Biceps Anchor Repair for SLAP Type IX Tears in Patients Under 20 Years Old

Biceps Anchor Repair for SLAP Type IX Tears in Patients Under 20 Years Old | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Biceps Anchor Repair for SLAP Type IX Tears in Patients Under 20 Years Old Kushtrim Grezda, Kreshnike Dedushi Hoti, Arber Lama, Florent Dauti, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7592366/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Anterior shoulder instability is the most frequent type of glenohumeral instability which poses diagnostic and surgical challenges, particularly in young, active patients. Type IX Superior Labrum Anterior to Posterior (SLAP) lesions represent a rare and complex subset of shoulder injuries that involves 360° of the glenohumeral labrum. Methods In our retrospective case series study, we evaluated four professional athletes aged 17–19 who sustained first-time traumatic shoulder dislocations and were diagnosed with Type IX SLAP lesions. Arthroscopic labral repair was performed by a single surgeon on all patients. Diagnosis was confirmed intraoperatively, with two cases identified preoperatively with MRI. Patients were evaluated postoperatively at 6, 12, and 24 months using the American Shoulder and Elbow Surgeons (ASES) and Constant-Murley (CS) scores. Results All patients reported improvement in shoulder function and stability post-surgery. Mean ASES scores improved from 50 preoperatively to 88 at 24 months, and Constant Scores rose from 46 to 88.8. Three of four patients returned to pre-injury levels of athletic performance, with all resuming full occupational duties. No complications or re-injuries were reported. Conclusion Arthroscopic SLAP repair provides an effective treatment for Type IX lesions in young athletes, preserving the native anatomy and supporting full functional recovery. While biceps tenodesis may be considered in older or degenerative cases, SLAP repair remains the preferred option in this patient population. Further studies with larger cohorts are warranted to validate these findings and guide long-term management. Type IX SLAP lesions Biceps tenodesis Bankart repair Figures Figure 1 Figure 2 Introduction Shoulder injuries represent a significant clinical challenge due to the intrinsic complexity of the glenohumeral joint’s anatomy and the high functional demands placed upon it during daily activities and athletic performance ( 1 ). Among these injuries, lesions of the superior labrum—involving the fibrocartilaginous rim that deepens the glenoid fossa and serves as the attachment site for the long head of the biceps tendon (LHBT)—have attracted considerable attention over recent decades ( 1 , 2 ). The superior labrum plays a dual role in providing both static and dynamic stability to the shoulder, and its disruption can impair load transmission and alter joint kinematics ( 1 ). Within this context, Superior Labrum Anterior to Posterior (SLAP) tears stand out due to the diagnostic uncertainties they evoke and the technical challenges they present in management ( 3 ). While the original classification system proposed by Snyder et al. encompassed four distinct types of SLAP lesions, further clinical experience and arthroscopic observations have led to the identification of up to ten subtypes that capture a broader spectrum of pathology ( 4 ). The Type IX SLAP (Type IX) lesion is one of the less frequently encountered variants within this expanded classification. Described as a pan-labral injury, Type IX lesions are characterized by a circumferential detachment that involves the superior labrum in its entirety, extending not only to the region of the biceps anchor but also encompassing both the anterior and posterior labral segments ( 5 ). While SLAP lesions are commonly associated with repetitive microtrauma in overhead athletes, several reports now indicate that Type IX lesions, given their unique circumferential pattern, are more frequently encountered following acute traumatic events, such as anterior dislocations induced by forced abduction and external rotation ( 5 ). Clinically, patients with Type IX SLAP tears tend to present with a constellation of nonspecific symptoms—a chronic, sometimes vague shoulder pain often accompanied by sensations of instability, mechanical clicking or locking, and decreased overall function ( 5 , 6 ). Because these symptoms overlap with other common shoulder pathologies, including rotator cuff impingement or instability, a definitive diagnosis of a Type IX tear demands a rigorous workup that incorporates a detailed clinical history, a targeted physical examination, and advanced imaging studies ( 1 , 5 , 7 ). Magnetic Resonance Imaging (MRI) and, more specifically, Magnetic Resonance Arthrography (MRA) have emerged as vital tools in delineating labral pathology, although arthroscopic evaluation remains the gold standard for the comprehensive assessment of these complex lesions ( 5 , 8 ). The heterogeneity of SLAP lesions has necessitated a nuanced evolution in treatment paradigms over the years. Historically, arthroscopic SLAP repair was the mainstay of treatment, with the primary objective of reattaching the detached labral tissue to the glenoid rim and restoring the normal anatomy of the biceps anchor ( 1 , 3 ). This approach has been particularly successful in addressing isolated Type II lesions, where the reconstitution of the superior labrum is critical for maintaining shoulder mechanics ( 3 , 9 ). However, the extensive nature of a Type IX lesion—with its pan-labral detachment and involvement of both the anterior and posterior labrum—poses substantial challenges to conventional repair techniques ( 1 , 5 ). The circumferential disengagement of the labral tissue in these cases frequently results in compromised tissue quality and a diminished potential for successful healing, thereby increasing the risk of repair failure ( 5 , 10 ). In response to these challenges, alternative surgical strategies have increasingly been explored to optimize outcomes in the management of Type IX SLAP lesions. Among these, the debate between biceps repair and biceps tenodesis has garnered significant attention in recent literature ( 3 , 9 ). The decision between employing biceps repair versus tenodesis is multifactorial and must take into account several patient-specific variables. Key determinants include patient age, activity level, quality of the labral tissue, and the presence of concomitant shoulder pathologies such as rotator cuff tears ( 3 , 11 ). In this article, we present a case series with a Type IX SLAP lesion in professional overhead athletes under 20 years old following an acute shoulder dislocation. Materials and methods This study was designed as a retrospective, consecutive, single-surgeon case series with prospectively collected data. We analyzed four patients who underwent arthroscopic treatment for type IX SLAP tears between October 2022 and May 2023. All the patients were professional players who suffered a first time acute shoulder dislocation. Indications for arthroscopic labral repair were based on a comprehensive clinical history, physical examination, and imaging findings from MRI. Two of the patients were diagnosed with SLAP IX from the MRI and confirmed intraoperatively while two others were diagnosed only intraoperatively. Patients were aged 17–19 years, with symptom duration ranging from 5 to 16 weeks. All cases were traumatic in origin. Ethical approval was obtained and informed consent was secured from all participants prior to inclusion in the study. All surgical procedures were performed under general anesthesia. Patients were positioned in the beach chair position, with the affected arm in an arm holder. The labrum was mobilized, debrided, and after preparing the bone bed with shallow decortication, the labrum was reattached using Knotless 1.8 FiberTak® soft anchor including the biceps. Anchors were placed at 7, 9, 12 (Fig. 1 ), 3, and 5 o’clock. Anterior Bankart repair was performed using three fixation points, while posterior Bankart repair utilized two fixation points. All anchors were inserted at a 45° angle, and sutures were secured with Duncan sliding knots. A final inspection of the repair was conducted before closing the portals. Postoperatively, patients were immobilized in a sling for six weeks. Following sling removal, a structured physical therapy program was initiated under the supervision of a qualified physiotherapist, adhering to a special designed rehabilitation protocol for SLAP, Bankart and reverse Bankart lesions. Clinical outcomes were assessed using two scoring systems: the American Shoulder and Elbow Surgeons Shoulder Score (ASES), and the Constant-Murley Shoulder Score (CS). Follow-up evaluations were conducted at 6 months, 1 year, and 2 years postoperatively. Results A total of four patients who underwent arthroscopic management of type IX were included in this analysis. Of these, three were male. Three of the injuries affected the dominant arm, while the other involved the non-dominant arm. All the cases were related to high-energy trauma: one was the result of a motor vehicle accident, while three other patients sustained injuries after falling during sports. All patients reported persistent shoulder pain and instability as their primary complaint. In three cases, patients described decreased range of motion. Two patients maintained full range of motion but expressed a strong fear of imminent shoulder dislocation. All four patients reported first time dislocation that required reduction under anesthesia. Time from injury to surgical intervention ranged from 5 to 16 weeks. Preoperative clinical assessments were conducted by the same orthopedic surgeon who performed the surgeries. All patients tested positive on the O’Brien’s test, Palm-Up test, as well as anterior and posterior apprehension tests, and Jerk test. However, one patient with the shortest time from the injury to the surgery, the clinical tests were not reliable due to strong apprehension of shoulder dislocation. Standard shoulder radiographs (anteroposterior and Y-view) were performed preoperatively to exclude bony abnormalities. All four patients underwent MRI and no CT scan was ordered because of very low probability for bone loss because of first time dislocation. Among the group, two cases were radiologically suspected of harboring a type IX. Final confirmation of the diagnosis and surgical planning was performed intraoperatively. Preoperative functional scores were assessed by the operating surgeon. These results are summarized in Fig. 2 . The mean preoperative scores were as follows: ASES 50 (range 42–59) and Constant Score 46 (38–53). Intraoperative findings confirmed 360° labral detachment in all four cases. All the patients exhibited a non-engaging Hill–Sachs lesion, and there was no evidence of rotator cuff pathology or HAGL lesion in any patient. Postoperative evaluations were carried out at 6, 12 and 24 months following surgery. The outcomes, presented in Table 1 and illustrated in Figs. 2 , demonstrated marked improvement in all two scoring systems across the follow-up intervals. Specifically, the mean ASES scores improved to 76.3 (63–89) at 6 months, 84.0 (71–94) at 12 months, and 88.0 (75–96) at 24 months at the same intervals. Similarly, the Constant Score rose to 70.0 (58–80), 82.5 (66–93), and 88.8 (71–98), at the same intervals. At the final follow-up, 75% (3 out of 4) of patients had returned to their pre-injury activity levels. All four patients were able to resume occupational duties. Individual patient demographics and injury characteristics are outlined in Table 1 . Functional scores improved in every case, with the exception of a slight decrease in the ASES score for patient 1 (Table 2). Discussion This study examines our case series outcomes for SLAP repair in patients with type IX lesions and compares these results with the current literature addressing the spectrum of SLAP tear management, including the emerging debate between biceps repair and tenodesis. Our case series demonstrated very good functional outcomes, as evidenced by high ASES and Constant scores, and a durable restoration of shoulder stability in a cohort where the pan-labral detachment pattern was managed with arthroscopic repair using suture anchor fixation ( 5 ). In our series the use of pan‐labral arthroscopic repair aimed at re‐establishing both the labral integrity and the stability provided by the long head of the biceps tendon (LHBT) insertion, which is well known to contribute to shoulder stability, particularly in athletes. The clinical and functional improvement observed aligns with reported outcomes in which isolated labral repairs have achieved significant improvements in patient-reported outcome measures such as the ASES and Constant scores ( 3 , 5 ). Type IX represents a distinct subgroup within the SLAP classification spectrum, characterized by a circumferential or “pan-labral” detachment that extends from the superior labrum into the anterior and posterior regions of the glenoid ( 1 , 5 ). This lesion pattern, though rare, creates a unique challenge for surgeons. Given the extensive detachment, optimal treatment must address not only the reattachment of the labrum but also the restoration of capsule-labral tension to regain proper glenohumeral stability. Our case series findings suggest that arthroscopic SLAP repair provides a viable method to achieve these goals when patient selection is careful and the repair is tailored to the pan‐labral pathology. This is consistent with earlier reports that have demonstrated good to excellent functional recovery after arthroscopic repair for complex labral tears ( 1 , 5 ). A central controversy in the management of SLAP lesions is whether to perform an anatomic repair that reattaches the labral tissue and biceps anchor or to perform a biceps tenodesis procedure. In our case series, the decision to perform SLAP repair rather than biceps tenodesis was based on patient age, activity level, and the integrity of the biceps tendon. In younger, high-demand patients with acute traumatic lesions and healthy biceps tendon quality, repair is often preferred to maintain the native anatomy, thereby preserving the dynamic stabilizing function of the LHBT ( 3 , 12 ). Although concerns have been raised about SLAP repair in terms of postoperative stiffness and inadequate return-to-sport in some series, our outcomes indicate that, with appropriate surgical technique, high functional scores and favorable return-to-activity rates can be achieved even in the context of a complex type IX tear ( 5 , 13 ). The literature indicates that SLAP repair is associated with reliable improvements in patient-reported outcomes, with several studies reporting ASES scores in the 90s and Constant scores that are comparably high postoperatively ( 3 , 13 ). In contrast, while biceps tenodesis has been shown in some systematic reviews and comparative studies to result in higher return-to-sport rates and lower reoperation rates, particularly in older populations or those with degenerative changes in the labrum, the superiority of tenodesis is less clear in younger populations with traumatic labral injuries ( 9 , 14 ). The decision framework, therefore, often hinges on patient age and tissue quality: in patients under 35 to 40 years with relatively preserved labral tissue, the preservation of the biceps-labral complex through repair appears to offer benefits in terms of maintaining shoulder stability during high-demand activities ( 11 , 13 ). It is also essential to consider the long-term implications of treatment choice. Preservation of the LHBT through SLAP repair may be associated with better joint stability over the long term, particularly in patients with high physical demands, whereas biceps tenodesis, although effective in pain relief and functional recovery, potentially alters the biomechanics of the shoulder–elbow unit ( 8 , 9 ). Longitudinal studies have indicated that the natural history of repaired SLAP lesions in the younger population is favorable, with sustained improvements in outcome scores over mid- to long-term follow-up periods ( 3 , 14 ). Nevertheless, more research is needed to determine whether these benefits persist beyond the intermediate follow-up period, particularly when compared to the outcomes of biceps tenodesis in similar patient populations. Several limitations of the study must be acknowledged. First, the retrospective nature of the analysis may introduce bias; however, this was mitigated through prospective data collection. Second, the absence of randomization may contribute to selection bias. Third, due to the rarity of this lesion, no formal sample size calculation was performed prior to the study, resulting in a relatively small patient cohort. Lastly, the cases were performed only by one surgeon but utilizing a consistent technique. In conclusion, our discussion highlights that for young, active patients with type IX, arthroscopic SLAP repair yields excellent clinical outcomes, preserves native shoulder anatomy, and restores the functional stability necessary for high-level athletic performance. Although the literature on biceps tenodesis indicates certain advantages in more degenerative cases and in older populations, our findings support the continued use of SLAP repair in the appropriate patient subset. Ultimately, the choice between these surgical strategies should be guided by individual patient factors and lesion characteristics, as well as by the surgeon’s experience and technical expertise ( 3 , 11 , 15 ). Further research with larger cohorts and long-term follow-up is essential to refine treatment algorithms and optimize outcomes for this challenging group of lesions. Table 1 Preoperative and postoperative clinical results of every patient Time Point ASES Score (0–100) Constant Score (0–100) Preoperative 50.0 (42–59) 46 (38–53) 6 months follow-up 76.3 (63–89) 70.0 (58–80) 12 months follow-up 84.0 (71–94) 82.5 (66–93) 24 months follow-up 88.0 (75–96) 88.8 (71–98) Declarations Ethics approval and consent to participate: Ethics approval was obtained from the institutional review board, and written informed consent was obtained from all participants. Consent for publication: All patients provided consent for publication of anonymized data and images. Funding: The authors received no funding for this study. Author Contribution KG conceived and designed the study, performed surgeries, and drafted the manuscript. KDH contributed to imaging evaluation. AL, FD, HS, and ET contributed to data collection, analysis, and manuscript revision. All authors read and approved the final manuscript. Acknowledgement The authors thank the clinical and physiotherapy teams for their support. Data Availability The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. References Van Blarcum GS, Svoboda SJ. Glenohumeral instability related to special conditions: SLAP tears, pan-labral tears, and multidirectional instability. Sports Med Arthrosc Rev. 2017;25(3):e12–e17. Elser F, Braun S, Dewing CB, Giphart JE, Millett PJ. Anatomy, function, injuries, and treatment of the long head of the biceps brachii tendon. Arthroscopy. 2011;27(4):581–92. Ek ET, Shi LL, Tompson JD, Freehill MT, Warner JJ. Surgical treatment of isolated type II superior labrum anterior-posterior (SLAP) lesions: repair versus biceps tenodesis. J Shoulder Elbow Surg. 2014;23(7):1059–65. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthroscopy. 1990;6(4):274–9. Amorim E, Maganinho P, Rodrigues-Gomes D, Rodrigues-Gomes S, Sevivas N. Type IX superior labrum anterior and posterior lesion in a professional football player: A rare pattern of shoulder instability in a non-throwing athlete. Cureus. 2023;15(2):e34722. Morse KW, Eno JJ, Altchek DW, Dines JS. Injuries of the biceps and superior labral complex in overhead athletes. Curr Rev Musculoskelet Med. 2019;12:72–9. Eckers F, Loske S, Ek ET, Müller AM. Current understanding and new advances in the surgical management of reparable rotator cuff tears: A scoping review. J Clin Med. 2023;12(5):1713. Knesek M, Skendzel JG, Dines JS, Altchek DW, Allen AA, Bedi A. Diagnosis and management of superior labral anterior posterior tears in throwing athletes. Am J Sports Med. 2013;41(2):444–60. Civan O, Bilsel K, Kapicioglu M, Ozenci AM. Repair versus biceps tenodesis for the SLAP tears: A systematic review. J Orthop Surg (Hong Kong). 2021;29(2):23094990211004794. Ranieri R, Nabergoj M, Xu L, Coz PL, Mohd Don AF, Lädermann A, et al. Complications of long head of the biceps tenotomy in association with arthroscopic rotator cuff repair: Risk factors and influence on outcomes. J Clin Med. 2022;11(19):5657. Johannsen AM, Costouros JG. A treatment-based algorithm for the management of type-II SLAP tears. Open Orthop J. 2018;12:282–8. Denard PJ, Lädermann A, Parsley BK, Burkhart SS. Arthroscopic biceps tenodesis compared with repair of isolated type II SLAP lesions in patients older than 35 years. Orthopedics. 2014;37(3):e292–7. Lacheta L, Horan MP, Nolte PC, Goldenberg BT, Dekker TJ, Millett PJ. SLAP repair versus subpectoral biceps tenodesis for isolated SLAP type 2 lesions in overhead athletes younger than 35 years: Comparison of minimum 2-year outcomes. Orthop J Sports Med. 2022;10(6):23259671221105239. Familiari F, Huri G, Simonetta R, McFarland EG. SLAP lesions: current controversies. EFORT Open Rev. 2019;4(1):25–32. Sandler AB, Scanaliato JP, Baird MD, Dunn JC, Parnes N. Lower reoperation and higher return-to-sport rates after biceps tenodesis versus SLAP repair in young patients: A systematic review. Arthrosc Sports Med Rehabil. 2022;4(5):e1887–95. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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1","display":"","copyAsset":false,"role":"figure","size":1099230,"visible":true,"origin":"","legend":"\u003cp\u003eSuperior and anterior anchor placement\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7592366/v1/5a478106e50a9b03a7842e4b.png"},{"id":93569941,"identity":"3d3f23e7-eaa9-4783-aebd-bfae98416315","added_by":"auto","created_at":"2025-10-15 08:55:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":149759,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative and postoperative clinical results for every patient\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7592366/v1/fcb65970411094114a0c7e2e.png"},{"id":98203274,"identity":"2df67745-5db4-428a-b6af-bd127cdd8d40","added_by":"auto","created_at":"2025-12-15 08:10:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1757380,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7592366/v1/5f8108a7-0252-4528-af4b-fbf5481de24e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Biceps Anchor Repair for SLAP Type IX Tears in Patients Under 20 Years Old","fulltext":[{"header":"Introduction","content":"\u003cp\u003eShoulder injuries represent a significant clinical challenge due to the intrinsic complexity of the glenohumeral joint\u0026rsquo;s anatomy and the high functional demands placed upon it during daily activities and athletic performance (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Among these injuries, lesions of the superior labrum\u0026mdash;involving the fibrocartilaginous rim that deepens the glenoid fossa and serves as the attachment site for the long head of the biceps tendon (LHBT)\u0026mdash;have attracted considerable attention over recent decades (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The superior labrum plays a dual role in providing both static and dynamic stability to the shoulder, and its disruption can impair load transmission and alter joint kinematics (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Within this context, Superior Labrum Anterior to Posterior (SLAP) tears stand out due to the diagnostic uncertainties they evoke and the technical challenges they present in management (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). While the original classification system proposed by Snyder et al. encompassed four distinct types of SLAP lesions, further clinical experience and arthroscopic observations have led to the identification of up to ten subtypes that capture a broader spectrum of pathology (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe Type IX SLAP (Type IX) lesion is one of the less frequently encountered variants within this expanded classification. Described as a pan-labral injury, Type IX lesions are characterized by a circumferential detachment that involves the superior labrum in its entirety, extending not only to the region of the biceps anchor but also encompassing both the anterior and posterior labral segments (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). While SLAP lesions are commonly associated with repetitive microtrauma in overhead athletes, several reports now indicate that Type IX lesions, given their unique circumferential pattern, are more frequently encountered following acute traumatic events, such as anterior dislocations induced by forced abduction and external rotation (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eClinically, patients with Type IX SLAP tears tend to present with a constellation of nonspecific symptoms\u0026mdash;a chronic, sometimes vague shoulder pain often accompanied by sensations of instability, mechanical clicking or locking, and decreased overall function (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Because these symptoms overlap with other common shoulder pathologies, including rotator cuff impingement or instability, a definitive diagnosis of a Type IX tear demands a rigorous workup that incorporates a detailed clinical history, a targeted physical examination, and advanced imaging studies (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Magnetic Resonance Imaging (MRI) and, more specifically, Magnetic Resonance Arthrography (MRA) have emerged as vital tools in delineating labral pathology, although arthroscopic evaluation remains the gold standard for the comprehensive assessment of these complex lesions (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe heterogeneity of SLAP lesions has necessitated a nuanced evolution in treatment paradigms over the years. Historically, arthroscopic SLAP repair was the mainstay of treatment, with the primary objective of reattaching the detached labral tissue to the glenoid rim and restoring the normal anatomy of the biceps anchor (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). This approach has been particularly successful in addressing isolated Type II lesions, where the reconstitution of the superior labrum is critical for maintaining shoulder mechanics (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). However, the extensive nature of a Type IX lesion\u0026mdash;with its pan-labral detachment and involvement of both the anterior and posterior labrum\u0026mdash;poses substantial challenges to conventional repair techniques (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The circumferential disengagement of the labral tissue in these cases frequently results in compromised tissue quality and a diminished potential for successful healing, thereby increasing the risk of repair failure (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn response to these challenges, alternative surgical strategies have increasingly been explored to optimize outcomes in the management of Type IX SLAP lesions. Among these, the debate between biceps repair and biceps tenodesis has garnered significant attention in recent literature (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The decision between employing biceps repair versus tenodesis is multifactorial and must take into account several patient-specific variables. Key determinants include patient age, activity level, quality of the labral tissue, and the presence of concomitant shoulder pathologies such as rotator cuff tears (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn this article, we present a case series with a Type IX SLAP lesion in professional overhead athletes under 20 years old following an acute shoulder dislocation.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThis study was designed as a retrospective, consecutive, single-surgeon case series with prospectively collected data. We analyzed four patients who underwent arthroscopic treatment for type IX SLAP tears between October 2022 and May 2023. All the patients were professional players who suffered a first time acute shoulder dislocation. Indications for arthroscopic labral repair were based on a comprehensive clinical history, physical examination, and imaging findings from MRI. Two of the patients were diagnosed with SLAP IX from the MRI and confirmed intraoperatively while two others were diagnosed only intraoperatively.\u003c/p\u003e\u003cp\u003ePatients were aged 17\u0026ndash;19 years, with symptom duration ranging from 5 to 16 weeks. All cases were traumatic in origin. Ethical approval was obtained and informed consent was secured from all participants prior to inclusion in the study.\u003c/p\u003e\u003cp\u003eAll surgical procedures were performed under general anesthesia. Patients were positioned in the beach chair position, with the affected arm in an arm holder. The labrum was mobilized, debrided, and after preparing the bone bed with shallow decortication, the labrum was reattached using Knotless 1.8 FiberTak\u0026reg; soft anchor including the biceps. Anchors were placed at 7, 9, 12 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), 3, and 5 o\u0026rsquo;clock. Anterior Bankart repair was performed using three fixation points, while posterior Bankart repair utilized two fixation points. All anchors were inserted at a 45\u0026deg; angle, and sutures were secured with Duncan sliding knots. A final inspection of the repair was conducted before closing the portals.\u003c/p\u003e\u003cp\u003ePostoperatively, patients were immobilized in a sling for six weeks. Following sling removal, a structured physical therapy program was initiated under the supervision of a qualified physiotherapist, adhering to a special designed rehabilitation protocol for SLAP, Bankart and reverse Bankart lesions.\u003c/p\u003e\u003cp\u003eClinical outcomes were assessed using two scoring systems: the American Shoulder and Elbow Surgeons Shoulder Score (ASES), and the Constant-Murley Shoulder Score (CS). Follow-up evaluations were conducted at 6 months, 1 year, and 2 years postoperatively.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of four patients who underwent arthroscopic management of type IX were included in this analysis. Of these, three were male. Three of the injuries affected the dominant arm, while the other involved the non-dominant arm. All the cases were related to high-energy trauma: one was the result of a motor vehicle accident, while three other patients sustained injuries after falling during sports.\u003c/p\u003e\u003cp\u003eAll patients reported persistent shoulder pain and instability as their primary complaint. In three cases, patients described decreased range of motion. Two patients maintained full range of motion but expressed a strong fear of imminent shoulder dislocation. All four patients reported first time dislocation that required reduction under anesthesia. Time from injury to surgical intervention ranged from 5 to 16 weeks.\u003c/p\u003e\u003cp\u003ePreoperative clinical assessments were conducted by the same orthopedic surgeon who performed the surgeries. All patients tested positive on the O\u0026rsquo;Brien\u0026rsquo;s test, Palm-Up test, as well as anterior and posterior apprehension tests, and Jerk test. However, one patient with the shortest time from the injury to the surgery, the clinical tests were not reliable due to strong apprehension of shoulder dislocation.\u003c/p\u003e\u003cp\u003eStandard shoulder radiographs (anteroposterior and Y-view) were performed preoperatively to exclude bony abnormalities. All four patients underwent MRI and no CT scan was ordered because of very low probability for bone loss because of first time dislocation. Among the group, two cases were radiologically suspected of harboring a type IX. Final confirmation of the diagnosis and surgical planning was performed intraoperatively.\u003c/p\u003e\u003cp\u003ePreoperative functional scores were assessed by the operating surgeon. These results are summarized in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The mean preoperative scores were as follows: ASES 50 (range 42\u0026ndash;59) and Constant Score 46 (38\u0026ndash;53).\u003c/p\u003e\u003cp\u003eIntraoperative findings confirmed 360\u0026deg; labral detachment in all four cases. All the patients exhibited a non-engaging Hill\u0026ndash;Sachs lesion, and there was no evidence of rotator cuff pathology or HAGL lesion in any patient.\u003c/p\u003e\u003cp\u003ePostoperative evaluations were carried out at 6, 12 and 24 months following surgery. The outcomes, presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and illustrated in Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, demonstrated marked improvement in all two scoring systems across the follow-up intervals. Specifically, the mean ASES scores improved to 76.3 (63\u0026ndash;89) at 6 months, 84.0 (71\u0026ndash;94) at 12 months, and 88.0 (75\u0026ndash;96) at 24 months at the same intervals. Similarly, the Constant Score rose to 70.0 (58\u0026ndash;80), 82.5 (66\u0026ndash;93), and 88.8 (71\u0026ndash;98), at the same intervals.\u003c/p\u003e\u003cp\u003eAt the final follow-up, 75% (3 out of 4) of patients had returned to their pre-injury activity levels. All four patients were able to resume occupational duties. Individual patient demographics and injury characteristics are outlined in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Functional scores improved in every case, with the exception of a slight decrease in the ASES score for patient 1 (Table\u0026nbsp;2).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examines our case series outcomes for SLAP repair in patients with type IX lesions and compares these results with the current literature addressing the spectrum of SLAP tear management, including the emerging debate between biceps repair and tenodesis. Our case series demonstrated very good functional outcomes, as evidenced by high ASES and Constant scores, and a durable restoration of shoulder stability in a cohort where the pan-labral detachment pattern was managed with arthroscopic repair using suture anchor fixation (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In our series the use of pan‐labral arthroscopic repair aimed at re‐establishing both the labral integrity and the stability provided by the long head of the biceps tendon (LHBT) insertion, which is well known to contribute to shoulder stability, particularly in athletes. The clinical and functional improvement observed aligns with reported outcomes in which isolated labral repairs have achieved significant improvements in patient-reported outcome measures such as the ASES and Constant scores (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eType IX represents a distinct subgroup within the SLAP classification spectrum, characterized by a circumferential or \u0026ldquo;pan-labral\u0026rdquo; detachment that extends from the superior labrum into the anterior and posterior regions of the glenoid (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). This lesion pattern, though rare, creates a unique challenge for surgeons. Given the extensive detachment, optimal treatment must address not only the reattachment of the labrum but also the restoration of capsule-labral tension to regain proper glenohumeral stability. Our case series findings suggest that arthroscopic SLAP repair provides a viable method to achieve these goals when patient selection is careful and the repair is tailored to the pan‐labral pathology. This is consistent with earlier reports that have demonstrated good to excellent functional recovery after arthroscopic repair for complex labral tears (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA central controversy in the management of SLAP lesions is whether to perform an anatomic repair that reattaches the labral tissue and biceps anchor or to perform a biceps tenodesis procedure. In our case series, the decision to perform SLAP repair rather than biceps tenodesis was based on patient age, activity level, and the integrity of the biceps tendon. In younger, high-demand patients with acute traumatic lesions and healthy biceps tendon quality, repair is often preferred to maintain the native anatomy, thereby preserving the dynamic stabilizing function of the LHBT (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Although concerns have been raised about SLAP repair in terms of postoperative stiffness and inadequate return-to-sport in some series, our outcomes indicate that, with appropriate surgical technique, high functional scores and favorable return-to-activity rates can be achieved even in the context of a complex type IX tear (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe literature indicates that SLAP repair is associated with reliable improvements in patient-reported outcomes, with several studies reporting ASES scores in the 90s and Constant scores that are comparably high postoperatively (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In contrast, while biceps tenodesis has been shown in some systematic reviews and comparative studies to result in higher return-to-sport rates and lower reoperation rates, particularly in older populations or those with degenerative changes in the labrum, the superiority of tenodesis is less clear in younger populations with traumatic labral injuries (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The decision framework, therefore, often hinges on patient age and tissue quality: in patients under 35 to 40 years with relatively preserved labral tissue, the preservation of the biceps-labral complex through repair appears to offer benefits in terms of maintaining shoulder stability during high-demand activities (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIt is also essential to consider the long-term implications of treatment choice. Preservation of the LHBT through SLAP repair may be associated with better joint stability over the long term, particularly in patients with high physical demands, whereas biceps tenodesis, although effective in pain relief and functional recovery, potentially alters the biomechanics of the shoulder\u0026ndash;elbow unit (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Longitudinal studies have indicated that the natural history of repaired SLAP lesions in the younger population is favorable, with sustained improvements in outcome scores over mid- to long-term follow-up periods (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Nevertheless, more research is needed to determine whether these benefits persist beyond the intermediate follow-up period, particularly when compared to the outcomes of biceps tenodesis in similar patient populations.\u003c/p\u003e\u003cp\u003eSeveral limitations of the study must be acknowledged. First, the retrospective nature of the analysis may introduce bias; however, this was mitigated through prospective data collection. Second, the absence of randomization may contribute to selection bias. Third, due to the rarity of this lesion, no formal sample size calculation was performed prior to the study, resulting in a relatively small patient cohort. Lastly, the cases were performed only by one surgeon but utilizing a consistent technique.\u003c/p\u003e\u003cp\u003eIn conclusion, our discussion highlights that for young, active patients with type IX, arthroscopic SLAP repair yields excellent clinical outcomes, preserves native shoulder anatomy, and restores the functional stability necessary for high-level athletic performance. Although the literature on biceps tenodesis indicates certain advantages in more degenerative cases and in older populations, our findings support the continued use of SLAP repair in the appropriate patient subset. Ultimately, the choice between these surgical strategies should be guided by individual patient factors and lesion characteristics, as well as by the surgeon\u0026rsquo;s experience and technical expertise (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Further research with larger cohorts and long-term follow-up is essential to refine treatment algorithms and optimize outcomes for this challenging group of lesions.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePreoperative and postoperative clinical results of every patient\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime Point\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eASES Score (0\u0026ndash;100)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eConstant Score (0\u0026ndash;100)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50.0 (42\u0026ndash;59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46 (38\u0026ndash;53)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6 months follow-up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e76.3 (63\u0026ndash;89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70.0 (58\u0026ndash;80)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12 months follow-up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e84.0 (71\u0026ndash;94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82.5 (66\u0026ndash;93)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24 months follow-up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e88.0 (75\u0026ndash;96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88.8 (71\u0026ndash;98)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003cp\u003e Ethics approval was obtained from the institutional review board, and written informed consent was obtained from all participants.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003cp\u003e All patients provided consent for publication of anonymized data and images.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eThe authors received no funding for this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eKG conceived and designed the study, performed surgeries, and drafted the manuscript. KDH contributed to imaging evaluation. AL, FD, HS, and ET contributed to data collection, analysis, and manuscript revision. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors thank the clinical and physiotherapy teams for their support.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eVan Blarcum GS, Svoboda SJ. Glenohumeral instability related to special conditions: SLAP tears, pan-labral tears, and multidirectional instability. Sports Med Arthrosc Rev. 2017;25(3):e12\u0026ndash;e17.\u003c/li\u003e\n\u003cli\u003eElser F, Braun S, Dewing CB, Giphart JE, Millett PJ. Anatomy, function, injuries, and treatment of the long head of the biceps brachii tendon. Arthroscopy. 2011;27(4):581\u0026ndash;92.\u003c/li\u003e\n\u003cli\u003eEk ET, Shi LL, Tompson JD, Freehill MT, Warner JJ. Surgical treatment of isolated type II superior labrum anterior-posterior (SLAP) lesions: repair versus biceps tenodesis. J Shoulder Elbow Surg. 2014;23(7):1059\u0026ndash;65.\u003c/li\u003e\n\u003cli\u003eSnyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthroscopy. 1990;6(4):274\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eAmorim E, Maganinho P, Rodrigues-Gomes D, Rodrigues-Gomes S, Sevivas N. Type IX superior labrum anterior and posterior lesion in a professional football player: A rare pattern of shoulder instability in a non-throwing athlete. Cureus. 2023;15(2):e34722.\u003c/li\u003e\n\u003cli\u003eMorse KW, Eno JJ, Altchek DW, Dines JS. Injuries of the biceps and superior labral complex in overhead athletes. Curr Rev Musculoskelet Med. 2019;12:72\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eEckers F, Loske S, Ek ET, M\u0026uuml;ller AM. Current understanding and new advances in the surgical management of reparable rotator cuff tears: A scoping review. J Clin Med. 2023;12(5):1713.\u003c/li\u003e\n\u003cli\u003eKnesek M, Skendzel JG, Dines JS, Altchek DW, Allen AA, Bedi A. Diagnosis and management of superior labral anterior posterior tears in throwing athletes. Am J Sports Med. 2013;41(2):444\u0026ndash;60.\u003c/li\u003e\n\u003cli\u003eCivan O, Bilsel K, Kapicioglu M, Ozenci AM. Repair versus biceps tenodesis for the SLAP tears: A systematic review. J Orthop Surg (Hong Kong). 2021;29(2):23094990211004794.\u003c/li\u003e\n\u003cli\u003eRanieri R, Nabergoj M, Xu L, Coz PL, Mohd Don AF, L\u0026auml;dermann A, et al. Complications of long head of the biceps tenotomy in association with arthroscopic rotator cuff repair: Risk factors and influence on outcomes. J Clin Med. 2022;11(19):5657.\u003c/li\u003e\n\u003cli\u003eJohannsen AM, Costouros JG. A treatment-based algorithm for the management of type-II SLAP tears. Open Orthop J. 2018;12:282\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eDenard PJ, L\u0026auml;dermann A, Parsley BK, Burkhart SS. Arthroscopic biceps tenodesis compared with repair of isolated type II SLAP lesions in patients older than 35 years. Orthopedics. 2014;37(3):e292\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eLacheta L, Horan MP, Nolte PC, Goldenberg BT, Dekker TJ, Millett PJ. SLAP repair versus subpectoral biceps tenodesis for isolated SLAP type 2 lesions in overhead athletes younger than 35 years: Comparison of minimum 2-year outcomes. Orthop J Sports Med. 2022;10(6):23259671221105239.\u003c/li\u003e\n\u003cli\u003eFamiliari F, Huri G, Simonetta R, McFarland EG. SLAP lesions: current controversies. EFORT Open Rev. 2019;4(1):25\u0026ndash;32.\u003c/li\u003e\n\u003cli\u003eSandler AB, Scanaliato JP, Baird MD, Dunn JC, Parnes N. Lower reoperation and higher return-to-sport rates after biceps tenodesis versus SLAP repair in young patients: A systematic review. Arthrosc Sports Med Rehabil. 2022;4(5):e1887\u0026ndash;95.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Type IX SLAP lesions, Biceps tenodesis, Bankart repair","lastPublishedDoi":"10.21203/rs.3.rs-7592366/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7592366/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eAnterior shoulder instability is the most frequent type of glenohumeral instability which poses diagnostic and surgical challenges, particularly in young, active patients. Type IX Superior Labrum Anterior to Posterior (SLAP) lesions represent a rare and complex subset of shoulder injuries that involves 360\u0026deg; of the glenohumeral labrum.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eIn our retrospective case series study, we evaluated four professional athletes aged 17\u0026ndash;19 who sustained first-time traumatic shoulder dislocations and were diagnosed with Type IX SLAP lesions. Arthroscopic labral repair was performed by a single surgeon on all patients. Diagnosis was confirmed intraoperatively, with two cases identified preoperatively with MRI. Patients were evaluated postoperatively at 6, 12, and 24 months using the American Shoulder and Elbow Surgeons (ASES) and Constant-Murley (CS) scores.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAll patients reported improvement in shoulder function and stability post-surgery. Mean ASES scores improved from 50 preoperatively to 88 at 24 months, and Constant Scores rose from 46 to 88.8. Three of four patients returned to pre-injury levels of athletic performance, with all resuming full occupational duties. No complications or re-injuries were reported.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eArthroscopic SLAP repair provides an effective treatment for Type IX lesions in young athletes, preserving the native anatomy and supporting full functional recovery. While biceps tenodesis may be considered in older or degenerative cases, SLAP repair remains the preferred option in this patient population. Further studies with larger cohorts are warranted to validate these findings and guide long-term management.\u003c/p\u003e","manuscriptTitle":"Biceps Anchor Repair for SLAP Type IX Tears in Patients Under 20 Years Old","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-15 08:54:09","doi":"10.21203/rs.3.rs-7592366/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"953a5ffa-3060-459f-b1f4-7167168f37f0","owner":[],"postedDate":"October 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-15T08:09:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-15 08:54:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7592366","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7592366","identity":"rs-7592366","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}