Incidence and Return to Play After Biceps Tenodesis in Professional Baseball Players

Published:November 13, 2017DOI:


      To determine return to play (RTP) rates after biceps tenodesis (BT) in professional baseball players.


      Major League Baseball has maintained a prospective database containing all major and minor league baseball players who have undergone shoulder surgery since 2010. All players who had undergone BT were included. Minimum follow-up was 24 months, and thus we included data from 2010 to 2013. Using this database we determined the incidence, demographics, prior surgery history, concomitant procedures, RTP rates, and time to RTP.


      Between 2010 and 2013, 17 professional baseball players underwent BT. Seventy-one percent of the 17 were pitchers, and 29% of the 17 were in the major league. Forty-seven percent of the 17 had a history of a prior shoulder surgery and 47% of the 17 underwent concomitant labral repair. For all players, RTP after BT was 35%, whereas RTP after BT without a concomitant reconstructive procedure was 44% in 10 ± 6 months, and 25% for those who underwent both BT and a concomitant reconstructive procedure (P = .620). All players who RTP were able to return to at least 20 games at their preoperative level of play. Return to professional play was 80% among position players and 17% among pitchers (P = .028). For those pitchers who RTP, performance was not statistically changed.


      Professional baseball players who undergo BT have a 35% rate of return to their prior level of play. Whereas pitchers have only a 17% rate of RTP, position players have an 80% rate of RTP. Of those who returned, all returned to their prior level of play. The pitchers who returned had no significant change in performance statistics.

      Level of Evidence

      Level IV, therapeutic study, a case series.
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        • Werner S.L.
        • Gill T.J.
        • Murray T.A.
        • Cook T.D.
        • Hawkins R.J.
        Relationships between throwing mechanics and shoulder distraction in professional baseball pitchers.
        Am J Sports Med. 2001; 29: 354-358
        • Fleisig G.S.
        • Barrentine S.W.
        • Escamilla R.F.
        • Andrews J.R.
        Biomechanics of overhand throwing with implications for injuries.
        Sports Med. 1996; 21: 421-437
        • Fleisig G.S.
        • Andrews J.R.
        • Dillman C.J.
        • Escamilla R.F.
        Kinetics of baseball pitching with implications about injury mechanisms.
        Am J Sports Med. 1995; 23: 233-239
        • Chalmers P.N.
        • Sgroi T.
        • Riff A.J.
        • et al.
        Correlates with history of injury in youth and adolescent pitchers.
        Arthroscopy. 2015; 31: 1349-1357
        • Burkhart S.
        • Morgan C.
        SLAP lesions in the overhead athlete.
        Orthop Clin North Am. 2001; 32: 431-441
        • Burkhart S.S.
        • Morgan C.D.
        • Kibler W.B.
        Shoulder injuries in overhead athletes. The “dead arm” revisited.
        Clin Sports Med. 2000; 19: 125-158
        • Burkhart S.S.
        • Morgan C.D.
        The peel-back mechanism: Its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation.
        Arthroscopy. 1998; 14: 637-640
        • Burkhart S.S.
        • Morgan C.D.
        • Kibler W.B.
        The disabled throwing shoulder: Spectrum of pathology. Part I: Pathoanatomy and biomechanics.
        Arthroscopy. 2003; 19: 404-420
        • Lesniak B.P.
        • Baraga M.G.
        • Jose J.
        • Smith M.K.
        • Cunningham S.
        • Kaplan L.D.
        Glenohumeral findings on magnetic resonance imaging correlate with innings pitched in asymptomatic pitchers.
        Am J Sports Med. 2013; 41: 2022-2027
        • Sheridan K.
        • Kreulen C.
        • Kim S.
        • Mak W.
        • Lewis K.
        • Marder R.
        Accuracy of magnetic resonance imaging to diagnose superior labrum anterior-posterior tears.
        Knee Surg Sports Traumatol Arthrosc. 2015; 23: 2645-2650
        • Keener J.D.
        • Brophy R.H.
        Superior labral tears of the shoulder: Pathogenesis, evaluation, and treatment.
        J Am Acad Orthop Surg. 2009; 17: 627-637
        • Boileau P.
        • Parratte S.
        • Chuinard C.
        • Roussanne Y.
        • Shia D.
        • Bicknell R.
        Arthroscopic treatment of isolated type II SLAP lesions: Biceps tenodesis as an alternative to reinsertion.
        Am J Sports Med. 2009; 37: 929-936
        • Frank R.M.
        • Nho S.J.
        • McGill K.C.
        • et al.
        Retrospective analysis of arthroscopic superior labrum anterior to posterior repair: Prognostic factors associated with failure.
        Adv Orthop. 2013; 2013: 1-7
        • Kim S.-H.
        • Ha K.-I.
        • Kim S.-H.
        • Choi H.-J.
        Results of arthroscopic treatment of superior labral lesions.
        J Bone Joint Surg Am. 2002; 84: 981-985
        • Enad J.G.
        • Gaines R.J.
        • White S.M.
        • Kurtz C.A.
        Arthroscopic superior labrum anterior-posterior repair in military patients.
        J Shoulder Elbow Surg. 2007; 16: 300-305
        • Ide J.
        Sports activity after arthroscopic superior labral repair using suture anchors in overhead-throwing athletes.
        Am J Sports Med. 2005; 33: 507-514
        • Cohen D.B.
        • Coleman S.
        • Drakos M.C.
        • et al.
        Outcomes of isolated type II SLAP lesions treated with arthroscopic fixation using a bioabsorbable tack.
        Arthroscopy. 2006; 22: 136-142
        • Chalmers P.N.
        • Trombley R.
        • Cip J.
        • et al.
        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. 2014; 42: 2825-2836
        • Provencher M.T.
        • LeClere L.E.
        • Romeo A.A.
        Subpectoral biceps tenodesis.
        Sports Med Arthrosc. 2008; 16: 170-176
        • Kumar V.P.
        • Satku K.
        • Balasubramaniam P.
        The role of the long head of biceps brachii in the stabilization of the head of the humerus.
        Clin Orthop Relat Res. 1989; 244: 172-175
        • Strauss E.J.
        • Salata M.J.
        • Sershon R.A.
        • et al.
        Role of the superior labrum after biceps tenodesis in glenohumeral stability.
        J Shoulder Elbow Surg. 2014; 23: 485-491
        • Patzer T.
        • Habermeyer P.
        • Hurschler C.
        • et al.
        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. 2012; 21: 1580-1587
        • Laughlin W.A.
        • Fleisig G.S.
        • Scillia A.J.
        • Aune K.T.
        • Cain E.L.
        • Dugas J.R.
        Deficiencies in pitching biomechanics in baseball players with a history of superior labrum anterior-posterior repair.
        Am J Sports Med. 2014; 42: 2837-2841
        • Denard P.J.
        • Lädermann A.
        • Parsley B.K.
        • Burkhart S.S.
        Arthroscopic biceps tenodesis compared with repair of isolated type II SLAP lesions in patients older than 35 years.
        Orthopedics. 2014; 37: e292-e297
        • Werner B.C.
        • Pehlivan H.C.
        • Hart J.M.
        • et al.
        Biceps tenodesis is a viable option for salvage of failed SLAP repair.
        J Shoulder Elbow Surg. 2014; 23: e179-e184
        • Gupta A.K.
        • Chalmers P.N.
        • Klosterman E.L.
        • et al.
        Subpectoral biceps tenodesis for bicipital tendonitis with SLAP tear.
        Orthopedics. 2015; 38: e48-e53
        • Ek E.T.H.
        • Shi L.L.
        • Tompson J.D.
        • Freehill M.T.
        • Warner J.J.P.
        Surgical treatment of isolated type II superior labrum anterior-posterior (SLAP) lesions: Repair versus biceps tenodesis.
        J Shoulder Elbow Surg. 2014; 23: 1059-1065
        • Fedoriw W.W.
        • Ramkumar P.
        • McCulloch P.C.
        • Lintner D.M.
        Return to play after treatment of superior labral tears in professional baseball players.
        Am J Sports Med. 2014; 42: 1155-1160
        • Neri B.R.
        • ElAttrache N.S.
        • Owsley K.C.
        • Mohr K.
        • Yocum L.A.
        Outcome of type II superior labral anterior posterior repairs in elite overhead athletes: Effect of concomitant partial-thickness rotator cuff tears.
        Am J Sports Med. 2011; 39: 114-120
        • Neuman B.J.
        • Boisvert C.B.
        • Reiter B.
        • Lawson K.
        • Ciccotti M.G.
        • Cohen S.B.
        Results of arthroscopic repair of type II superior labral anterior posterior lesions in overhead athletes: Assessment of return to preinjury playing level and satisfaction.
        Am J Sports Med. 2011; 39: 1883-1888

      Linked Article

      • Editorial Commentary: The Shoulder Biceps Tendon and Baseball Continue Their Controversial Relationship
        ArthroscopyVol. 34Issue 3
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          The optimal treatment of shoulder SLAP tears in high-level baseball players remains highly controversial. In pitchers, many SLAP lesions are found incidentally on magnetic resonance imaging and may in fact be adaptive to the baseball pitcher's mechanics of throwing. Surgical repair of SLAP lesions requires lengthy rehabilitation, and outcomes have been similar to or worse than the results after nonoperative treatment. The treatment option of biceps tenodesis is an appealing alternative to SLAP repair, but the indications and technique of biceps tenodesis in the elite pitcher still need to be defined.
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