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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.

78 citationsUpdated Aug 2026

Overview

Arthroscopic treatment of SLAP tears yields predictably good functional results and an acceptable rate of return to sport 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]. In patients younger than 50 years with coexistent rotator cuff tear, predictable short-term surgical results and return to activity can be expected after repair of type II SLAP lesions [2]. For patients with combined 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].

Nonoperative treatment of SLAP tears in athletes can be successful, particularly in patients who complete their rehabilitation program before attempting a return to play [3]. Consequently, SLAP repair should continue to be considered as an option for SLAP tear treatment only after nonsurgical management has failed [23]. In young active populations, 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 does not affect postoperative clinical and patient-reported outcomes [11].

Specific lesion subtypes demonstrate distinct outcomes. In military patients with type V SLAP lesions, 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 [7]. 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 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].

Anatomy & Pathophysiology

Kinematics and Biomechanics

Temporal and kinematic motions at the shoulder are prominent predictors of shoulder anterior force in high school and professional baseball pitchers [30]. Optimum restoration of shoulder function requires activation of all kinetic chain segments to re-establish the interactions that existed before injury [37]. Three-dimensional shoulder kinematics normalize after rotator cuff repair [31], and observed changes in scapular kinematics are associated with an increased overall range of motion, suggesting restored function of shoulder muscles [31]. Surgical techniques for rotator cuff repair should be tailored to optimize residual cuff activation to restore balanced shoulder mechanics [33].

Subacromial pressures are significantly altered by arm position, increasing during abduction, flexion, and internal rotation, and decreasing during external rotation [38]. Significant differences in glenohumeral joint contact patterns are detected due to abduction angle and shoulder condition [35]. Superior capsular reconstruction (SCR) may not depress the humeral head during functional abduction [32], although postoperative improvements in subjective and clinical outcomes following SCR may be affected by mechanisms other than changes in shoulder kinematics [32].

Osseous and Structural Anatomy

Glenoid morphology can be normalized during the intermediate to long-term postoperative period after arthroscopic repair of chronic osseous Bankart lesions, even in shoulders with a smaller fragment [39]. The critical shoulder angle can be analyzed on plain radiographs to help manage functional expectations in patients with cuff tear arthropathy [40]. Neither higher critical shoulder angle nor acromion index impaired clinical results over time after arthroscopic supraspinatus tendon repair [41]. Residual rotator cuff subregions can partially restore humeral head centering and glenohumeral contact mechanics in progressive rotator cuff tears [42].

Ligamentous and Soft Tissue Structures

The supraspinatus cord, and not the coracohumeral ligament, is the key structure responsible for the transmission of anterior shoulder abduction force [43]. 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 [45].

Classification

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

Clinical Presentation

Prognosis and Outcomes: Arthroscopic repair of isolated type II SLAP lesions using suture anchors yields satisfactory functional outcomes and return to pre-injury sports levels, with delayed but significant pain relief observed at 6 months [16]. 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]. Combined posterior labral and SLAP repair leads to statistically and clinically significant increases in outcome scores and high rates of return to active-duty military service, which do not differ significantly from results after isolated posterior labral repair [17]. Arthroscopic evaluation and repair of posterior labral lesions result in 93% of patients returning to sport and 82% returning without any limitations [21].

Risk Factors and Complications: Patients who underwent SLAP repair are 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 is 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].

Concomitant Pathology and Management: Concomitant shoulder pathology should be treated at the time of SLAP repair [6]. 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]. Nonsurgical treatment can resolve pain effectively and restore function in patients with SLAP tears or biceps lesions [9].

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 combinations of these radiographic signs, a prompt MRI examination and a referral to a shoulder specialist are recommended [61]. No correlations between functional outcomes and radiographic shoulder findings at mid-term were identified for shoulder superior capsular reconstruction using xenograft [19].

MRI: The position of the musculotendinous junction (MTJ) with respect to the glenoid face is a reliable, identifiable marker on MRI scans that can be predictive of healing after double-row rotator cuff repair [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: Arthroscopic evaluation and repair of posterior labral lesions resulted in 93% of patients returning to sport and 82% returning without any limitations at 2-year follow-up [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]. Arthroscopic SLAP repairs show favorable clinical and radiological outcomes, but return to play may still be problematic in elite baseball players [67]. Nearly a quarter of athletes were unable to return to play after arthroscopic superior labral repair [25]. 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 an appropriate and effective initial treatment for superior labral injuries, unless obvious pathologic changes alter glenohumeral joint mechanics or other associated injuries are present [50]. Overall, nonoperative treatment of SLAP tears in athletes can be successful, particularly in patients who complete their rehabilitation program before attempting return to play [3]. An initial trial of nonoperative management may be considered in young active patients with isolated SLAP tear [48].

Operative

Indications: SLAP repair in throwing athletes should be approached with caution [75].

Surgical Approach / Technique: Arthroscopic repair of isolated Type II SLAP yields comparable results to Type II SLAP repairs treated in combination with other shoulder conditions, although the combined treatment group demonstrated significantly better results in two of three measured parameters [10]. Posterior repair of isolated type 2 superior labrum anterior–posterior lesion prevents external rotation deficiency [15]. An effective arthroscopic technique exists 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]. Surgeons must be aware of the uncommon cause of shoulder pain from new SLAP lesion development after arthroscopic, isolated decompression of ganglion cyst; careful capsulotomy with minimal resection is required to prevent labral damage [73].

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

Pain Management: There is no clear consensus regarding optimal post-operative rehabilitation following arthroscopic shoulder stabilisation [69]. Management through PRP-based strategies in the postoperative rehabilitation of patients with ARCR is effective for pain intensity, ROM, and shoulder function [70]. Patients 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 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]. Periarticular corticosteroid injections remain a safe and effective analgesia method during rotator cuff repair surgery [57].

Other Considerations: It is anatomically possible that the suprascapular nerve could sustain iatrogenic injury during labral anchor placement during SLAP repair [72]. Drilling through lateral transmuscular portal lowers the risk of suprascapular nerve injury during arthroscopic SLAP repair [72]. 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 Diagnosis and Revision: 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].

Recovery

Light activity (weeks): Immediate self-rehabilitation after open Latarjet procedures enables recovery of preoperative shoulder mobility at 3 months [51]. This approach is safe, with no adverse events related to self-rehabilitation reported [55]. For arthroscopic rotator cuff repair, approximately 75% of pain relief and 50% of functional recovery can be expected at 3 months, although larger tears demonstrate a slower speed of recovery [26].

Full activity (months): 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]. 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]. Specific exercises for scapular control can be used as part of a comprehensive rehabilitation program for restoration of shoulder function [64]. Anterior shoulder stabilization procedures lead to high, though varied, reported return to sport and return to preinjury rates across all studied cohorts [27]. 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].

Complete recovery / outcome plateau (months): 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]. 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]. The patient returned with full function and subjective assessment showing excellent results 22 years postoperatively after open repair for a large cuff tear [54].

Rehabilitation protocol: 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].

Functional milestones: 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]. Studies reviewed reported moderate return to play and return to previous level of performance rates following SLAP repairs in competitive overhead athletes [78]. Overall, nearly a quarter of athletes were unable to return to play after arthroscopic superior labral repair [25]. Arthroscopic revision type II SLAP repairs yield worse results than primary repairs, with workers' compensation patients and overhead athletes doing especially worse [60].

Other Considerations: Patient selection and pathology significantly influence outcomes. Revision surgery carries a poorer prognosis compared to primary repair, particularly in specific demographic groups [60]. Simultaneous procedures, such as biceps tenodesis, may alter the trajectory of functional recovery and pain relief [84].

Key Evidence

  • [L4] Long-term outcomes after isolated labral repair for SLAP lesions are good and independent of age. [1] (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. [2] (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. [3] (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. [4] (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. [5] (10.1016/j.arthro.2011.09.005)
  • [L4] The results suggest that concomitant shoulder pathology should be treated at the time of SLAP repair. [6] (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. [7] (10.1177/03635465231169238)
  • [L3] Patients who underwent SLAP repair were associated with a higher risk of revision surgery and subsequent rotator cuff strain diagnosis. [8] (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] (10.1007/s00167-007-0334-8)
  • [L3] Surgical positioning for arthroscopic posterior shoulder labral repair did not affect postoperative clinical and patient-reported outcomes. [11] (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. [12] (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. [13] (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. [14] (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. [15] (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. [16] (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. [17] (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. [18] (10.5435/00124635-200910000-00005)
  • [L5] No correlations between functional outcomes and radiographic shoulder findings at mid-term were identified. [19] (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. [20] (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. [21] (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. [22] (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. [23] (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. [24] (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. [25] (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. [26] (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. [27] (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. [28] (10.1007/s00167-008-0524-z)
  • [L4] Temporal and kinematic motions at the shoulder were prominent predictors of shoulder anterior force for both cohorts. [30] (10.1177/17585732221098721)
  • [L4] The observed changes in scapular kinematics are associated with an increased overall range of motion and suggest restored function of shoulder muscles. [31] (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. [32] (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. [33] (10.2106/jbjs.25.01543)
  • [L4] Significant differences in joint contact patterns were detected due to abduction angle and shoulder condition. [35] (10.1155/2010/162136)
  • [Paper] Optimum restoration of shoulder function requires activation of all kinetic chain segments to re-establish the interactions that existed before injury. [37] (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. [38] (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. [39] (10.2106/jbjs.n.01033)
  • [L4] Analyzing critical shoulder angle on plain radiographs may help manage functional expectations in these patients. [40] (10.1016/j.jseint.2020.05.003)
  • [L3] Neither higher critical shoulder angle nor acromion index impaired clinical results over time. [41] (10.1016/j.jseint.2020.07.010)
  • [L5] Residual RC subregions can partially restore humeral head centering and glenohumeral contact mechanics in progressive RC tears. [42] (10.2106/jbjs.25.01073)
  • [L5] The supraspinatus cord, and not the coracohumeral ligament, is the key structure responsible for the transmission of anterior shoulder abduction force. [43] (10.1016/j.jseint.2024.12.024)
  • [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. [45] (10.1177/0363546512466067)
  • [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. [46] (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. [47] (10.1007/s00167-014-3350-5)
  • [L3] An initial trial of nonoperative management may be considered in young active patients with isolated SLAP tear. [48] (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. [49] (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. [50] (10.1016/j.arthro.2025.03.059)
  • [L4] Immediate self-rehabilitation after open Latarjet procedures enabled recovery of preoperative shoulder mobility at 3 months. [51] (10.1007/s00167-019-05635-8)
  • [L3] For experienced shoulder surgeons, the Snyder classification is a reliable system for identifying SLAP lesions. [53] (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. [54] (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. [55] (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. [56] (10.1177/0363546515572602)
  • [L2] It remains a safe and effective analgesia method during rotator cuff repair surgery. [57] (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. [58] (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. [60] (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. [61] (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. [62] (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. [63] (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. [64] (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. [66] (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. [67] (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. [68] (10.1016/j.jseint.2024.09.016)
  • [L4] There is no clear consensus regarding optimal post-operative rehabilitation following arthroscopic shoulder stabilisation. [69] (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. [70] (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. [71] (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. [72] (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. [73] (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. [74] (10.1016/j.arthro.2024.09.053)
  • [L5] SLAP repair in throwing athletes should be approached with caution. [75] (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. [76] (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. [77] (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. [78] (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. [80] (10.1016/j.jseint.2023.01.002)
  • [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. [83] (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. [84] (10.1016/j.jseint.2019.12.010)
  • [L5] Outcomes after surgical management of failed SLAP repair are inferior to those of primary repair. [90] (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. [94] (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. [95] (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

[30] Relationships between throwing mechanics and shoulder anterior force in high school and professional baseball pitchers. Shoulder & Elbow. 2022. DOI: 10.1177/17585732221098721

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

[32] 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

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

[35] In Vivo Measurement of Glenohumeral Joint Contact Patterns. EURASIP Journal on Advances in Signal Processing. 2009. DOI: 10.1155/2010/162136

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

[38] 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

[39] 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

[40] 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

[41] 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

[42] Compensatory Load Sharing by Residual Rotator Cuff Subregions Preserves Glenohumeral Mechanics in Partial and Massive Tears. Journal of Bone and Joint Surgery. 2026. DOI: 10.2106/jbjs.25.01073

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

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

[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

[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

[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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