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

Background: Poor results after repair of type 2 SLAP tears are relatively common and some have reported better results after biceps tenodesis or tenotomy than repair. In addition, some believe that the long head of the biceps is expendable. Therefore, many now favor biceps tenotomy or tenodesis over biceps anchor repair either in all patients or in older patients, reserving SLAP lesion repair only for young athletes. Hypothesis: We hypothesized that repair of the biceps anchor of the labrum would be effective in all patients regardless of age provided that care was taken not to overtighten the labrum and that rotator cuff pain as the primary pain generator had been ruled out. Methods: All patients with type 2 SLAP lesion repair by the senior author since he began repairing them with suture anchors were prospectively evaluated. Patients with more than one other concomitant procedure, simultaneous rotator cuff repair or worker’s compensation status were excluded. Results: 77% of patients were available for minimum two year followup. No patient had subsequent surgery or manipulation under anesthesis as a result of their SLAP repair. Standardized shoulder test score increased by 4 points. Mean SANE score decreased from 53 pre-op to 14 post-op. Results were the same in those over versus under 40 years of age. Conclusion: Anatomic repair of Type 2 SLAP lesions at the biceps anchor without biceps tenodesis or tenotomy can produce good results in patients of all ages.

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National trends in the diagnosis and repair of SLAP lesions in the United States

Journal of Orthopaedic Surgery ◽

10.1177/2309499019888552 ◽

2019 ◽

Vol 28 (1) ◽

pp. 230949901988855 ◽

Cited By ~ 1

Author(s):

Mark C Dougherty ◽

J Erik Kulenkamp ◽

Haroutioun Boyajian ◽

Jason L Koh ◽

Michael J Lee ◽

...

Keyword(s):

United States ◽

Private Insurance ◽

The United States ◽

Population Based ◽

Shoulder Surgery ◽

Biceps Tenodesis ◽

Superior Labrum ◽

Slap Repair ◽

Slap Tear ◽

Arthroscopic Slap Repair

Background: Since superior labrum anterior-to-posterior (SLAP) tear was introduced as an International Classification of Diseases-Ninth Revision, Clinical Modification diagnosis in 1994, awareness, diagnosis, and surgical treatment of this disorder has increased. Here, we aim to clarify trends in the frequency of SLAP tear diagnosis and arthroscopic SLAP repair surgery in the United States. Methods: Using private insurance claims from 2003 to 2013 in MarketScan (approximately 55 million Americans), we identified patients with SLAP tear diagnosis or arthroscopic SLAP repair surgery. Population-based rates of SLAP diagnosis and related shoulder procedures were calculated. Results: A total of 329,643 patients in the MarketScan database received a SLAP tear diagnosis. In all, 62.8% underwent some form of shoulder surgery after diagnosis. SLAP diagnosis increased from 28.0 per 100,000 in 2003 to 142.4 per 100,000 in 2013 ( p < 0.0001); the rate of shoulder surgery in these patients increased from 20.1 per 100,000 in 2003 to 74.1 per 100,000 in 2013 ( p < 0.0001). However, the percentage of patients with SLAP tears who got shoulder surgery decreased ( p < 0.0001). In 2003, almost no patient got biceps tenodesis for SLAP tears; by 2013, 18.1% of surgeries for SLAP tear were biceps tenodesis. Isolated arthroscopic SLAP repairs peaked in 2009 at 28.4 per 100,000 and stabilized thereafter. Conclusion: We confirmed prior reports that SLAP diagnosis increased from 2003 to 2013, although the percentage of these patients who underwent surgery decreased over this period. Arthroscopic SLAP repair doubled but then plateaued after 2009. Biceps tenodesis now accounts for a substantial portion of surgeries for SLAP tear. This may reflect an improved understanding of superior labrum anatomy and biomechanics.

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Loop Biceps Tenotomy: An Arthroscopic Technique for Long Head of Biceps Tenotomy

Arthroscopy Techniques ◽

10.1016/j.eats.2014.04.005 ◽

2014 ◽

Vol 3 (4) ◽

pp. e427-e430 ◽

Cited By ~ 5

Author(s):

Jean-Noel Goubier ◽

Thomas Bihel ◽

Elodie Dubois ◽

Frédéric Teboul

Keyword(s):

Arthroscopic Technique ◽

Long Head Of Biceps ◽

Biceps Tenotomy ◽

Long Head

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Long Head of Biceps Tenotomy Is Not Inferior to Suprapectoral Tenodesis in Arthroscopic Repair of Nontraumatic Rotator Cuff Tears: A Multicenter, Non-inferiority, Randomized, Controlled Clinical Trial

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2021.01.036 ◽

2021 ◽

Author(s):

Derek F.P. van Deurzen ◽

Kiem G. Auw Yang ◽

Ron Onstenk ◽

Eric E.J. Raven ◽

Maaike P.J. van den Borne ◽

...

Keyword(s):

Clinical Trial ◽

Rotator Cuff ◽

Arthroscopic Repair ◽

Rotator Cuff Tears ◽

Controlled Clinical Trial ◽

Randomized Controlled Clinical Trial ◽

Randomized Controlled ◽

Long Head Of Biceps ◽

Biceps Tenotomy ◽

Long Head

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Complications in Biceps Tendon Management: Long Head of Biceps Tenotomy and Tenodesis

Complications in Arthroscopic Shoulder Surgery ◽

10.1007/978-3-030-24574-0_11 ◽

2019 ◽

pp. 103-111

Author(s):

Johannes Plath

Keyword(s):

Biceps Tendon ◽

Long Head Of Biceps ◽

Biceps Tenotomy ◽

Long Head

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Risk Factors for Revision Surgery After Superior Labral Anterior-Posterior Repair: A National Perspective

The American Journal of Sports Medicine ◽

10.1177/0363546517691950 ◽

2017 ◽

Vol 45 (7) ◽

pp. 1640-1644 ◽

Cited By ~ 12

Author(s):

Samuel A. Taylor ◽

Ryan M. Degen ◽

Alexander E. White ◽

Moira M. McCarthy ◽

Lawrence V. Gulotta ◽

...

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Revision Surgery ◽

Significant Risk ◽

Biceps Tenodesis ◽

Time Of Surgery ◽

Slap Repair ◽

Long Head ◽

Slap Tear ◽

Anterior Posterior

Background: Data regarding risk factors for revision surgery after superior labral anterior-posterior (SLAP) repair are limited to institutional series. Purpose: To define risk factors for revision surgery after SLAP repair among patients in a large national database. Study Design: Case-control study; Level of evidence, 3. Methods: A national insurance database was queried for patients undergoing arthroscopic SLAP repair (Current Procedural Terminology [CPT] code 29807) for the diagnosis of a SLAP tear. Patients without a CPT modifier for laterality were excluded. Revision surgery was defined as (1) subsequent ipsilateral SLAP repair (CPT 29807), (2) ipsilateral arthroscopic debridement for the diagnosis of a SLAP tear (CPT 29822 or 29823, with diagnosis code 840.7), (3) subsequent ipsilateral arthroscopic biceps tenodesis (CPT 29828), (4) subsequent ipsilateral open biceps tenodesis (CPT 23430), and (5) subsequent biceps tenotomy (CPT 23405). Multivariable binomial logistic regression analysis was performed to identify risk factors for revision surgery after SLAP repair, including patient demographics/comorbidities, concomitant diagnoses, and concomitant procedures performed. Odds ratios (ORs), 95% CIs, and P values were calculated. The estimated financial impact of revision surgery was also calculated. Results: There were 4751 patients who met inclusion and exclusion criteria. Overall, 121 patients (2.5%) required revision surgery after SLAP repair. Regression analysis identified numerous risk factors for revision surgery, including age >40 years (OR, 1.5; 95% CI, 1.2-1.8; P = .045), female sex (OR, 1.5; 95% CI, 1.3-1.8; P = .010), obesity (OR, 1.8; 95% CI, 1.5-2.2; P = .001), smoking (OR, 2.0; 95% CI, 1.6-2.4; P < .0001), and diagnosis of biceps tendinitis (OR, 3.5; 95% CI, 3.0-4.2; P < .0001) or long head of the biceps tearing (OR, 5.1; 95% CI, 4.1-6.3; P < .0001) at or before the time of surgery. Concomitant rotator cuff repair and distal clavicle excision were not significant risk factors for revision surgery. The cost of revision surgery averaged almost $9000. Conclusion: Risk factors for revision surgery after SLAP repair include age >40 years, female sex, obesity, smoking, and diagnosis of biceps tendinitis or long head of the biceps tearing. The diagnosis of biceps tendinitis (OR, 3.5) or long head of the biceps tearing (OR, 5.1) at or before the time of surgery was an especially significant risk factor for revision surgery. The high cost of revision surgery highlights the importance of appropriate indications to avoid the need for subsequent procedures.

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Arthroscopic isolated long head of biceps tenotomy in patients with degenerative rotator cuff tears: mid-term clinical results and prognostic factors

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-020-02787-z ◽

2020 ◽

Author(s):

Egbert J. D. Veen ◽

Ashvin V. Boeddha ◽

Ronald L. Diercks ◽

Ydo V. Kleinlugtenbelt ◽

Ellie B. M. Landman ◽

...

Keyword(s):

Prognostic Factors ◽

Rotator Cuff ◽

Clinical Results ◽

Rotator Cuff Tears ◽

Long Head Of Biceps ◽

Biceps Tenotomy ◽

Long Head ◽

Acromiohumeral Distance ◽

And Function

Abstract Introduction The long head of biceps tendon is frequently involved in degenerative rotator cuff tears. Therefore, this study explored the clinical results of an isolated biceps tenotomy and identified prognostic factors for improvement in pain and function. Materials and methods Between 2008 and 2017, an arthroscopic isolated biceps tenotomy was performed on 64 patients with a degenerative rotator cuff tear (> 65 years). Primary outcome was patient-perceived improvement in pain and function. Potential prognostic factors for improvement in pain and function were identified. Results A perceived improvement in pain was reported in 78% of the patients at three months after surgery and in 75% at a mean follow-up of 4.2 years (1–7 years; n = 55). A perceived improvement in function was observed in 49% of patients at three months and in 76% of patients at follow-up. Patients with a preoperatively normal acromiohumeral distance (> 10 mm) reported an improvement in pain and function significantly more often. Retraction of the supraspinatus tendon Patte 3 was significantly associated with worse functional outcome. Conclusions A biceps tenotomy can be a reliable treatment option for patients with symptomatic degenerative cuff tears who fail conservative treatment and have a normal acromiohumeral distance (> 10 mm).

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Molecular Pattern and Density of Axons in the Long Head of the Biceps Tendon and the Superior Labrum

Journal of Clinical Medicine ◽

10.3390/jcm8122129 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2129

Author(s):

Sandra Boesmueller ◽

Roland Blumer ◽

Bernhard Gesslbauer ◽

Lena Hirtler ◽

Christian Fialka ◽

...

Keyword(s):

Biceps Tendon ◽

Total Shoulder Arthroplasty ◽

Absolute Number ◽

Nociceptive Transmission ◽

Superior Labrum ◽

Molecular Pattern ◽

Slap Repair ◽

Nociceptive Fibers ◽

Long Head ◽

Reverse Total Shoulder

The type II superior labrum anterior to posterior (SLAP) repair is a viable option in young and demanding patients, although a prolonged period of pain after surgery is described in the literature. The reason for this fact remains unknown. Thus, the purpose of this study was to investigate the molecular pattern of the biceps tendon anchor, where the sutures for repair are placed. The long head of the biceps tendon (LHBT), including the superior labrum, was dissected in the setting of reverse total shoulder arthroplasty. Immunohistochemical staining was performed using neurofilament (NF) and protein gene product (PGP) 9.5 as general markers for axons and calcitonin gene-related peptide (CGRP) and substance P for nociceptive transmission. A quantitative assessment was performed according to the two regions of interest (ROIs), i.e., the anterosuperior (ROI I) and the posterosuperior labrum (ROI II). Eleven LHBTs with a mean age of 73 years (range: 66–87 years) were harvested intraoperatively. Six LHBTs were gained in osteoarthrosis and five in fractures. We found an inhomogeneous distribution of axons in the anterosuperior and posterosuperior parts of the labrum in all the specimens irrespective of the age, gender, and baseline situation. There was a significantly higher number (p < 0.01) as well as density (p < 0.001) of NF-positive axons in ROI I compared to ROI II. Nociceptive fibers were always found along the NF-positive axons. Thus, our results indicate that the biceps tendon anchor itself is a highly innervated region comprising different nerve qualities. The anterosuperior labrum contains a higher absolute number and density of axons compared to the posterosuperior parts. Furthermore, we were able to prove the presence of nociceptive fibers in the superior labrum. The results obtained in this study could contribute to the variability of pain after SLAP repair.

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