scholarly journals Superior Labrum Anterior-Posterior (SLAP) Repair Versus Subpectoral Biceps Tenodesis for Isolated SLAP II Lesions in Overhead Athletes Aged Younger 35 Years: A Comparison of Minimum Two-Year Outcomes

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0041
Author(s):  
Marilee Horan ◽  
Travis Dekker ◽  
Brandon Goldenberg ◽  
Grant Dornan ◽  
Liam Peebles ◽  
...  
Keyword(s):  
Return To Sports ◽  
Type Ii ◽  
Biceps Tenodesis ◽  
Overhead Athletes ◽  
Slap Repair ◽  
Group I ◽  
Group Ii ◽  
Subpectoral Biceps Tenodesis ◽  
Repair Group ◽  
Anterior Posterior

Objectives: In young overhead athletes with isolated superior labrum anterior-posterior (SLAP) type II lesions it remains unclear if patients benefit more from either SLAP repair or biceps tenodesis. The purpose of our study is to evaluate clinical outcomes and return to sports rates in overhead athletes suffering from symptomatic SLAP type II lesions who have undergone either biceps tenodesis or SLAP repair. Methods: A retrospective analysis of prospectively collected data was performed in patients who underwent subpectoral biceps tenodesis (group I) or SLAP repair (group II) for the treatment of isolated SLAP type II lesions, were younger than 35 years at time of surgery, participated in overhead sports, and were at least two years out from surgery. Clinical outcomes were assessed by the use of the American Shoulder and Elbow Society Score (ASES), Single Assessment Numerical Evaluation Score (SANE), Quick Disabilities of the Arm, and Shoulder and Hand Score (QuickDASH) and the General Health SF-12 physical component. Return to sports and patient satisfaction were documented. Clinical failures requiring revision surgery and complications were reported. Results: Minimum 2-year follow-up was obtained in 12/14 (85.7%) patients in group I and in 23/27 (85%) patients in group II. Preoperative baseline scores between both groups showed no significantdifferences (p > 0.05). When group I was compared to group II, no significant differences inpostoperative outcome scores were detected (p > 0.05). For biceps tenodesis (Group I) vs SLAP repair (Group II): ASES score was mean 91.6 ± 11.3 vs 88.6 ± 16.9, SANE score was mean 77.5 ± 28.0 vs. 82.3 ± 24.4, QuickDASH score was mean 9.2± 12.2 vs 9.4 ± 14.5, and SF-12 was mean 52.0 ± 6.1 vs 52.6 ± 7.8. No difference in return to sports rate (91% vs 91%, p > .05) was noted. 1 patient in group I and 2 patients in group II failed. Conclusion: This study showed that both techniques of SLAP repair and subpectoral biceps tenodesis provide excellent clinical results with high return to overhead sports rate and low failure rate in a young and high-demanding patient cohort for the treatment of isolated SLAP type II lesions.

Biceps Tenodesis as an Attractive Alternative to Superior Labral Anterior-Posterior (SLAP) Repair for Type II SLAP Lesions in Active-Duty Military Patients Younger Than 35 Years

2021 ◽  
pp. 036354652110493
Author(s):  
Nata Parnes ◽  
John C. Dunn ◽  
Hunter Czajkowski ◽  
Michael J. DeFranco ◽  
Clare K. Green ◽  
...  
Keyword(s):  
Active Duty ◽  
Type Ii ◽  
Biceps Tenodesis ◽  
Active Duty Military ◽  
Slap Repair ◽  
Military Patients ◽  
Subpectoral Biceps Tenodesis ◽  
Arthroscopic Slap Repair ◽  
Repair Group ◽  
Anterior Posterior

Background: Biceps tenodesis has been suggested as a superior surgical technique compared with isolated labral repair for superior labral anterior-posterior (SLAP) tears in patients older than 35 years. The superiority of this procedure in younger patients, however, is yet to be determined. Purpose: To compare the outcomes of arthroscopic SLAP repair with those of arthroscopic-assisted subpectoral biceps tenodesis for type II SLAP tears in active-duty military patients younger than 35 years. Study Design: Cohort study; Level of evidence, 3. Methods: Preoperative and postoperative evaluations with a minimum 5-year follow-up including the visual analog scale (VAS), the Single Assessment Numeric Evaluation (SANE), and the American Shoulder and Elbow Surgeons (ASES) shoulder score were administered, and scores were compared between 2 groups of patients younger than 35 years. One group included 25 patients who underwent SLAP repair, and the second group included 23 patients who underwent arthroscopic-assisted subpectoral biceps tenodesis. Results: The preoperative patient age ( P = .3639), forward flexion ( P = .8214), external rotation ( P = .5134), VAS pain score ( P = .4487), SANE score ( P = .6614), and ASES score ( P = .6519) did not vary significantly between the 2 study groups. Both groups demonstrated statistically significant increases in function as measured by the ASES and SANE and decreases in pain as measured by the VAS at a minimum of 5 years postoperatively. Also at a minimum of 5 years postoperatively, patients in the tenodesis group had lower pain (1.3 vs 2.6, respectively; P = .0358) and higher SANE (84.0 vs 63.3, respectively; P = .0001) and ASES (85.7 vs 75.4, respectively; P = .0342) scores compared with those in the repair group. Failure rate was 20.0% in the repair group versus 0.0% in the tenodesis group ( P = .0234). Conclusion: Active-duty military patients younger than 35 years with type II SLAP tears had more predictable improvement in pain, better functional outcomes, and lower failure rates after biceps tenodesis compared with SLAP repair for type II SLAP tears. Overall, the results of this study indicate that arthroscopic- assisted subpectoral biceps tenodesis is superior to arthroscopic SLAP repair for the treatment of type II SLAP tears in military patients younger than 35 years.

Biceps Tenodesis for Superior Labrum Anterior-Posterior Tear in the Overhead Athlete: A Systematic Review

2020 ◽  
pp. 036354652092117 ◽  
Author(s):  
Travis L. Frantz ◽  
Andrew G. Shacklett ◽  
Adam S. Martin ◽  
Jonathan D. Barlow ◽  
Grant L. Jones ◽  
...  
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Return To Sports ◽  
Biceps Tenodesis ◽  
Inclusion Criteria ◽  
Overhead Athletes ◽  
Overhead Athlete ◽  
Slap Repair ◽  
Slap Tear ◽  
Anterior Posterior

Background: Superior labrum anterior-posterior (SLAP) lesion is a common shoulder injury, particularly in overhead athletes. While surgical management has traditionally consisted of SLAP repair, high rates of revision and complications have led to alternative techniques, such as biceps tenodesis (BT). While BT is commonly reserved for older nonoverhead athletes, indications for its use have expanded in recent years. Purpose: To determine functional outcomes and return-to-sport rates among overhead athletes after BT for SLAP tear. Study Design: Systematic review. Methods: A systematic review was performed for any articles published before July 2019. The search phrase “labral tear” was used to capture maximum results, followed by keyword inclusion of “SLAP tear” and “biceps tenodesis.” Inclusion criteria included outcome studies of BT for isolated SLAP tear in athletes participating in any overhead sports, not limited to throwing alone. Abstracts and manuscripts were independently reviewed to determine eligibility. When clearly delineated, outcome variables from multiple studies were combined. Results: After full review, 8 articles met inclusion criteria (99 athletes; mean age, 19.8-47 years), with baseball and softball players the most common among them (n = 62). Type II SLAP tear was the most common diagnosis, and 0% to 44% of athletes had a failed previous SLAP repair before undergoing BT. Only 1 study included patients with concomitant rotator cuff repair. Open subpectoral BT was most commonly used, and complication rates ranged from 0% to 14%, with wound erythema, traumatic biceps tendon rupture, brachial plexus neurapraxia, and adhesive capsulitis being reported. Combined reported postoperative functional scores were as follows: American Shoulder and Elbow Surgeons, 81.7 to 97; 12-Item Short Form Health Survey physical, 50 to 54; visual analog scale for pain, 0.8-1.5; Kerlan Jobe Orthopaedic Clinic, 66 to 79; and satisfaction, 80% to 87%. The overall return-to-sports rate for overhead athletes was 70% (60 of 86). For studies that clearly delineated outcomes based on level of play/athlete, the combined return-to-sports rate was 69% (11 of 16) for recreational overhead athletes, 80% (4 of 5) for competitive/collegiate athletes, and 60% (18 of 30) for professionals. Conclusion: BT in the overhead athlete offers encouraging functional outcomes and return-to-sports rates, particularly in the recreational athlete. It can be successfully performed as an index operation rather than SLAP repair, as well as in a younger patient population. Careful consideration should be given to elite overhead athletes, particularly pitchers, who tend to experience poorer outcomes.

scholarly journals Variability in Rehabilitation Protocols after Superior Labrum Anterior Posterior Surgical Repair

2021 ◽  
Vol 14 ◽  
pp. 243-248
Author(s):  
Christina Hermanns ◽  
Reed Coda ◽  
Sana Cheema ◽  
Matthew Vopat ◽  
Armin Tarakemeh ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Surgical Repair ◽  
Return To Sport ◽  
Return To Sports ◽  
Biceps Tenodesis ◽  
Slap Repair ◽  
Rehabilitation Protocols ◽  
Google Search ◽  
Improve Patient ◽  
Anterior Posterior

Introduction. Rehabilitation after a superior labral anterior posterior (SLAP) repair is an important aspect of patient outcomes, however, no standardized rehabilitation protocol has been defined. The purpose of this paper is to assess the variability of rehabilitation after SLAP repair to understand the need for standardization to improve patient outcomes. Methods. Protocols for SLAP repairs were collected through a search for Academic Orthopedic Programs and a general google search using the terms “[Program Name (if applicable)] SLAP Repair Rehab Protocol”. Protocols were compared by sling, range of motion (ROM), physical therapy, return to sport (RTS), return to throwing, and biceps engagement/ biceps tenodesis recommendations. Protocols for non-operative or generalized shoulders were excluded.  Results. Sixty protocols were included. A total of 61.7% (37/60) recommended a sling for four to six weeks and 90% (54/60) included a full ROM recommendation, but time was variable. There were different exercises recommended, but pendulum swings were recommended by 53% (32/60), submaximal isometrics by 55% (33/60), and scapular strengthening by 65% (39/60). Of the sixty protocols, 33% (20/60) recommended return to sports in 24 weeks and 38.3% (23/60) recommended allowing throwing in 16 weeks. Conclusion. There was variability in protocols for SLAP repair, especially time until full ROM, RTS, and biceps strengthening. Time in sling and scapular strengthening were the least variable. A lack of specificity within protocols in what return to throwing meant for functional ability made it difficult to compare protocols. Considering the large number of Orthopedic programs, a relatively small number had published protocols. Further studies are needed to evaluate a standardized post-operative rehabilitation for SLAP repairs to improve outcomes.

Subpectoral Biceps Tenodesis for Failed Type II SLAP Repair

Orthopedics ◽  
2013 ◽  
Vol 36 (6) ◽  
pp. e273-e728 ◽  
Author(s):  
Anil K. Gupta ◽  
Benjamin Bruce ◽  
Emma L. Klosterman ◽  
Frank McCormick ◽  
Joshua Harris ◽  
...  
Keyword(s):  
Type Ii ◽  
Biceps Tenodesis ◽  
Slap Repair ◽  
Subpectoral Biceps Tenodesis

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

2021 ◽  
pp. 036354652110398
Author(s):  
Myung Ho Shin ◽  
Samuel Baek ◽  
Tae Min Kim ◽  
HyunTae Kim ◽  
Kyung-Soo Oh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Complication Rate ◽  
Meta Analysis ◽  
Return To Sport ◽  
Rate Of Return ◽  
Biceps Tenodesis ◽  
Overhead Athletes ◽  
Slap Lesions ◽  
Slap Repair ◽  
Repair Group

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.

scholarly journals Subpectoral Biceps Tenodesis for Failed Type II SLAP Repair

2013 ◽  
Vol 1 (4_suppl) ◽  
pp. 2325967113S0008 ◽  
Author(s):  
Anil K. Gupta ◽  
Benjamin Bruce ◽  
Emma Klosterman ◽  
Francis McCormick ◽  
Joshua D. Harris ◽  
...  
Keyword(s):  
Type Ii ◽  
Biceps Tenodesis ◽  
Slap Repair ◽  
Subpectoral Biceps Tenodesis

Arthroscopic Treatment of Isolated Type II SLAP Lesions

2009 ◽  
Vol 37 (5) ◽  
pp. 929-936 ◽  
Author(s):  
Pascal Boileau ◽  
Sebastien Parratte ◽  
Christopher Chuinard ◽  
Yannick Roussanne ◽  
Derek Shia ◽  
...  
Keyword(s):  
Constant Score ◽  
Sports Participation ◽  
Slap Lesion ◽  
Viable Alternative ◽  
Successful Outcome ◽  
Type Ii ◽  
Biceps Tenodesis ◽  
Overhead Athletes ◽  
Slap Repair ◽  
Previous Level

Background Overhead athletes report an inconsistent return to their previous level of sport and satisfaction after arthroscopic SLAP lesion repair. Hypothesis Arthroscopic biceps tenodesis offers a viable alternative to the repair of an isolated type II SLAP lesion. Study Design Cohort study; Level of evidence, 3. Methods Twenty-five consecutive patients operated for an isolated type II SLAP lesion between 2000 and 2004 were evaluated at a mean of 35 months postoperatively (range, 24-69). Patients with associated instability, rotator cuff rupture, posterosuperior impingement, or previous shoulder surgery were excluded. Ten patients (10 men) with an average age of 37 years (range, 19-57) had a SLAP repair performed with suture anchors. Fifteen patients (9 men and 6 women) with an average age of 52 years (range, 28-64) underwent arthroscopic biceps tenodesis performed with an absorbable interference screw. Arthroscopic diagnosis and treatment were performed by a single experienced shoulder surgeon, and all patients were reviewed by an independent examiner. Results In the repair group, the Constant score improved from 65 to 83 points; however, 60% (6 of 10) of the patients were disappointed because of persistent pain or inability to return to their previous level of sports participation. In the tenodesis group, the Constant score improved from 59 to 89 points, and 93% (14/15) were satisfied or very satisfied. Thirteen patients (87%) were able to return to their previous level of sports participation following biceps tenodesis, compared with only 20% (2 of 10) after SLAP repair (P = .01). Four patients with failed SLAP repairs underwent subsequent biceps tenodesis, resulting in a successful outcome and a full return to their previous level of sports activity. Conclusion Arthroscopic biceps tenodesis can be considered an effective alternative to the repair of a type II SLAP lesion, allowing patients to return to a presurgical level of activity and sports participation. The results of biceps reinsertion are disappointing compared with biceps tenodesis. Furthermore, biceps tenodesis may provide a viable alternative for the salvage of a failed SLAP repair. As the age of the 2 treatment groups differed, these findings should be confirmed by future studies.

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