Subtypes analysis and treatment strategies of Type V SLAP lesions.

Background: While the shoulder arthroscopic treatment protocols for Type V superior labrum anterior-to-posterior (SLAP) lesions have become popular, there are still some special cases that cannot be adequately addressed by the existing classification and protocols in clinical practice. This article presents a case series and summary of the classification and treatment of such special cases. Methods: Twenty-six cases of Type V SLAP lesions treated at the Jiangsu Province Hospital of Chinese Medicine from June 2016 to March 2023 were retrospectively analyzed. The labral lesions were observed and recorded during arthroscopic surgery. Repair surgery was subsequently performed depending on the extent of the labrum lesion. Visual Analog Scale, American Shoulder and Elbow Surgeons, Disability of the arm, shoulder, and Hhand, Rowe scores, and Western Ontario Shoulder Instability Index were determined. The healing status after repair was assessed using shoulder magnetic resonance imaging at the 3-month postoperative follow-up. Results: According to the findings of shoulder arthroscopy, the Type V SLAP lesions can be further classified into three subtypes: (1) Bankart lesion combined with Type II SLAP lesion (designated as subtype Va in this study); (2) Bankart lesion combined with Type III SLAP lesion (designated as subtype Vb in this study); (3) Bony Bankart lesion combined with Type II SLAP lesion (designated as subtype Vc in this study). Of the 26 cases, 14 (53%) had a Va-type lesion, 5 (20%) had a Vb-type lesion, and 7 (27%) had a Vc-type lesion.The mean follow-up time was 15 months (range, 14-16 months). At the 3-month postoperative follow-up, all patients showed labral continuity on shoulder magnetic resonance imaging. The visual analog scale score decreased from 4.47 ± 2.80 to 0.04 ± 0.20, whereas the American Shoulder and Elbow Surgeons score improved from 29.12 ± 15.43 to 89.38 ± 3.59. The disability of the arm, shoulder, and hand score improved from 52.62 ± 19.90 to 8.50 ± 3.05, whereas the Rowe score improved from 49.19 ± 19.00 to 89.31 ± 3.56. The Western Ontario Shoulder Instability Index scores improved from 94.42 ± 9.25 at the 6-month postoperative follow-up to 26.58 ± 8.90 at the final follow-up. Conclusion: Arthroscopic labrum repair is effective in the treatment of Type V SLAP lesions. However, because these lesions present with three distinct subtypes, the surgical procedure should be adapted accordingly.