Quantifying the Extent of a Type II SLAP Lesion Required to Cause Peel-Back of the Glenoid Labrum-A Cadaveric Study

Aruna Seneviratne, Kenneth Montgomery, Babette Bevilacqua, Bashir Zikria

Research output: Contribution to journalArticle

Abstract

Purpose: To quantify the extent of labral disruption required to cause it to peel back when the peel-back test is performed. Methods: Ten cadaveric shoulders were prepared by removal of the deltoid and rotator cuff muscles. The glenohumeral joint was concentrically reduced and brought into 90° abduction and maximal external rotation. The peel-back of the labrum was graded 0, 1, or 2. The labrum was sequentially detached from the glenoid in the following order: biceps anchor only, 1 o'clock, 2 o'clock, 11 o'clock, and 3 o'clock positions. After each labral cut, the peel-back test was performed. Labral repair was performed with a single suture anchor placed at the 12:30 o'clock position; labral peel-back was reassessed. Results: A progressive increase was noted in peel-back grade with sequential cutting of the labrum posteriorly. However, disruption of the anchor alone did not lead to a positive peel-back sign. Disruption to the 2 o'clock position resulted in a positive peel-back sign overall in 9 of 10 shoulders (5 were grade 1, and 4 were grade 2). No increase was seen in peel-back grade with anterior extension of the labral detachment. Labral repair with a single anchor placed at the 12:30 o'clock position eliminated labral peel-back in 100% of shoulders. Conclusions: Detachment of the biceps anchor alone does not cause peel-back. The labrum must be disrupted to at least the 2 o'clock position before overt (grade 2) peel-back is observed. A single suture anchor placed at 12:30 o'clock eliminated peel-back of the labrum. Clinical Relevance: Validation of the peel-back test as an important diagnostic tool during shoulder arthroscopy.

Original languageEnglish (US)
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Volume22
Issue number11
DOIs
StatePublished - Nov 2006
Externally publishedYes

Fingerprint

Shoulder Joint
Suture Anchors
Rotator Cuff
Arthroscopy
Muscles

Keywords

  • Labrum
  • Peel-back test
  • Shoulder arthroscopy
  • Shoulder surgery
  • SLAP lesion

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Quantifying the Extent of a Type II SLAP Lesion Required to Cause Peel-Back of the Glenoid Labrum-A Cadaveric Study. / Seneviratne, Aruna; Montgomery, Kenneth; Bevilacqua, Babette; Zikria, Bashir.

In: Arthroscopy - Journal of Arthroscopic and Related Surgery, Vol. 22, No. 11, 11.2006.

Research output: Contribution to journalArticle

@article{adb9b9e9f5f6465985545a75991813d0,
title = "Quantifying the Extent of a Type II SLAP Lesion Required to Cause Peel-Back of the Glenoid Labrum-A Cadaveric Study",
abstract = "Purpose: To quantify the extent of labral disruption required to cause it to peel back when the peel-back test is performed. Methods: Ten cadaveric shoulders were prepared by removal of the deltoid and rotator cuff muscles. The glenohumeral joint was concentrically reduced and brought into 90° abduction and maximal external rotation. The peel-back of the labrum was graded 0, 1, or 2. The labrum was sequentially detached from the glenoid in the following order: biceps anchor only, 1 o'clock, 2 o'clock, 11 o'clock, and 3 o'clock positions. After each labral cut, the peel-back test was performed. Labral repair was performed with a single suture anchor placed at the 12:30 o'clock position; labral peel-back was reassessed. Results: A progressive increase was noted in peel-back grade with sequential cutting of the labrum posteriorly. However, disruption of the anchor alone did not lead to a positive peel-back sign. Disruption to the 2 o'clock position resulted in a positive peel-back sign overall in 9 of 10 shoulders (5 were grade 1, and 4 were grade 2). No increase was seen in peel-back grade with anterior extension of the labral detachment. Labral repair with a single anchor placed at the 12:30 o'clock position eliminated labral peel-back in 100{\%} of shoulders. Conclusions: Detachment of the biceps anchor alone does not cause peel-back. The labrum must be disrupted to at least the 2 o'clock position before overt (grade 2) peel-back is observed. A single suture anchor placed at 12:30 o'clock eliminated peel-back of the labrum. Clinical Relevance: Validation of the peel-back test as an important diagnostic tool during shoulder arthroscopy.",
keywords = "Labrum, Peel-back test, Shoulder arthroscopy, Shoulder surgery, SLAP lesion",
author = "Aruna Seneviratne and Kenneth Montgomery and Babette Bevilacqua and Bashir Zikria",
year = "2006",
month = "11",
doi = "10.1016/j.arthro.2006.06.017",
language = "English (US)",
volume = "22",
journal = "Arthroscopy - Journal of Arthroscopic and Related Surgery",
issn = "0749-8063",
publisher = "W.B. Saunders Ltd",
number = "11",

}

TY - JOUR

T1 - Quantifying the Extent of a Type II SLAP Lesion Required to Cause Peel-Back of the Glenoid Labrum-A Cadaveric Study

AU - Seneviratne, Aruna

AU - Montgomery, Kenneth

AU - Bevilacqua, Babette

AU - Zikria, Bashir

PY - 2006/11

Y1 - 2006/11

N2 - Purpose: To quantify the extent of labral disruption required to cause it to peel back when the peel-back test is performed. Methods: Ten cadaveric shoulders were prepared by removal of the deltoid and rotator cuff muscles. The glenohumeral joint was concentrically reduced and brought into 90° abduction and maximal external rotation. The peel-back of the labrum was graded 0, 1, or 2. The labrum was sequentially detached from the glenoid in the following order: biceps anchor only, 1 o'clock, 2 o'clock, 11 o'clock, and 3 o'clock positions. After each labral cut, the peel-back test was performed. Labral repair was performed with a single suture anchor placed at the 12:30 o'clock position; labral peel-back was reassessed. Results: A progressive increase was noted in peel-back grade with sequential cutting of the labrum posteriorly. However, disruption of the anchor alone did not lead to a positive peel-back sign. Disruption to the 2 o'clock position resulted in a positive peel-back sign overall in 9 of 10 shoulders (5 were grade 1, and 4 were grade 2). No increase was seen in peel-back grade with anterior extension of the labral detachment. Labral repair with a single anchor placed at the 12:30 o'clock position eliminated labral peel-back in 100% of shoulders. Conclusions: Detachment of the biceps anchor alone does not cause peel-back. The labrum must be disrupted to at least the 2 o'clock position before overt (grade 2) peel-back is observed. A single suture anchor placed at 12:30 o'clock eliminated peel-back of the labrum. Clinical Relevance: Validation of the peel-back test as an important diagnostic tool during shoulder arthroscopy.

AB - Purpose: To quantify the extent of labral disruption required to cause it to peel back when the peel-back test is performed. Methods: Ten cadaveric shoulders were prepared by removal of the deltoid and rotator cuff muscles. The glenohumeral joint was concentrically reduced and brought into 90° abduction and maximal external rotation. The peel-back of the labrum was graded 0, 1, or 2. The labrum was sequentially detached from the glenoid in the following order: biceps anchor only, 1 o'clock, 2 o'clock, 11 o'clock, and 3 o'clock positions. After each labral cut, the peel-back test was performed. Labral repair was performed with a single suture anchor placed at the 12:30 o'clock position; labral peel-back was reassessed. Results: A progressive increase was noted in peel-back grade with sequential cutting of the labrum posteriorly. However, disruption of the anchor alone did not lead to a positive peel-back sign. Disruption to the 2 o'clock position resulted in a positive peel-back sign overall in 9 of 10 shoulders (5 were grade 1, and 4 were grade 2). No increase was seen in peel-back grade with anterior extension of the labral detachment. Labral repair with a single anchor placed at the 12:30 o'clock position eliminated labral peel-back in 100% of shoulders. Conclusions: Detachment of the biceps anchor alone does not cause peel-back. The labrum must be disrupted to at least the 2 o'clock position before overt (grade 2) peel-back is observed. A single suture anchor placed at 12:30 o'clock eliminated peel-back of the labrum. Clinical Relevance: Validation of the peel-back test as an important diagnostic tool during shoulder arthroscopy.

KW - Labrum

KW - Peel-back test

KW - Shoulder arthroscopy

KW - Shoulder surgery

KW - SLAP lesion

UR - http://www.scopus.com/inward/record.url?scp=33750446655&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33750446655&partnerID=8YFLogxK

U2 - 10.1016/j.arthro.2006.06.017

DO - 10.1016/j.arthro.2006.06.017

M3 - Article

C2 - 17084291

AN - SCOPUS:33750446655

VL - 22

JO - Arthroscopy - Journal of Arthroscopic and Related Surgery

JF - Arthroscopy - Journal of Arthroscopic and Related Surgery

SN - 0749-8063

IS - 11

ER -