Purpose
To evaluate the functional and athletic outcomes after primary subpectoral biceps
tenodesis for type II SLAP tear in overhead athletes.
Methods
All competitive elite athletes with type II SLAP tears undergoing biceps tenodesis
by a single surgeon were isolated between 2007 and 2015. Exclusion criteria were applied
to individuals not involved in overhead athletics, clinical follow-up <24 months,
adjacent rotator cuff or labral repair, concomitant SLAP repair, and/or previous arthroscopic
shoulder surgery. Patient-reported outcome measures included visual analog scale (VAS),
Kerlan Jobe Orthopaedic Clinic shoulder score, and Single Assessment Numerical Assessment.
Clinical and sporting outcomes were recorded using a sports-specific questionnaire.
Results
Of 22 identified patients, 16 competitive overhead athletes (72.7%; 11 men, 5 women)
with a mean age of 21.0 years were available at mean 4.5-year follow-up. Baseball
or softball comprised the majority of patients (n = 9; 56.3%), followed by gymnastics
(n = 2), swimming (n = 2), and other sports (n = 3). At mean 4.1 months postoperatively,
13 patients (81.3%) returned to previous level of athletic activity, whereas 2 patients
(12.5%) failed to return to sporting activity and 1 (6.3%) returned at a lower level
of competition. VAS pain significantly decreased from an average of 4.4 preoperatively
to 1.7 postoperatively (P = .002), and mean Single Assessment Numerical Assessment scores also demonstrated
significant improvement (55.4-76.7; P = .008). Final mean Kerlan Jobe Orthopaedic Clinic score was 74.0 (standard deviation
25.9), including 2 patients with suboptimal outcomes due to persistent pain. There
were no significant differences in mean forward flexion or rotation in either the
adducted or throwing position (P > .05), although small, significant decreases in postoperative active abduction were
noted (165° vs 155°; P = .003).
Conclusions
In the current series of competitive overhead athletes, 81% of patients returned to
previous level of play at an average of 4.1 months postoperatively after subpectoral
biceps tenodesis for symptomatic SLAP tear. Athletes reliably experienced significant
decreased activity-related pain with athletic function.
Level of Evidence
IV, case series.
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References
- Trends in the diagnosis of SLAP lesions in the US military.Knee Surg Sports Traumatol Arthrosc. 2015; 23: 1453-1459
- Return to sport after arthroscopic superior labral anterior-posterior repair: A systematic review.Sports Health. 2019; 11: 520-527
- Return to sport after the surgical treatment of superior labrum anterior to posterior tears: A systematic review.Orthop J Sports Med. 2019; 72325967119841892
- 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
- Subpectoral biceps tenodesis for the treatment of type II and IV superior labral anterior and posterior lesions.Am J Sports Med. 2014; 42: 2128-2135
- Subpectoral biceps tenodesis for bicipital tendonitis with SLAP tear.Orthopedics. 2015; 38: e48-e53
- Subpectoral biceps tenodesis for treatment of isolated type II SLAP lesions in a young and active population.Arthroscopy. 2018; 34: 371-376
Shin MH, Baek S, Kim TM, Kim H, Oh KS, Chung SW. Biceps tenodesis versus superior labral anterior and posterior (SLAP) lesion repair for the treatment of slap lesion in overhead athletes: A systematic review and meta-analysis [published online September 30, 2021]. Am J Sports Med. doi:10.1177/03635465211039822.
- Biceps tenodesis for superior labrum anterior-posterior tear in the overhead athlete: A systematic review.Am J Sports Med. 2021; 49: 522-528
- Management of proximal biceps pathology in overhead athletes: What is the role of biceps tenodesis?.Am J Orthop (Belle Mead NJ). 2017; 46: E71-E78
- Biceps tenodesis is a viable option for management of proximal biceps injuries in patients less than 25 years of age.Arthroscopy. 2019; 35: 1036-1041
- Torsional fracture of the humerus after subpectoral biceps tenodesis with an interference screw: A biomechanical cadaveric study.Clin Biomech (Bristol, Avon). 2015; 30: 915-920
- A humerus fracture in a baseball pitcher after biceps tenodesis.Am J Sports Med. 2014; 42: 877-879
- The utility of the KJOC score in professional baseball in the United States.Am J Sports Med. 2013; 41: 2167-2173
- Labral repair versus biceps tenodesis for primary surgical management of type II superior labrum anterior to posterior tears: A systematic review.Arthroscopy. 2019; 35: 1927-1938
- Poor outcomes after SLAP repair: Descriptive analysis and prognosis.Arthroscopy. 2009; 25: 849-855
- 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
- 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
- Return to play and prior performance in major league baseball pitchers after repair of superior labral anterior-posterior tears.Orthop J Sports Med. 2016; 42325967116675822
- Nonoperative treatment of superior labrum anterior posterior tears: Improvements in pain, function, and quality of life.Am J Sports Med. 2010; 38: 1456-1461
- Arthroscopic treatment of isolated type II SLAP lesions: Biceps tenodesis as an alternative to reinsertion.Am J Sports Med. 2009; 37: 929-936
- Risk factors for revision surgery after superior labral anterior–posterior repair: A national perspective.Am J Sports Med. 2017; 45: 1640-1644
- Etiology, diagnosis, and management of failed SLAP repair.J Am Acad Orthop Surg. 2014; 22: 554-565
- Biceps tenodesis is a viable option for salvage of failed SLAP repair.J Shoulder Elbow Surg. 2014; 23: e179-e184
- Outcomes of primary biceps subpectoral tenodesis in an active population: A prospective evaluation of 101 patients.Arthroscopy. 2019; 35: 3205-3210
- Return to play after treatment of superior labral tears in professional baseball players [published correction appears in Am J Sports Med 2015;43:NP46].Am J Sports Med. 2014; 42: 1155-1160
- Open subpectoral biceps tenodesis may be an alternative to arthroscopic repair for SLAP tears in patients under 30.Arthroscopy. 2022; 38: 307-312
- Incidence and return to play after biceps tenodesis in professional baseball players.Arthroscopy. 2018; 34: 747-751
- Combined SLAP repair and biceps tenodesis for superior labral anterior-posterior tears.Knee Surg Sports Traumatol Arthrosc. 2016; 24: 3870-3876
- The efficacy of biceps tenodesis in the treatment of failed superior labral anterior posterior repairs.Am J Sports Med. 2014; 42: 820-825
- Clinical outcomes after subpectoral biceps tenodesis with an interference screw.Am J Sports Med. 2008; 36: 1922-1929
- Subpectoral biceps tenodesis with interference screw fixation.Arthroscopy. 2005; 21: 896
- Complications associated with subpectoral biceps tenodesis: Low rates of incidence following surgery.J Shoulder Elbow Surg. 2010; 19: 764-768
- Proximal humerus shaft fracture as a complication after keyhole-plasty. A case report.Unfallchirurgie. 1995; 21 ([in German]): 198-201
- Proximal humerus fracture after keyhole biceps tenodesis.Am J Orthop (Belle Mead NJ). 2010; 39: E61-E63
- Humeral fracture following subpectoral biceps tenodesis in 2 active, healthy patients.J Shoulder Elbow Surg. 2011; 20: e7-e11
- Applied biomechanics of baseball pitching.in: Magee D.J. Manske R.C. Zachazewski J.E. Quillen W.S. Athletic and sport issues in musculoskeletal rehabilitation. Elsevier Saunders, St. Louis2011: 350-384
- Editorial Commentary: Does size matter: Drill holes in subpectoral biceps tenodesis?.Arthroscopy. 2017; 33: 1503-1505
- Minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state of outcome measures relating to shoulder pathology and surgery: A systematic review.Curr Rev Musculoskelet Med. 2021; 14: 27-46
- Concomitant biceps tenodesis improves outcomes for SLAP repair: Minimum 2-Year clinical outcomes after SLAP II-IV repair versus tenodesis versus both.Arthrosc Sports Med Rehabil. 2021; 3: e2007-e2014
- Establishing clinically significant outcomes for patient-reported outcomes measurement information system after biceps tenodesis.Arthroscopy. 2021; 37: 1731-1739
Article info
Publication history
Published online: August 17, 2022
Accepted:
July 13,
2022
Received:
April 10,
2020
Footnotes
See commentary on page 17
The authors report the following potential conflicts of interest or sources of funding: B.R.W. reports personal fees from AANA, during the conduct of the study; other from Sparta, Kaliber Labs, and Vivorte; grants, personal fees, and nonfinancial support from Arthrex; personal fees from Vericel and Elsevier, outside the submitted work; and board or committee member, American Orthopaedic Society for Sports Medicine, American Academy of Orthopaedic Surgeons, and AANA. A.A.R. reports other financial or material support from AANA; board or committee member, American Shoulder and Elbow Surgeons; IP royalties, other financial or material support; paid consultant; paid presenter or speaker; and research support from Arthrex; other financial or material support from Major League Baseball; editorial or governing board, Orthopedics; board or committee member, Orthopedics Today; editorial or governing board, Paragen Technologies; research support; stock or stock options from Paragen Technologies; editorial or governing board, SAGE; publishing royalties, financial, or material support from Saunders/Mosby-Elsevier; editorial or governing board; publishing royalties, and financial or material support SLACK Incorporated; and editorial or governing board, Wolters Kluwer Health-Lippincott Williams & Wilkins. ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
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© 2022 by the Arthroscopy Association of North America
