Purpose
To examine the outcomes of SLAP repair versus biceps tenodesis (BT) for the index
treatment of isolated type II SLAP tears.
Methods
A search of PubMed, MEDLINE, and EMBASE was performed in April 2018 for English-language
studies that presented outcomes data on patients with isolated type II SLAP tears
treated with either SLAP repair or BT at the primary surgical time point.
Results
Twenty-three studies (i.e., 2 randomized control trials, 7 retrospective cohort, 3
prospective cohort, 4 case-control, and 7 case series) were included. Isolated type
II SLAP tears were treated via SLAP repair in 781 patients with a mean age of 35 years
(range, 22-58 years) and a mean postoperative follow-up of 35 months (range, 3-63 months).
BT was performed in 100 patients with a mean age of 44 years (range, 18-64 years)
and a mean postoperative follow-up of 32 months (range, 24-75 months). Similar postoperative
scores were noted in both the SLAP repair and BT groups for American Shoulder and
Elbow Surgeons, Constant, University of California, Los Angeles, and visual analog
scale pain scores. The rate of return to sports was 20% to 95% for SLAP repair and
73% to 100% for BT. Reoperation rates for SLAP repair and BT were 2.9% to 40% and
0% to 15.3%, respectively.
Conclusions
This study suggests that SLAP repair and BT are both acceptable as index treatment
for isolated type II SLAP tears. SLAP repair remains the most commonly performed index
procedure; however, BT appears equally efficacious and may represent an attractive
alternative.
Level of Evidence
Level IV, systematic review of Level I through IV studies.
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References
- Glenoid labrum tears related to the long head of the biceps.Am J Sports Med. 1985; 13: 337-341
- SLAP lesions of the shoulder.Arthroscopy. 1990; 6: 274-279
- Superior labrum anterior to posterior (SLAP) lesions of the shoulder.Orthop Trauma. 2011; 25: 190-197
- An analysis of 140 injuries to the superior glenoid labrum.J Shoulder Elbow Surg. 1995; 4: 243-248
- Chapter 42: Shoulder anatomy and biomechanics.in: Mark Miller S.T. DeLee & Drez’s orthopaedic sports medicine. Ed. 4. Saunders, Philadelphia2014: 437
- The long head of the biceps tendon has minimal effect on in vivo glenohumeral kinematics: A biplane fluoroscopy study.Am J Sports Med. 2012; 40: 202-212
- Superior labral tears: Repair versus biceps tenodesis.J Shoulder Elbow Surg. 2011; 20: S2-S8
- A prospective analysis of 179 type 2 superior labrum anterior and posterior repairs: Outcomes and factors associated with success and failure.Am J Sports Med. 2013; 41: 880-886
- Surgical treatment of symptomatic superior labrum anterior-posterior tears in patients older than 40 years: A systematic review.Am J Sports Med. 2015; 43: 1274-1282
- Biceps tenodesis versus labral repair for superior labrum anterior-to-posterior tears: A systematic review and meta-analysis.J Shoulder Elbow Surg. 2018; 27: 1913-1919
- Surgical trends in the treatment of superior labrum anterior and posterior lesions of the shoulder: Analysis of data from the American Board of Orthopaedic Surgery Certification Examination Database.Am J Sports Med. 2014; 42: 1904-1910
- The measurement of observer agreement for categorical data.Biometrics. 1977; 33: 159-174
- Revised grades of recommendation for summaries or reviews of orthopaedic surgical studies.J Bone Joint Surg Am. 2006; 88: 1161-1162
- Methodological index for non-randomized studies (MINORS): Development and validation of a new instrument.ANZ J Surg. 2003; 73: 712-716
- Arthroscopic stabilization of type II SLAP lesions using an absorbable tack.Arthroscopy. 2001; 17: 19-24
- The trans-rotator cuff approach to SLAP lesions: Technical aspects for repair and a clinical follow-up of 31 patients at a minimum of 2 years.Arthroscopy. 2002; 18: 372-377
- Sports activity after arthroscopic superior labral repair using suture anchors in overhead-throwing athletes.Am J Sports Med. 2005; 33: 507-514
- Outcomes of isolated type II SLAP lesions treated with arthroscopic fixation using a bioabsorbable tack.Arthroscopy. 2006; 22: 136-142
- Arthroscopic repair of type II superior labral anterior posterior lesions with and without acromioplasty: A clinical analysis of 50 patients.Am J Sports Med. 2007; 35: 749-753
- Isolated and combined Type II SLAP repairs in a military population.Knee Surg Sports Traumatol Arthrosc. 2007; 15: 1382-1389
- Arthroscopic repair of isolated type II superior labrum anterior-posterior lesion.Knee Surg Sports Traumatol Arthrosc. 2008; 16: 1151-1157
- Arthroscopic treatment of isolated type II SLAP lesions: Biceps tenodesis as an alternative to reinsertion.Am J Sports Med. 2009; 37: 929-936
- Outcomes after arthroscopic repair of type-II SLAP lesions.J Bone Joint Surg Am. 2009; 91: 1595-1603
- The effect of age on the outcomes of arthroscopic repair of type II superior labral anterior and posterior lesions.Am J Sports Med. 2010; 38: 2299-2303
- Arthroscopic fixation of isolated type II SLAP lesions using a two-portal technique.Acta Orthop Belg. 2011; 77: 160-166
- Arthroscopic repair of type II superior labrum anterior posterior (SLAP) lesions in patients over the age of 45 years: A prospective study.Arch Orthop Trauma Surg. 2011; 131: 1107-1113
- A new technique of arthroscopic fixation using double anchors for SLAP lesions.Knee Surg Sports Traumatol Arthrosc. 2012; 20: 1939-1946
- Vertical versus horizontal suture configuration for the repair of isolated type II SLAP lesion through a single anterior portal: A randomized controlled trial.Arthroscopy. 2011; 27: 1605-1613
- Arthroscopic biceps tenodesis compared with repair of isolated type II SLAP lesions in patients older than 35 years.Orthopedics. 2014; 37: e292-e297
- Suture anchors or transglenoidal sutures for arthroscopic repair of isolated SLAP-2 lesions? A matched-pair comparison of functional outcome and return to sports.Arch Orthop Trauma Surg. 2013; 133: 227-235
- Surgical treatment of isolated type II superior labrum anterior-posterior (SLAP) lesions: Repair versus biceps tenodesis.J Shoulder Elbow Surg. 2014; 23: 1059-1065
- A new anatomic technique for type II SLAP lesions repair.Knee Surg Sports Traumatol Arthrosc. 2016; 24: 456-463
- Combined SLAP repair and biceps tenodesis for superior labral anterior-posterior tears.Knee Surg Sports Traumatol Arthrosc. 2016; 24: 3870-3876
- Clinical outcome of arthroscopic SLAP repair: Conventional vertical knot versus knotless horizontal mattress sutures.Knee Surg Sports Traumatol Arthrosc. 2016; 24: 464-469
- Sham surgery versus labral repair or biceps tenodesis for type II SLAP lesions of the shoulder: A three-armed randomised clinical trial.Br J Sports Med. 2017; 51: 1759-1766
- Subpectoral biceps tenodesis for treatment of isolated type II SLAP lesions in a young and active population.Arthroscopy. 2018; 34: 371-376
- Risk factors for revision surgery after superior labral anterior-posterior repair: A national perspective.Am J Sports Med. 2017; 45: 1640-1644
- Return to play after treatment of superior labral tears in professional baseball players.Am J Sports Med. 2014; 42: 1155-1160
- SLAP lesions: A treatment algorithm.Knee Surg Sports Traumatol Arthrosc. 2016; 24: 447-455
- 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
- Return to play after type II superior labral anterior-posterior lesion repairs in athletes: A systematic review.Clin Orthop Relat Res. 2012; 470: 1595-1600
- The outcome of type II SLAP repair: A systematic review.Arthroscopy. 2010; 26: 537-545
- 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
- Outcomes of type II superior labrum, anterior to posterior (SLAP) repair: Prospective evaluation at a minimum two-year follow-up.J Shoulder Elbow Surg. 2010; 19: 859-867
- Poor outcomes after SLAP repair: Descriptive analysis and prognosis.Arthroscopy. 2009; 25: 849-855
- Outcomes of revision arthroscopic type II superior labral anterior posterior repairs.Am J Sports Med. 2011; 39: 1290-1294
- Arthroscopic knot removal for failed superior labrum anterior-posterior repair secondary to knot-induced pain.Am J Sports Med. 2017; 45: 2563-2568
- Disorders of the proximal and distal aspects of the biceps muscle.J Bone Joint Surg Am. 2013; 95: 1235-1245
- Biceps tenodesis vs. repair for type II SLAP tears in patients under 30 years-old.Orthop J Sports Med. 2017; 5
- From systematic reviews to clinical recommendations for evidence-based health care: Validation of Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) for grading of clinical relevance.Open Dent J. 2010; 4: 84-91
Article Info
Publication History
Published online: April 30, 2019
Accepted:
December 9,
2018
Received:
July 13,
2018
Footnotes
See commentary on page 1939
The authors report the following potential conflicts of interest or sources of funding: A.L. receives support from Arthrex and Tornier . Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2018 by the Arthroscopy Association of North America
