Abstract
Purpose
Long-head biceps tenodesis has been suggested as an alternative to superior labral anterior–posterior (SLAP) repair. However, an unrepaired superior labral tear may increase glenohumeral translation, and thus, labral repair may be considered in the setting of biceps tenodesis.
Methods
Patients who underwent tenodesis, SLAP repair, or combined tenodesis and labral repair for SLAP tears were included. The indication for combined tenodesis and labral repair was biceps tendonitis in the setting of a SLAP lesion with labral instability. Demographics, range of motion, return to work, return to sport, American Shoulder and Elbow Surgeons (ASES) scores, and visual analogue pain scale (VAS) scores were recorded.
Results
Eighty-six patients were included: 18 underwent combined tenodesis and labral repair, 45 underwent SLAP repair alone, and 23 underwent tenodesis alone. There were no significant differences in rates of return to pre-operative level of play (n.s.) or return to full duties at work (n.s.). These groups differed significantly in ASES scores (p = 0.015) and VAS scores (p = 0.019) with combined tenodesis and labral repair patients having lower scores than patients undergoing either tenodesis or SLAP repair alone. A subgroup analysis of patients who did not have Worker’s Compensation claims demonstrated similar results with significant differences in ASES scores, which were lowest among the combined tenodesis and labral repair cohort (p = 0.045).
Conclusions
High-demand patients with biceps tendonitis in the setting of a SLAP lesion with labral instability who undergo combined tenodesis and SLAP repair have significantly worse outcomes than patients who undergo either isolated labral repair for type II SLAP tears or isolated biceps tenodesis for a SLAP tear and biceps tendonitis.
Level of evidence
Treatment, Level III.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Alpantaki K (2005) Sympathetic and sensory neural elements in the tendon of the long head of the biceps. J Bone Joint Surg Am 87:1580–1583
Andrews JR, Carson WG, McLeod WD (1985) Glenoid labrum tears related to the long head of the biceps. Am J Sports Med 13:337–341
Bankart AS (1923) Recurrent or habitual dislocation of the shoulder-joint. Br Med J 2:1132–1133
Boileau P, Parratte S, Chuinard C, Roussanne Y, Shia D, Bicknell R (2009) Arthroscopic treatment of isolated type II SLAP lesions: biceps tenodesis as an alternative to reinsertion. Am J Sports Med 37:929–936
Chalmers PN, Trombley R, Cip J, Monson B, Forsythe B, Nicholson GP, Bush-Joseph CA, Cole BJ, Wimmer MA, Romeo AA, Verma NN (2014) Postoperative restoration of upper extremity motion and neuromuscular control during the overhand pitch: evaluation of tenodesis and repair for superior labral anterior-posterior tears. Am J Sports Med 42:2825–2836
Cohen DB, Coleman S, Drakos MC, Allen AA, O’Brien SJ, Altchek DW, Warren RF (2006) Outcomes of isolated type II SLAP lesions treated with arthroscopic fixation using a bioabsorbable tack. Arthroscopy 22:136–142
Denard PJ, Lädermann A, Parsley BK, Burkhart SS (2014) Arthroscopic biceps tenodesis compared with repair of isolated type II SLAP lesions in patients older than 35 years. Orthopedics 37:e292–e297
Edwards SL, Lee JA, Bell J-E, Packer JD, Ahmad CS, Levine WN, Bigliani LU, Blaine TA (2010) Nonoperative treatment of superior labrum anterior posterior tears: improvements in pain, function, and quality of life. Am J Sports Med 38:1456–1461
Ek ETH, Shi LL, Tompson JD, Freehill MT, Warner JJP (2014) Surgical treatment of isolated type II superior labrum anterior-posterior (SLAP) lesions: repair versus biceps tenodesis. J Shoulder Elbow Surg 23:1059–1065
Gorantla K, Gill C, Wright RW (2010) The outcome of type II SLAP repair: a systematic review. Arthroscopy 26:537–545
Gupta AK, Bruce B, Klosterman EL, McCormick F, Harris J, Romeo AA (2013) Subpectoral biceps tenodesis for failed type II SLAP repair. Orthopedics 36:e723–e728
Kim TK, Queale WS, Cosgarea AJ, McFarland EG (2003) Clinical features of the different types of SLAP lesions: an analysis of one hundred and thirty-nine cases. J Bone Joint Surg Am 85-A:66–71
Lazarus MD, Sidles JA, Harryman DT, Matsen FA (1996) Effect of a chondral-labral defect on glenoid concavity and glenohumeral stability: a cadaveric model. J Bone Joint Surg Am 78:94–102
Mazzocca AD, Cote MP, Arciero CL, Romeo AA, Arciero RA (2008) Clinical outcomes after subpectoral biceps tenodesis with an interference screw. Am J Sports Med 36:1922–1929
Mazzocca AD, Rios CG, Romeo AA, Arciero RA (2005) Subpectoral biceps tenodesis with interference screw fixation. Arthroscopy 21:896
Morgan CD, Burkhart SS, Palmeri M, Gillespie M (1998) Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears. Arthroscopy 14:553–565
Patzer T, Habermeyer P, Hurschler C, Bobrowitsch E, Wellmann M, Kircher J, Schofer MD (2012) The influence of superior labrum anterior to posterior (SLAP) repair on restoring baseline glenohumeral translation and increased biceps loading after simulated SLAP tear and the effectiveness of SLAP repair after long head of biceps tenotomy. J Shoulder Elbow Surg 21:1580–1587
Snyder SJ, Banas MP, Karzel RP (1995) An analysis of 140 injuries to the superior glenoid labrum. J Shoulder Elbow Surg 4:243–248
Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ (1990) SLAP lesions of the shoulder. Arthroscopy 6:274–279
Strauss EJ, Salata MJ, Sershon RA, Garbis N, Provencher MT, Wang VM, McGill KC, Bush-Joseph CA, Nicholson GP, Cole BJ, Romeo AA, Verma NN (2014) Role of the superior labrum after biceps tenodesis in glenohumeral stability. J Shoulder Elbow Surg 23:485–491
Verma NN, Garretson R, Romeo AA (2007) Outcome of arthroscopic repair of type II SLAP lesions in worker’s compensation patients. HSS J 3:58–62
Yung PS-H, Fong DT-P, Kong M-F, Lo C-K, Fung K-Y, Ho EP-Y, Chan DK-C, Chan K-M (2008) Arthroscopic repair of isolated type II superior labrum anterior–posterior lesion. Knee Surg Sports Traumatol Arthrosc 16:1151–1157
Funding
No funding was received for this study.
Author information
Authors and Affiliations
Corresponding author
Additional information
This study has been approved under Rush University Medical Center Institutional Review Board protocol # 11050602.
The work for this manuscript was performed at Rush University Medical Center in Chicago, IL, USA.
Rights and permissions
About this article
Cite this article
Chalmers, P.N., Monson, B., Frank, R.M. et al. Combined SLAP repair and biceps tenodesis for superior labral anterior–posterior tears. Knee Surg Sports Traumatol Arthrosc 24, 3870–3876 (2016). https://doi.org/10.1007/s00167-015-3774-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-015-3774-6