Effectiveness of biceps tenodesis versus SLAP repair for surgical treatment of isolated SLAP lesions: A systemic review and meta-analysis

Background: Superior labral anterior and posterior (SLAP) lesions are common injuries in overhead athletes. As a surgical treatment for SLAP lesions, SLAP repair has been traditionally performed. Recently, biceps tenodesis has been performed as an alternative treatment option; however, there is no review for outcome comparisons between these 2 procedures in overhead athletes. Purpose: The aim of this study was to compare the outcomes of SLAP repair versus biceps tenodesis, especially in overhead athletes with SLAP lesions. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: An electronic literature search was performed in Medline, Embase, Scopus, and the Cochrane Library. The studies were appraised using the Methodological Index for Non-randomized Studies (MINORS) tool. Studies that had a minimum follow-up of 2 years, included only patients with SLAP lesions without other major shoulder pathologies, and included only patients who engaged in overhead sports were included. The functional outcomes of the American Shoulder and Elbow Surgeons (ASES) score, rate of return to sport, rate of return to preinjury level of sport, and complication rate were subjected to meta-analysis. Results: A total of 332 articles were identified, and 13 were included in the systematic review. Even though the postoperative ASES scores were slightly higher in the biceps tenodesis group than in the SLAP repair group, no statistically significant differences were found between the groups (biceps tenodesis, 95% CI = 91.71-96.75, I2 = 0.00; SLAP repair, 95% CI = 85.47-94.46, I2 = 16.3; P = .085) The rate of return to sport and the return to preinjury level of sport were slightly higher in the biceps tenodesis group than in the SLAP repair group; however, in meta-analysis these factors did not reach statistical significance (return to sport: biceps tenodesis, 95% CI = 0.66-0.91, I2 = 0.00; SLAP repair, 95% CI = 0.68-0.93, I2 = 70.23; P = .94) (return to preinjury level of sport: biceps tenodesis, 95% CI = 0.61-0.89, I2 = 17.78; SLAP repair, 95% CI = 0.53-0.82, I2 = 58.07; P = .37). The biceps tenodesis group showed a lower complication rate compared with the SLAP repair group without statistical significance (biceps tenodesis, 95% CI = 0.013-0.145, I2 = 0.00; SLAP repair, 95% CI = 0.049-0.143, I2 = 0.00; P = .25). Conclusion: The results of biceps tenodesis, compared with SLAP repair, were not inferior in the surgical treatment of overhead athletes with SLAP lesions with regard to the ASES score, rate of return to sport, rate of return to preinjury level of sport, and complication rate. Further high-level, randomized controlled studies are needed to confirm this result.

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Efficacy of various core decompression techniques versus non-operative treatment for osteonecrosis of the femoral head: a systemic review and network meta-analysis of randomized controlled trials

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04808-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Quanzhe Liu ◽

Wenlai Guo ◽

Rui Li ◽

Jae Hyup Lee

Keyword(s):

Surgical Treatment ◽

Bone Graft ◽

Statistical Difference ◽

Radiographic Progression ◽

Meta Analysis ◽

Core Decompression ◽

Systemic Review ◽

Current Evidence ◽

Cochrane Library ◽

Non Surgical Treatment

Abstract Background Various Joint-preserving therapy (JPT) methods have been performed and tried in recent decades, but their results and efficacy were inconsistent and controversial. The purpose of this study is to evaluate its effectiveness and whether there are statistical differences in treatment between different interventions based on published RCT studies. Methods Following the PRISMA-NMA checklist, Medline, EMBASE, Web of Science, and Cochrane Library databases were searched and collected related RCT studies. The sources were searched from inception up to October 30, 2020. The primary outcomes including the rate of radiographic progression and conversion to THA and the secondary outcome -Harris Hip Scores (HHS) were extracted and compared in a Network meta-analysis. Results Seventeen RCT studies involving 784 patients (918 hips) with seven interventions including CD (core decompression), CD + BG (bone graft), CD + TI (tantalum rod implantation), CD + CT (Cell therapy), CD + BG + CT, VBG (vascularized bone graft), and nonsurgical or conservative treatment for ONFH were evaluated. In the radiographic progression results, CD + CT showed a relatively better result than CD, CD + BG and non-surgical treatment, the surface under the cumulative ranking curve (SUCRA) plot displayed that CD + CT (96.4%) was the best, followed by CD (64.1%).In conversion to THA results, there were no significant differences between the JPT methods and non-surgical treatment. In HHS, there was also no significant difference, other than CD + BG showed a statistical difference than non-surgical treatment only in terms of Cis, but the SUCRA was highest in non-surgical treatment (80.5%) followed by CD + CT (72.8%). Conclusions This Net-work meta-analysis demonstrated that there was no statistical difference in the outcome of radiographic progression and conversion to THA, also in HHS, other than CD + CT showed a relatively superior result in radiographic progression than nonsurgical treatment, namely, it’s maybe an effective method for delaying disease progression or reducing disease development based on current evidence.

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Arthroscopic treatment of type II superior labral anterior to posterior (SLAP) lesions in a younger population: minimum 2-year outcomes are similar between SLAP repair and biceps tenodesis

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-020-05971-0 ◽

2020 ◽

Author(s):

Kevin F. Dunne ◽

Michael Knesek ◽

Vehniah K. Tjong ◽

Brett D. Riederman ◽

Charles J. Cogan ◽

...

Keyword(s):

Arthroscopic Treatment ◽

Type Ii ◽

Biceps Tenodesis ◽

Slap Lesions ◽

Slap Repair

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SLAP tears and return to sport and work: current concepts

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2020-000537 ◽

2021 ◽

pp. jisakos-2020-000537

Author(s):

Matthew R LeVasseur ◽

Michael R Mancini ◽

Benjamin C Hawthorne ◽

Anthony A Romeo ◽

Emilio Calvo ◽

...

Keyword(s):

Treatment Options ◽

Return To Sport ◽

Operative Management ◽

Return To Play ◽

Biceps Tenodesis ◽

Overhead Athletes ◽

Slap Lesions ◽

Slap Repair ◽

Biceps Tenotomy ◽

Sporting Activities

Superior labrum, anterior and posterior (SLAP) lesions are common and identified in up to 26% of shoulder arthroscopies, with the greatest risk factor appearing to be overhead sporting activities. Symptomatic patients are treated with physical therapy and activity modification. However, after the failure of non-operative measures or when activity modification is precluded by athletic demands, SLAP tears have been managed with debridement, repair, biceps tenodesis or biceps tenotomy. Recently, there have been noticeable trends in the operative management of SLAP lesions with older patients receiving biceps tenodesis and younger patients undergoing SLAP repair, largely with suture anchors. For overhead athletes, particularly baseball players, SLAP lesions remain a difficult pathology to manage secondary to concomitant pathologies and unpredictable rates of return to play. As a consequence, the most appropriate surgical option in elite throwers is controversial. The objective of this current concepts review is to discuss the anatomy, mechanism of injury, presentation, diagnosis and treatment options of SLAP lesions and to present current literature on outcomes affecting return to sport and work.

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

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2013.09.030 ◽

2014 ◽

Vol 23 (7) ◽

pp. 1059-1065 ◽

Cited By ~ 75

Author(s):

Eugene T.H. Ek ◽

Lewis L. Shi ◽

Jeffrey D. Tompson ◽

Michael T. Freehill ◽

Jon J.P. Warner

Keyword(s):

Surgical Treatment ◽

Type Ii ◽

Biceps Tenodesis ◽

Slap Lesions ◽

Superior Labrum ◽

Anterior Posterior

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SLAP lesions: current controversies

EFORT Open Reviews ◽

10.1302/2058-5241.4.180033 ◽

2019 ◽

Vol 4 (1) ◽

pp. 25-32 ◽

Cited By ~ 3

Author(s):

Filippo Familiari ◽

Gazi Huri ◽

Roberto Simonetta ◽

Edward G. McFarland

Keyword(s):

Surgical Treatment ◽

Physical Examination ◽

Clinical Presentation ◽

Patient Characteristics ◽

Diagnostic Value ◽

Shoulder Injuries ◽

Biceps Tenodesis ◽

Glenoid Labrum ◽

Slap Lesions ◽

Slap Tear

Knowledge of the pertinent anatomy, pathogenesis, clinical presentation and treatment of the spectrum of injuries involving the superior glenoid labrum and biceps origin is required in treating the patient with a superior labrum anterior and posterior (SLAP) tear. Despite the plethora of literature regarding SLAP lesions, their clinical diagnosis remains challenging for a number of reasons. First, the diagnostic value of many of the available physical examination tests is inconsistent and ambiguous. Second, SLAP lesions most commonly occur concomitantly with other shoulder injuries. Third, SLAP lesions have no specific associated pain pattern. Outcomes following surgical treatment of SLAP tears vary depending on the method of treatment, associated pathology and patient characteristics. Biceps tenodesis has been receiving increasing attention as a possible treatment for SLAP tears. Cite this article: EFORT Open Rev 2019;4:25-32. DOI: 10.1302/2058-5241.4.180033.

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SLAP lesions, An Opinion Piece

The Open Orthopaedics Journal ◽

10.2174/1874325001812010342 ◽

2018 ◽

Vol 12 (1) ◽

pp. 342-345

Author(s):

Cecilie P. Schrøder

Keyword(s):

Prospective Studies ◽

Slap Lesion ◽

Labral Repair ◽

Biceps Tenodesis ◽

Slap Lesions ◽

Results Of Treatment ◽

Sham Surgery ◽

Surgery Group ◽

Opinion Piece ◽

Slap Repair

SLAP lesions were first classified by Snyder in 1990. Results of treatment have been controversial without clear consensus. All have agreed that prospective studies would be useful. We conducted such a study between 2008 to 2114 that randomized treatment between sham surgery, biceps tenodesis and labral repair. No significant differences in results between the groups were found. Crossover between groups was only possible from the sham surgery group and this may introduce some degree of bias. However, the six month outcomes between all three groups before any crossover were statistically identical. Our results also do not favor biceps tenodesis versus SLAP repair when surgery is performed. Based on these results we have narrowed our indications for SLAP lesion surgery. We still treat some SLAP lesions surgically and individualize our treatment in each such cases. Most SLAP lesion patients, however, are ultimately treated non-operatively.

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Superior Labral Anterior Posterior Repair and Biceps Tenodesis Surgery: Trends of the American Board of Orthopaedic Surgery Database

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00419 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0041

Author(s):

Travis Frantz ◽

Anirudh Gowd ◽

Brandon Erickson ◽

Anthony Romeo ◽

Gregory Cvetanovich

Keyword(s):

Orthopaedic Surgery ◽

Significant Decline ◽

Biceps Tenodesis ◽

Case Volume ◽

Slap Lesions ◽

Slap Repair ◽

Trends Over Time ◽

Arthroscopic Rotator Cuff ◽

Over Time ◽

Anterior Posterior

Objectives: Recent evidence has specified indications for performing Superior Labrum Anterior and Posterior (SLAP) repair and biceps tenodesis (BT) for the treatment of bicipital-labral lesions in the shoulder. Trends in performance of these procedures are expected to reflect the growing body of research regarding this topic. The purpose of this study was to report practice trends for the surgical treatment of SLAP lesions, particularly in older patients, as the management of isolated SLAP lesions remains controversial. Methods: The American Board of Orthopaedic Surgery (ABOS) database was retrospectively queried between 2012-2017 by Current Procedural Terminology for SLAP repair (29807), open BT (23430), and arthroscopic BT (29828). The patient population was excluded if any concomitant open shoulder procedure was performed. Trends over time were evaluated with respect to case volume, patient age, surgeon subspecialty. Separate trends were evaluated with and without concomitant arthroscopic rotator cuff repair (RCR, CPT: 29827). Results: A total of 9,908 cases met inclusion/exclusion criteria: 4,632 performed with RCR and 5,276 performed without. Mean age of patients without RCR was 40.8 +/- 13.8, while those receiving RCR was 55.0 +/- 9.9 years . In patients without RCR, there was a significant decline in rate of SLAP repairs performed over this period (p < 0.001). No significant change was noted in mean age of patients receiving arthroscopic BT, open BT, SLAP repair, and BT + SLAP. A significantly greater proportion of patients receiving open and arthroscopic BT were over 35 years old, compared to those receiving SLAP repair (p < 0.001). Within the RCR cohort, there was also a significant decline in concomitant SLAP repairs performed (p < 0.001) over the study period. With respect to biceps tenodesis, in the RCR cohort, open was performed in 52.2% of cases while arthroscopic was performed in 47.8%, while in the cohort without RCR open was performed in 74.9% and arthroscopic was performed in 25.9%. Conclusion: The ABOS database reveals significantly reduced rates of SLAP repairs being performed. Trends with age remain consistent over time, in that SLAP repairs were predominantly performed in younger patients. Arthroscopic biceps tenodesis was performed much more frequently with RCR than without.

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