The superior labral anterior posterior tear, or SLAP lesion, was first described by Andrews in 1985. Snyder classified these lesions in 1990, and their classification is widely recognized as a tenet of orthopaedic knowledge for orthopaedic surgeons worldwide. Moreover, the SLAP lesion is considered heavily in the decision-making process by many orthopaedic surgeons when formulating a treatment plan for patients with these conditions.
The Snyder classification divides SLAP tears into 4 types. Type I lesions represent degenerative fraying of the superior labrum without compromise of the labral attachment to the glenoid or the biceps anchor. They are treated with debridement and are rarely considered a source of clinical symptoms. Type II lesions are the most common lesions and have a biceps anchor that is detached from the superior glenoid tubercle. These lesions are treated with labral repair to the glenoid to reestablish biceps anchor stability. Type III lesions consist of a bucket-handle tear of a meniscoid superior labrum with a normal biceps tendon attachment. The clinical symptoms are a result of the mobile labral fragment, and these are treated with arthroscopic debridement. Type IV lesions also have a bucket-handle tear of the labrum, but the tear extends into the biceps tendon. The treatment of these lesions depends on the extent of biceps tearing, the stability of the superior labrum, and the age and activity level of the patient. Generally, these lesions are treated with tenodesis/tenotomy with or without labral repair.
