Reapiring techniques of SLAP lesion effect the vascular supply of long head of biceps tendon
Type II superior labrum anterior and posterior (SLAP) lesions are usually treated with arthroscopic SLAP repair. A vascular supply of proximal long head of biceps tendon (LHBT) passes through soft tissue nearby SLAP repair site.
Objectives: To evaluate intratendinous vascular supply of proximal LHBT resulting from SLAP repair and compare between each SLAP repair techniques.
Forty-five fresh cadaveric shoulders were divided into 3 major groups: normal, created SLAP and repaired SLAP group. SLAP lesions were repaired using 3 common techniques: two-anchors with simple sutures, one-anchor with double sutures and one-anchor with horizontal mattress suture. Each group had 9 shoulders. India-ink was injected into acromial branch of thoracoacromial artery. Proximal LHBT was resected for histological cross-sectional study. Intratendinous vascular distance was measured and compared between each groups.
The vascular supply of proximal LHBT was seen macroscopically at anterodorsal surface. It derived from soft tissue lying anterior to LHBT origin. In normal shoulder, intratendinous vascular distance was 16.92 ± 1.49 mm (95%CI: 15.78-18.06). There was no significant difference between normal shoulder and created SLAP group (P=0.503). By comparing non-repaired SLAP to each repair technique, the technique using two-anchors with simple sutures showed no significant difference (P=0.716) , while the others showed significant difference disruption of blood supply (P=0.0002). There was significant difference between each techniques (P=0.0001).
Main vascular supply of proximal LHBT comes from anterior direction. Some techniques of SLAP repair might disrupt the vascularization. The technique using two-anchors with simple sutures, one anchor at 3-mm anterior to anterior boarder and one at posterior boarder of tendon, can preserve vascularization of LHBT.