evidence

  • [L4] Long-term outcomes after isolated labral repair for SLAP lesions are good and independent of age. (10.1016/j.arthro.2012.02.025)
  • [L3] Predictable short-term surgical results and return to activity can be expected after repair of type II SLAP lesions in patients younger than 50 years who have coexistent rotator cuff tear. (10.1177/0363546509347364)
  • [L4] Overall, nonoperative treatment of SLAP tears in athletes can be successful, especially in the subset of patients who are able to complete their rehabilitation program before attempting a return to play. (10.1016/j.jse.2021.12.022)
  • [L3] In a young active population, primary arthroscopic biceps tenodesis is a viable surgical alternative to labral repair for type II SLAP lesions. (10.1007/s00167-020-05971-0)
  • [L4] In 87% of cases, a good or excellent functional outcome can be anticipated after arthroscopic repair of type II SLAP lesions with the described techniques. (10.1016/j.arthro.2011.09.005)
  • [L4] The results suggest that concomitant shoulder pathology should be treated at the time of SLAP repair. (10.1016/j.jse.2006.05.015)
  • [L3] Both arthroscopic-assisted subpectoral biceps tenodesis combined with anterior labral repair and arthroscopic SLAP repair led to statistically and clinically significant increases in outcome scores, marked improvements in pain, and high rates of return to unrestricted active duty in military patients with type V SLAP lesions. (10.1177/03635465231169238)
  • [L3] Patients who underwent SLAP repair were associated with a higher risk of revision surgery and subsequent rotator cuff strain diagnosis. (10.1016/j.jse.2023.12.015)
  • [L3] In a population of active duty males, arthroscopic repair of isolated Type II SLAP had comparable results with a cohort of Type II SLAP repairs treated in combination with other shoulder conditions, with the combined treatment group having significantly better results in two of three parameters measured. (10.1007/s00167-007-0334-8)
  • [L3] Surgical positioning for arthroscopic posterior shoulder labral repair did not affect postoperative clinical and patient-reported outcomes. (10.1177/03635465221095243)
  • [L3] Following arthroscopic repair, patients with Type V SLAP tears had a similar overall rate of return to play when compared directly to a control group of patients who underwent arthroscopic Bankart repair alone. (10.1007/s00167-020-06388-5)
  • [L3] In patients with rotator cuff and labral lesions, arthroscopic treatment of both lesions yields good clinical outcomes, restoration of motion, and a high degree of patient satisfaction. (10.1177/0363546507300062)
  • [L3] We identified a 10.1% incidence of subsequent surgery after isolated SLAP repair, often related to an additional diagnosis, suggesting that clinicians should consider other potential causes of shoulder pain when considering surgery for patients with SLAP lesions. (10.1016/j.arthro.2016.01.053)
  • [L4] Arthroscopic type 2 SLAP repair induced good short- and long-term clinical outcomes, return to overhead activities, and subjective satisfaction in the general population, regardless of age. (10.1007/s00167-021-06608-6)
  • [L4] Arthroscopic repair of isolated type II SLAP lesions with suture anchors leads to a satisfactory functional outcome and return to pre-injury sports levels, with delayed, but significant pain relief observed 6 months after surgery. (10.1186/s12891-017-1620-3)
  • [L3] Combined posterior labral and SLAP repair led to statistically and clinically significant increases in outcome scores and high rates of return to active-duty military service that did not differ significantly from the results after isolated posterior labral repair. (10.1177/03635465231181702)
  • [L5] Recent outcomes studies have shown predictably good functional results and an acceptable rate of return to sport and/or work with arthroscopic treatment of SLAP tears. (10.5435/00124635-200910000-00005)
  • [L5] No correlations between functional outcomes and radiographic shoulder findings at mid-term were identified. (10.1016/j.arthro.2025.07.020)
  • [L4] The authors present an effective arthroscopic technique for managing combined anterior shoulder instability and type IV SLAP lesions by repairing all pathoanatomy present, including the superior labrum and biceps tendon split. (10.1016/j.arthro.2009.04.075)
  • [L4] Arthroscopic evaluation and repair of these posterior labral lesions resulted in 26 of 28 patients (93%) returning to sport and 23 of 28 (82%) returning without any limitations. (10.1016/j.arthro.2010.01.006)
  • [L3] Glenoid Bone Loss was identified as a significant prognostic factor for patients not returning to sport following Arthroscopic Labral Repair. (10.1016/j.jse.2023.02.060)
  • [L4] SLAP repair should continue to be considered as an option for SLAP tear treatment only after nonsurgical management has failed. (10.1177/0363546517728256)
  • [L4] The study confirms good clinical and radiological results for arthroscopic repair of subscapularis lesions, with a classification system applicable during imaging workup showing differences in results between lesion types. (10.1016/j.otsr.2012.10.004)
  • [L4] Overall, nearly a quarter of athletes were unable to return to play after arthroscopic superior labral repair. (10.1177/03635465241246122)
  • [L4] At 3 months, approximately 75% of pain relief and 50% of functional recovery can be expected, with larger tears having a slower speed of recovery. (10.1016/j.jse.2016.11.002)
  • [L4] Anterior shoulder stabilization procedures lead to high, though varied, reported return to sport and return to preinjury rates across all studied cohorts. (10.1016/j.arthro.2025.07.032)
  • [Case_report] Implant related complications should be considered when patients present with recurrent pain after arthroscopic SLAP repair using suture anchors, in particular during overhead activity. (10.1007/s00167-008-0524-z)
  • [L1] Acromioplasty offers statistically modest improvements in shoulder function but does not meaningfully enhance pain relief or reduce re-tear rates. (10.5397/cise.2025.00458)
  • [L4] The observed changes in scapular kinematics are associated with an increased overall range of motion and suggest restored function of shoulder muscles. (10.1016/j.jse.2015.10.021)
  • [L3] These data suggest that SCR may not depress the humeral head during functional abduction, as previously postulated, and postoperative improvements in subjective and clinical outcomes may be affected by mechanisms other than changes in shoulder kinematics. (10.1016/j.arthro.2021.06.018)
  • [L5] The authors suggest that surgical techniques should be tailored to optimize residual cuff activation to restore balanced shoulder mechanics. (10.2106/jbjs.25.01543)
  • [Paper] Additional biomechanical and clinical investigations are needed. (10.1007/s00402-010-1203-3)
  • [L4] While shoulder arthroplasty leads to some degree of strength improvement across all planes of motion, the magnitude is modest and may not be perceptible to patients. (10.1016/j.jse.2025.06.020)
  • [Paper] Optimum restoration of shoulder function requires activation of all kinetic chain segments to re-establish the interactions that existed before injury. (10.1016/j.csm.2008.07.001)
  • [L4] Subacromial pressures are significantly altered by arm position, increasing during abduction, flexion, and internal rotation, and decreasing during external rotation. (10.1016/j.jse.2005.08.017)
  • [L4] Glenoid morphology can be normalized during the intermediate to long-term postoperative period, even in shoulders with a smaller fragment. (10.2106/jbjs.n.01033)
  • [L4] Analyzing critical shoulder angle on plain radiographs may help manage functional expectations in these patients. (10.1016/j.jseint.2020.05.003)
  • [L3] Neither higher critical shoulder angle nor acromion index impaired clinical results over time. (10.1016/j.jseint.2020.07.010)
  • [L5] The supraspinatus cord, and not the coracohumeral ligament, is the key structure responsible for the transmission of anterior shoulder abduction force. (10.1016/j.jseint.2024.12.024)
  • [L4] This technique restores glenoid bone defects and preserves the normal shoulder anatomy. (10.1016/j.arthro.2020.10.036)
  • [L5] Proper treatment of throwers with SLAP tears requires a thorough understanding of the altered biomechanics and the indications for nonoperative management and arthroscopic treatment of these lesions. (10.1177/0363546512466067)
  • [L3] Five years after surgical repair for shoulder instability, the joint position sense improved significantly, to a level of normal, healthy shoulders. (10.1177/0363546503261719)
  • [L3] Most shoulders with early motion loss recover motion and rarely require capsular release. (10.1016/j.jse.2009.07.009)
  • [Paper] The results identify joint imbalance as a mechanical mechanism for joint damage and demonstrate the importance of preserving rotator cuff balance when treating active cuff tear patients. (10.1002/jor.22586)
  • [L2] In patients over the age of 45 years with a minimally retracted rotator cuff tear and associated SLAP lesion, arthroscopic repair of the rotator cuff with combined debridement of the type II SLAP lesion may provide greater patient satisfaction and functional outcome in terms of pain relief and motion. (10.1177/0363546509331940)
  • [L4] A contrast-filled gap between the labrum and glenoid on neutral CT arthrography after SLAP repair is frequently observed even in patients with satisfactory clinical outcomes. (10.1007/s00167-014-3350-5)
  • [L3] An initial trial of nonoperative management may be considered in young active patients with isolated SLAP tear. (10.1016/j.jse.2015.09.008)
  • [L4] A significant tear of the infraspinatus in combination with glenohumeral internal rotation deficit and SLAP tears in the throwing athlete results in a guarded prognosis in return to play at the same level. (10.1177/0363546512459481)
  • [L5] Nonoperative management is often an appropriate and effective initial treatment for superior labral injuries, unless there are obvious pathologic changes altering the mechanics of the glenohumeral joint or other associated injuries. (10.1016/j.arthro.2025.03.059)
  • [L4] Immediate self-rehabilitation after open Latarjet procedures enabled recovery of preoperative shoulder mobility at 3 months. (10.1007/s00167-019-05635-8)
  • [L5] The detailed approach described allows the arthroscopist access to the entire glenohumeral joint and transforms repair of complex intra-articular pathology into simple exercises in arthroscopic surgical technique. (10.1016/j.arthro.2009.09.019)
  • [L3] For experienced shoulder surgeons, the Snyder classification is a reliable system for identifying SLAP lesions. (10.1177/0363546510392332)
  • [L4] The patient returned with full function and subjective assessment showing excellent results 22 years postoperatively after open repair for a large cuff tear. (10.1016/j.jse.2016.08.005)
  • [L4] Immediate self-rehabilitation after open Latarjet procedures enables recovery of preoperative shoulder mobility at 3 months with no adverse events related to self-rehabilitation. (10.1016/j.jse.2021.03.057)
  • [L1] After arthroscopic supraspinatus tendon repair, image-guided PRP treatment on 2 occasions does not improve early tendon-bone healing or functional recovery. (10.1177/0363546515572602)
  • [L2] It remains a safe and effective analgesia method during rotator cuff repair surgery. (10.1016/j.otsr.2020.05.009)
  • [L4] Undergoing repair of the throwing or trail batting shoulder can delay return to sport by several months, though pitching workload returns to baseline by the second season postoperatively. (10.1016/j.jse.2025.01.024)
  • [L4] Arthroscopic revision type II SLAP repairs yield worse results than primary repairs as reported in the literature, with workers' compensation patients and overhead athletes doing especially worse. (10.1177/0363546511398648)
  • [L4] When patients with clinical suspicion of rotator cuff tear present with combinations of these radiographic signs, a prompt MRI examination and a referral to a shoulder specialist are recommended. (10.1016/j.jseint.2020.09.015)
  • [L3] Good to excellent results and high return to prior level of activity can be expected for the majority of properly indicated patients who undergo isolated type II superior labral anterior posterior repairs, regardless of age. (10.1177/0363546508328417)
  • [L5] Multimodal pain therapy after rotator cuff repair provided at least equivalent pain relief compared to opioid analgesia, and standardized prescription protocols can decrease opioid consumption without reducing patient satisfaction. (10.1016/j.arthro.2022.01.040)
  • [L3] These exercises can be used as part of a comprehensive rehabilitation program for restoration of shoulder function. (10.1177/0363546508316281)
  • [L4] In this pilot study, MR arthrogram was used to evaluate the labrum in detail 6 months postoperatively, but no features on postoperative MR arthrogram predicted either functional outcome or recurrent instability. (10.1177/1758573214550839)
  • [L4] Arthroscopic SLAP repairs show favorable clinical and radiological outcomes; however, the study findings raise a concern that return to play may still be problematic in elite baseball players. (10.1177/0363546513485361)
  • [L4] Participants with microtraumatic posterior shoulder instability demonstrated significant improvements in patient-reported outcome measures and high rates of return to sport following a 24-week conservative rehabilitation program. (10.1016/j.jseint.2024.09.016)
  • [L4] There is no clear consensus regarding optimal post-operative rehabilitation following arthroscopic shoulder stabilisation. (10.1177/17585732231154889)
  • [L4] Management through the PRP based on scientific evidence in the strategy of postoperative rehabilitation of patients with ARCR is effective for pain intensity, ROM, and shoulder function. (10.3390/medicina58060729)
  • [L3] Patients who were prescribed NSAIDs as part of a postoperative pain management regimen following primary arthroscopic labral repair for glenohumeral instability had similar patient-reported outcomes, revision rates, and rates of return to preinjury activities compared to those who were not prescribed NSAIDs. (10.1016/j.jse.2025.02.048)
  • [L5] It is anatomically possible that suprascapular nerve could sustain iatrogenic injury during labral anchor placement during SLAP repair. (10.1007/s00167-016-4086-1)
  • [L4] Surgeons should be aware of this uncommon cause of shoulder pain and perform careful capsulotomy with minimal resection to prevent labral damage. (10.1007/s00167-009-0851-8)
  • [L1] Criteria for determining successful return to sport and return to preinjury level after superior labral pathophysiology treatment were not reported by most studies. (10.1016/j.arthro.2024.09.053)
  • [L5] SLAP repair in throwing athletes should be approached with caution. (10.1016/j.arthro.2018.08.022)
  • [L4] The position of the MTJ with respect to the glenoid face is a reliable, identifiable marker on MRI scans that can be predictive of healing. (10.1016/j.arthro.2016.12.010)
  • [L4] Surgeons should be cautious of restoring labral height at the inferior glenoid location for successful arthroscopic Bankart repair. (10.1177/0363546514528791)
  • [L4] Studies reviewed reported moderate return to play and return to previous level of performance rates following SLAP repairs in competitive overhead athletes. (10.1016/j.arthro.2022.03.026)
  • [L3] While RTS testing in young athletes after posterior labral repair did not reduce recurrence or improve return to play compared to time-based clearance, two-thirds of athletes who underwent testing failed at least 1 section, indicating some functional deficit. (10.1016/j.jseint.2023.01.002)
  • [L4] Pooled analysis demonstrated sustained improvement in long-term shoulder scores and pain with a substantial retear rate in both groups, which was associated with inferior shoulder function. (10.1177/03635465211073332)
  • [L4] Arthroscopic repair of rotator cuff lesions gives very good results in terms of functional recovery, with recovery as early as 3 months, further improvement over the first year, and subsequent stabilization. (10.1016/j.arthro.2007.07.023)
  • [L3] Patients requiring RCR with simultaneous biceps tenodesis have lower baseline ASES function and earlier postoperative plateaus in pain relief and motion improvement following surgery. (10.1016/j.jseint.2019.12.010)
  • [L5] Outcomes after surgical management of failed SLAP repair are inferior to those of primary repair. (10.5435/jaaos-22-09-554)
  • [L3] The presence of concurrent glenohumeral osteoarthritis was associated with a significant increase in the odds of both short- and longer-term complications following ARCR. (10.1016/j.xrrt.2025.100659)
  • [L3] CAD and PAD significantly increase the risk of rotator cuff retear at 6 months, 1 year, and 4 years in addition to significantly increasing the risk of postoperative complications within 90 days following ARCR. (10.1002/arj.70004)

See Also

References

[1] Long‐Term Results After SLAP Repair: A 5‐Year Follow‐up Study of 107 Patients With Comparison of Patients Aged Over and Under 40 Years. Arthroscopy. 2012. DOI: 10.1016/j.arthro.2012.02.025

[2] The Effect of Rotator Cuff Tears on Surgical Outcomes after Type II Superior Labrum Anterior Posterior Tears in Patients Younger than 50 Years. The American Journal of Sports Medicine. 2009. DOI: 10.1177/0363546509347364

[3] Return to play following nonsurgical management of superior labrum anterior-posterior tears: a systematic review. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2021.12.022

[4] Arthroscopic treatment of type II superior labral anterior to posterior (SLAP) lesions in a younger population: minimum 2‐year outcomes are similar between SLAP repair and biceps tenodesis. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-05971-0

[5] Long‐Term Outcome After Arthroscopic Repair of Type II SLAP Lesions: Results According to Age and Workers' Compensation Status. Arthroscopy. 2012. DOI: 10.1016/j.arthro.2011.09.005

[6] Arthroscopic superior labrum anterior-posterior repair in military patients. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.05.015

[7] Midterm Outcomes Following Combined Biceps Tenodesis and Anterior Labral Repair in Active Duty Military Patients Younger Than 35 Years. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231169238

[8] Superior labrum anterior to posterior (SLAP) repair is associated with increased rate of subsequent rotator cuff diagnoses and revision surgery: a propensity-matched comparison. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.12.015

[9] Chapter 78 Superior Labrum Anterior to Posterior Tears and Lesions of the Proximal Biceps Tendon. 2019.

[10] Isolated and combined Type II SLAP repairs in a military population. Knee Surgery, Sports Traumatology, Arthroscopy. 2007. DOI: 10.1007/s00167-007-0334-8

[11] Beach-Chair Versus Lateral Decubitus Positioning for Arthroscopic Posterior Shoulder Labral Repair: A Retrospective Comparison of Clinical and Patient-Reported Outcomes. The American Journal of Sports Medicine. 2022. DOI: 10.1177/03635465221095243

[12] Type V superior labral anterior–posterior tears results in lower rates of return to play. Knee Surgery, Sports Traumatology, Arthroscopy. 2021. DOI: 10.1007/s00167-020-06388-5

[13] Outcomes of Combined Arthroscopic Rotator Cuff and Labral Repair. The American Journal of Sports Medicine. 2007. DOI: 10.1177/0363546507300062

[14] Subsequent Shoulder Surgery After Isolated Arthroscopic SLAP Repair. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2016.01.053

[15] Posterior repair of isolated type 2 superior labrum anterior–posterior lesion prevents external rotation deficiency: long‐term outcome study. Knee Surgery, Sports Traumatology, Arthroscopy. 2021. DOI: 10.1007/s00167-021-06608-6

[16] Progression of function and pain relief as indicators for returning to sports after arthroscopic isolated type II SLAP repair—a prospective study. BMC Musculoskeletal Disorders. 2017. DOI: 10.1186/s12891-017-1620-3

[17] Outcomes Following Combined Posterior Labral and SLAP Repair in Military Patients Younger Than 35 Years. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231181702

[18] Superior Labral Tears of the Shoulder: Pathogenesis, Evaluation, and Treatment. Journal of the American Academy of Orthopaedic Surgeons. 2009. DOI: 10.5435/00124635-200910000-00005

[19] Shoulder Superior Capsular Reconstruction Using Xenograft Shows No Deterioration in Functional Improvement at 5-Year Follow-Up. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2025. DOI: 10.1016/j.arthro.2025.07.020

[20] Combined Arthroscopic Repair of a Type IV SLAP Tear and Bankart Lesion. Arthroscopy. 2009. DOI: 10.1016/j.arthro.2009.04.075

[21] Arthroscopic Posterior Labral Repair in Athletes: Outcome Analysis at 2‐Year Follow‐up. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2010.01.006

[22] Prognostic Factors For Patients Not To Return To Sport Following Arthroscopic Labral Repair: A Retrospective Multicentre Study. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.02.060

[23] Return to Play and Outcomes in Baseball Players After Superior Labral Anterior-Posterior Repairs. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517728256

[24] Arthroscopic repair of subscapularis tears: Preliminary data from a prospective multicentre study. Orthopaedics & Traumatology: Surgery & Research. 2012. DOI: 10.1016/j.otsr.2012.10.004

[25] Return to Play After Arthroscopic Superior Labral Repair: A Systematic Review. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465241246122

[26] Speed of recovery after arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.11.002

[27] Ranges of Return to Sport Outcomes Following Anterior Shoulder Instability Surgery Are Influenced by Procedure, Athletic Level, and Follow-Up Duration: A Systematic Review. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2025. DOI: 10.1016/j.arthro.2025.07.032

[28] Posterosuperior suture granuloma impingement after arthroscopic SLAP repair using suture anchors: a case report. Knee Surgery, Sports Traumatology, Arthroscopy. 2008. DOI: 10.1007/s00167-008-0524-z

[29] Does acromioplasty enhance arthroscopic rotator cuff repair? A systematic review and meta-analysis of randomized trials. Clinics in Shoulder and Elbow. 2025. DOI: 10.5397/cise.2025.00458

[30] Three-dimensional shoulder kinematics normalize after rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.10.021

[31] Improved Outcomes Following Arthroscopic Superior Capsular Reconstruction May Not Be Associated With Changes in Shoulder Kinematics: An In Vivo Study. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2021.06.018

[32] Harnessing the Mechanical Resilience of the Rotator Cuff. Journal of Bone and Joint Surgery. 2026. DOI: 10.2106/jbjs.25.01543

[33] The low-profile Roman bridge technique for knotless double-row repair of the rotator cuff. Archives of Orthopaedic and Trauma Surgery. 2010. DOI: 10.1007/s00402-010-1203-3

[34] Minimal improvements in objective shoulder strength following shoulder arthroplasty: a systematic review. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.06.020

[35] Rehabilitation of the Athlete's Shoulder. Clinics in Sports Medicine. 2008. DOI: 10.1016/j.csm.2008.07.001

[36] Subacromial pressures in vivo and effects of selective experimental suprascapular nerve block. Journal of Shoulder and Elbow Surgery. 2006. DOI: 10.1016/j.jse.2005.08.017

[37] Clinical Outcome and Glenoid Morphology After Arthroscopic Repair of Chronic Osseous Bankart Lesions. Journal of Bone and Joint Surgery. 2015. DOI: 10.2106/jbjs.n.01033

[38] The effect of critical shoulder angle on functional compensation in the setting of cuff tear arthropathy. JSES International. 2020. DOI: 10.1016/j.jseint.2020.05.003

[39] Long-term follow-up of patients with a high critical shoulder angle and acromion index: is there an increased retear risk after arthroscopic supraspinatus tendon repair?. JSES International. 2020. DOI: 10.1016/j.jseint.2020.07.010

[40] Load transmission via the supraspinatus cord prevents muscle fatty degeneration, a biomechanical study. JSES International. 2025. DOI: 10.1016/j.jseint.2024.12.024

[41] Excellent Clinical and Radiological Midterm Outcomes for the Management of Recurrent Anterior Shoulder Instability by All-Arthroscopic Modified Eden-Hybinette Procedure Using Iliac Crest Autograft and Double-Pair Button Fixation System: 3-Year Clinical Case Series With No Loss to Follow-Up. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021. DOI: 10.1016/j.arthro.2020.10.036

[42] Diagnosis and Management of Superior Labral Anterior Posterior Tears in Throwing Athletes. The American Journal of Sports Medicine. 2012. DOI: 10.1177/0363546512466067

[43] Proprioception of the Shoulder Joint after Surgical Repair for Instability. The American Journal of Sports Medicine. 2004. DOI: 10.1177/0363546503261719

[44] Range of motion limitation after rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2009.07.009

[45] Disruption of the anterior–posterior rotator cuff force balance alters joint function and leads to joint damage in a rat model. Journal of Orthopaedic Research. 2014. DOI: 10.1002/jor.22586

[46] Arthroscopic Treatment of Concomitant Superior Labral Anterior Posterior (SLAP) Lesions and Rotator Cuff Tears in Patients over the Age of 45 Years. The American Journal of Sports Medicine. 2009. DOI: 10.1177/0363546509331940

[47] External rotation and active supination CT arthrography for the postoperative evaluation of type II superior labral anterior to posterior lesions. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-3350-5

[48] Predictive factors associated with failure of nonoperative treatment of superior labrum anterior-posterior tears. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.09.008

[49] Return to High-Level Throwing After Combination Infraspinatus Repair, SLAP Repair, and Release of Glenohumeral Internal Rotation Deficit. The American Journal of Sports Medicine. 2012. DOI: 10.1177/0363546512459481

[50] A Mechanistic Classification for Superior Labral Injuries Guides Operative Management. Arthroscopy. 2025. DOI: 10.1016/j.arthro.2025.03.059

[51] Immediate self‐rehabilitation after open Latarjet procedures enables recovery of preoperative shoulder mobility at 3 months. Knee Surgery, Sports Traumatology, Arthroscopy. 2019. DOI: 10.1007/s00167-019-05635-8

[52] Four‐Quadrant Approach to Capsulolabral Repair: An Arthroscopic Road Map to the Glenoid. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2009.09.019

[53] Reproducibility and Reliability of the Snyder Classification of Superior Labral Anterior Posterior Lesions Among Shoulder Surgeons. The American Journal of Sports Medicine. 2011. DOI: 10.1177/0363546510392332

[54] Dr. Charles Neer's last surgical case: a historical perspective. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.08.005

[55] Immediate Self-Rehabilitation After Open Latarjet Procedures Enables Recovery of Preoperative Shoulder Mobility At 3 Months. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.03.057

[56] Do Postoperative Platelet-Rich Plasma Injections Accelerate Early Tendon Healing and Functional Recovery After Arthroscopic Supraspinatus Repair?. The American Journal of Sports Medicine. 2015. DOI: 10.1177/0363546515572602

[57] How periarticular corticosteroid injections impact the integrity of arthroscopic rotator cuff repair. Orthopaedics & Traumatology: Surgery & Research. 2020. DOI: 10.1016/j.otsr.2020.05.009

[58] Return-to-sport and performance outcomes after isolated posterior labral repair in professional baseball players. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.01.024

[60] Outcomes of Revision Arthroscopic Type II Superior Labral Anterior Posterior Repairs. The American Journal of Sports Medicine. 2011. DOI: 10.1177/0363546511398648

[61] Radiographic greater tuberosity spurs and narrow acromiohumeral intervals are associated with advanced retraction of the supraspinatus tendon in patients with symptomatic rotator cuff tears. JSES International. 2021. DOI: 10.1016/j.jseint.2020.09.015

[62] Isolated Type II Superior Labral Anterior Posterior Lesions. The American Journal of Sports Medicine. 2009. DOI: 10.1177/0363546508328417

[63] Editorial Commentary: Multimodal, Opioid‐Free Pain Management After Rotator Cuff Repair May Be Safe and Effective, and Decreases the Risk of Drug Abuse. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.01.040

[64] Electromyographic Analysis of Specific Exercises for Scapular Control in Early Phases of Shoulder Rehabilitation. The American Journal of Sports Medicine. 2008. DOI: 10.1177/0363546508316281

[65] Chapter 24 Current Concepts in Rehabilitation of Rotator Cuff Pathology: Nonsurgical and Postoperative Considerations. 2019.

[66] Functional outcome and the structural integrity of arthroscopic Bankart repair: a prospective trial. Shoulder & Elbow. 2014. DOI: 10.1177/1758573214550839

[67] Clinical and Radiological Outcomes of Type 2 Superior Labral Anterior Posterior Repairs in Elite Overhead Athletes. The American Journal of Sports Medicine. 2013. DOI: 10.1177/0363546513485361

[68] The efficacy of conservative management of micro-traumatic posterior shoulder instability. JSES International. 2025. DOI: 10.1016/j.jseint.2024.09.016

[69] Rehabilitation following shoulder arthroscopic stabilisation surgery: A survey of UK practice. Shoulder & Elbow. 2023. DOI: 10.1177/17585732231154889

[70] Postoperative Rehabilitation Protocol Following Arthroscopic Rotator Cuff Repair: A Prospective Single-Arm Pragmatic Interventional Study. Medicina. 2022. DOI: 10.3390/medicina58060729

[71] No difference in clinical outcomes and return to sport and work with use of postoperative nonsteroidal anti-inflammatory medications following primary arthroscopic glenoid labral repair. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.02.048

[72] Drilling through lateral transmuscular portal lowers the risk of suprascapular nerve injury during arthroscopic SLAP repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2016. DOI: 10.1007/s00167-016-4086-1

[73] Development of new SLAP lesion after the arthroscopic, isolated decompression of ganglion cyst of the shoulder. Knee Surgery, Sports Traumatology, Arthroscopy. 2009. DOI: 10.1007/s00167-009-0851-8

[74] Ill‐defined Return‐to‐Sport Criteria and Inconsistent Unsuccessful Return Rates Caused by Various Reasons Not Necessarily Related to Treatment After Superior Labral Treatments: A Systematic Review. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.09.053

[75] Editorial Commentary: Buyer Beware—Throwers Undergoing Type VIII SLAP Repair Should Do So With Very Reasonable Expectations. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.08.022

[76] Influence of Preoperative Musculotendinous Junction Position on Rotator Cuff Healing After Double‐Row Repair. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2016.12.010

[77] Morphological Characteristics of the Repaired Labrum According to Glenoid Location and Its Clinical Relevance After Arthroscopic Bankart Repair. The American Journal of Sports Medicine. 2014. DOI: 10.1177/0363546514528791

[78] Moderate Return to Play and Previous Performance After SLAP Repairs in Competitive Overhead Athletes: A Systematic Review. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.03.026

[80] Criteria-based return-to-sport testing helps identify functional deficits in young athletes following posterior labral repair but may not reduce recurrence or increase return to play. JSES International. 2023. DOI: 10.1016/j.jseint.2023.01.002

[81] A Systematic Review of Long-term Clinical and Radiological Outcomes of Arthroscopic and Open/Mini-open Rotator Cuff Repairs. The American Journal of Sports Medicine. 2022. DOI: 10.1177/03635465211073332

[83] The Time for Functional Recovery After Arthroscopic Rotator Cuff Repair: Correlation With Tendon Healing Controlled by Computed Tomography Arthrography. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2007.07.023

[84] Effect of biceps tenodesis on speed of recovery after arthroscopic rotator cuff repair. JSES International. 2020. DOI: 10.1016/j.jseint.2019.12.010

[90] Etiology, Diagnosis, and Management of Failed SLAP Repair. Journal of the American Academy of Orthopaedic Surgeons. 2014. DOI: 10.5435/jaaos-22-09-554

[94] Outcomes following arthroscopic rotator cuff repair adversely affected by underlying diagnosis of glenohumeral osteoarthritis: a matched cohort analysis. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2025.100659

[95] Coronary Artery Disease and Peripheral Artery Disease Are Associated With Increased Rates of Retear and Postoperative Complications Following Primary Arthroscopic Rotator Cuff Repair. Arthroscopy. 2026. DOI: 10.1002/arj.70004

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b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

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