Shoulder
Surgical treatment of isolated type II superior labrum anterior-posterior (SLAP) lesions: repair versus biceps tenodesis

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Background

It is still unclear which patients with isolated type II superior labrum anterior-posterior (SLAP) lesions benefit from either superior labral repair or biceps tenodesis. This study evaluates the indications and outcomes of patients with isolated type II SLAP lesions who have undergone either procedure.

Methods

A retrospective analysis was performed of patients who had surgery for an isolated type II SLAP lesion between 2008 and 2011. There were 25 patients: 15 underwent biceps tenodesis, with a mean follow-up of 31 months (range, 26-43 months), and 10 underwent SLAP repair, with a mean follow-up of 35 months (range, 25-52 months). The mean age was 47 years (range, 30-59 years) in the tenodesis group and 31 years (range, 21-43 years) in the repair group.

Results

At latest follow-up, both groups showed significant improvements in subjective shoulder value and pain score. No difference was observed in American Shoulder and Elbow Surgeons score (93.0 vs 93.5, P = .45), patient satisfaction (93% vs 90%, P = .45), or return to preinjury sporting level (73% vs 60%, P = .66). Analysis of the indications for treatment showed that in the large majority, tenodesis was performed in older patients (>35 years) and patients who showed degenerative or frayed labrums whereas SLAP repairs were performed in younger and more active patients with healthy-appearing labral tissue. There was only 1 failure in the tenodesis group, and in the SLAP repair group, there were 2 cases of postoperative stiffness; all were treated nonoperatively.

Conclusion

In this study, we show that both biceps tenodesis and SLAP repair can provide good to excellent results if performed in appropriately selected patients with isolated type II SLAP lesions.

Section snippets

Patient selection

A retrospective analysis was performed of all patients who had undergone a superior labral repair or biceps tenodesis for an isolated type II SLAP lesion by the senior author (J.J.P.W.) between January 2008 and March 2011. Patients were included in the study if they showed both clinical and radiologic evidence of an isolated type II SLAP lesion. Patients with other types of SLAP lesions, such as types I, III, and IV, were excluded from the study. In addition, patients who had a concomitant

Characteristics of superior labral repair and biceps tenodesis groups

In the biceps tenodesis group, 13 patients (87%) had clear intraoperative evidence of degenerative superior labrums. In the remaining 2 patients, the superior labrum appeared to be of reasonable quality and tenodesis was performed based on the patients’ ages (56 years and 59 years). Of the 15 patients, 13 (93%) were aged older than 35 years. Concomitant subacromial decompression was performed in 11 patients (73%), and 1 patient had a distal clavicle excision.

All patients in the labral repair

Discussion

In this study, we hypothesized that both superior labral repair and biceps tenodesis could provide significant improvements in functional outcome, pain, and overall satisfaction if performed in appropriately selected patients. It has been the senior author’s preference to perform arthroscopic SLAP repairs for patients who were generally younger (<35 years) and/or those in whom healthy labral tissue was found at the time of arthroscopy. In contrast, for patients who were generally older (>35

Conclusions

In this study, we have shown that both superior labral repair and biceps tenodesis can provide good to excellent results with high patient satisfaction if performed in appropriately selected patients. Hence, we believe that each patient must be considered individually when one is deciding the appropriate form of management. It is our current treatment algorithm that in younger patients (<35 years) who are active and/or show healthy-looking labral tissue at the time of arthroscopy, SLAP repair

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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      Citation Excerpt :

      However, less consistent functional outcomes have been reported in overhead throwing athletes, with only 22% to 75% of athletes returning to preinjury level of sport participation(Fedoriw et al., 2014; Lorentz et al., 2022; Smith et al., 2016). In contrast, treating type II SLAP tears in overhead throwing athletes with arthroscopic biceps tenodesis using an interference screw fixation has yielded improved clinical outcomes, with return rates to preinjury level of sport participation exceeding 80% in prior studies (Chalmers et al., 2014; Ek et al., 2014). These superior outcomes of arthroscopic biceps tenodesis in terms of pain and function, when compared to arthroscopic SLAP repair, have been associated with the absence of traction in the superior glenoid labrum-biceps complex following the surgical transfer of the long head of the biceps brachii from its anatomical position at the superior glenoid to the bicipital groove of the humerus (Boileau et al., 2009; Strauss et al., 2014).

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    The Partners Healthcare Institutional Review Board has reviewed and approved this study (IRB No. 2012P000567).

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