Superior Labrum Anterior and Posterior (SLAP) lesions are defined as tears of the superior glenoid labrum and the origin of the long head of the biceps tendon. It is a common entity, especially in (overhead) athletes, and may lead to shoulder pain and impaired shoulder function. The diagnosis and treatment of SLAP lesions are still demanding. In most cases, the primary treatment is non-operatively including activity modification, avoidance of overhead tasks, physical therapy, nonsteroidal anti-inflammatory drugs, and injections. If conservative treatment fails, an arthroscopic repair of symptomatic SLAP lesions (SLAP repair) is indicated particularly for young athletes or an arthroscopic biceps tenodesis or tenotomy for older patients. However, the results of SLAP repairs in overhead athletes are limited with a low rate of patients who will regain their pre-injury level of performance. SLAP repairs in middle-aged and older patients showed worse results and higher revision rates as compared to younger patients. For those patients, tenotomy or tenodesis of the biceps tendon are often favored alternatives to SLAP repairs in order to improve postoperative results. This chapter presents relevant epidemiologic and aetiologic data, describes specific anatomical and biomechanical facts, and explains the diagnosis and classification of SLAP lesions. The authors show non-operative and surgical treatment options and present a treatment algorithm for SLAP lesions based upon the recent literature as well as the authors’ clinical experience. The type of lesion, age of patient, concomitant lesions, functional requirements, as well as sport activity level of the patient, need to be considered. In order to achieve good results and avoid overtreatment, physiological variations (Buford complex, sublabral hole) and stable degenerative changes of the SLAP complex (Type I SLAP lesions) have to be differentiated from “true” SLAP lesions. Following treatment algorithm is recommended by the authors: Type I: Conservative treatment or arthroscopic debridement, Type II: SLAP repairSLAP repair or Biceps tenotomy/tenodesis, Type III: Resection, Type IV: SLAP repair (Biceps tenotomy/tenodesis if >50% of biceps tendon is affected), Type V: Bankart-repair and SLAP repair, Type VI: Resection, Type VII: Refixation of the anterosuperior labrum and SLAP repair.