scholarly journals Treatment of Type Two Slap Lesion With Anatomic Suture Anchor Repair Without Biceps Tenotomy Or Tenodesis

2018 ◽  
Vol 12 (1) ◽  
pp. 324-330 ◽  
Author(s):  
Chadwick C. Prodromos ◽  
Susan Finkle ◽  
Alexander Dawes ◽  
Ji Young Baik
Keyword(s):  
Rotator Cuff ◽  
Senior Author ◽  
Slap Lesion ◽  
Biceps Tenodesis ◽  
Concomitant Procedure ◽  
Slap Repair ◽  
Biceps Tenotomy ◽  
Biceps Anchor ◽  
Long Head

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.

scholarly journals Return to Sport After the Surgical Treatment of Superior Labrum Anterior to Posterior Tears: A Systematic Review

2019 ◽  
Vol 7 (5) ◽  
pp. 232596711984189 ◽  
Author(s):  
Hussein Abdul-Rassoul ◽  
Matthew Defazio ◽  
Emily J. Curry ◽  
Joseph W. Galvin ◽  
Xinning Li
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Systematic Reviews ◽  
Return To Sport ◽  
Biceps Tenodesis ◽  
Inclusion Criteria ◽  
Slap Repair ◽  
Arthroscopic Slap Repair

Background: Controversy exists as to the optimal treatment of superior labrum anterior to posterior (SLAP) tears in athletes. There are no systematic reviews evaluating return-to-sport (RTS) rates after arthroscopic SLAP repair and biceps tenodesis. Purpose: To compare the overall RTS rates in patients with primary type 2 SLAP tears who were managed with arthroscopic SLAP repair versus biceps tenodesis. Study Design: Systematic review; Level of evidence, 4. Methods: A review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching the MEDLINE (PubMed), Embase (Elsevier), and Cochrane Library databases. Inclusion criteria were clinical studies that evaluated RTS rates after arthroscopic SLAP repair, arthroscopic SLAP repair with partial rotator cuff debridement, and biceps tenodesis. The studies were analyzed for quality and inclusion in the final analysis. Data relevant to RTS rates were then extracted and compiled, and outcomes were compared. Results: Of the 337 studies initially identified, 15 (501 patient-athletes) met inclusion criteria. These consisted of 195 patients who underwent isolated arthroscopic SLAP repair (mean age, 31 years; mean follow-up, 3.2 years), 222 patients who underwent arthroscopic SLAP repair with partial rotator cuff debridement (mean age, 22 years; mean follow-up, 5.1 years), and 84 patients who underwent biceps tenodesis (mean age, 42 years; mean follow-up, 3.3 years). The overall RTS rates were high for all 3 procedures (SLAP repair, 79.5%; SLAP repair with rotator cuff debridement, 76.6%; biceps tenodesis, 84.5%), with biceps tenodesis having the highest overall rate. Biceps tenodesis also had the highest RTS rate at the preinjury level (78.6%) compared with SLAP repair (63.6%) and SLAP repair with rotator cuff debridement (66.7%). Conclusion: Primary arthroscopic SLAP repair, arthroscopic SLAP repair with partial rotator cuff debridement, and biceps tenodesis all provide high RTS rates. Biceps tenodesis as an operative treatment of primary SLAP lesions may demonstrate an overall higher RTS rate when compared with traditional SLAP repair in older athletes. More, higher level studies are needed that control for age, level of activity, and type of sport (overhead vs nonoverhead) to determine the efficacy of biceps tenodesis as a primary alternative to arthroscopic SLAP repair in young athletes who present with type 2 SLAP tears.

scholarly journals A meta-analysis comparing tenotomy or tenodesis for lesions of the long head of the biceps tendon with concomitant reparable rotator cuff tears

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Yuyan Na ◽  
Yong Zhu ◽  
Yuting Shi ◽  
Yizhong Ren ◽  
Ting Zhang ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Constant Score ◽  
Biceps Tendon ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Rotator Cuff Tears ◽  
Biceps Tenodesis ◽  
Biceps Tenotomy ◽  
Long Head ◽  
Supination Strength

Abstract Background The best treatment for lesions of the long head of the biceps tendon (LHBT) with concomitant reparable rotator cuff tears is still controversial. The purpose of the meta-analysis was to compare clinical outcomes of biceps tenotomy and tenodesis for LHBT lesions. Methods A literature retrieval was conducted in MEDLINE, Embase, and Cochrane Library from 1979 to March 2018. Comparative studies (level of evidence I or II) comparing tenotomy and tenodesis for LHBT lesions with concomitant reparable rotator cuff tears were included. Risk of bias for all included studies was assessed using the Cochrane Collaboration’s risk of bias tool. Clinical outcomes compared were Popeye sign, Constant score, VAS pain score, cramping pain, elbow flexion and forearm supination strength, and re-tear of the rotator cuff. Results Two randomized controlled trials (RCTs) and five prospective cohort studies (PCS) with 288 biceps tenotomy patients and 303 biceps tenodesis patients were included in this review. Tenotomy resulted in significantly greater rates of Popeye sign (RR, 2.70 [95% CI, 1.80 to 4.04]; P < 0.01) and a less favorable Constant score (MD, − 1.09 [95% CI, − 1.90 to − 0.28]; P < 0.01) compared to tenodesis. No significant heterogeneity was found between the two groups across all parameters except forearm supination strength. Conclusions The current evidence indicates that biceps tenodesis for LHBT lesions with concomitant reparable rotator cuff tears results in decreased rate of Popeye sign and improved Constant score compared to biceps tenotomy. Trial registration PROSPERO, CRD42018105504. Registered on 13 August 2018.

scholarly journals SLAP Tears

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542110007
Author(s):  
Steven B. Cohen ◽  
John R. Matthews
Keyword(s):  
Rotator Cuff ◽  
Shoulder Arthroscopy ◽  
Biceps Tendon ◽  
Full Range ◽  
Contralateral Side ◽  
Highly Active ◽  
Slap Repair ◽  
Biceps Tenotomy ◽  
Labral Tears ◽  
Anterior Posterior

Background: Superior labral tears are frequently encountered during shoulder arthroscopy. Outcomes following superior labral anterior-posterior (SLAP) repairs in young athletes have been well documented. Superior labral repairs in older patient population continue to remain controversial due to concerns of postoperative complications including persistent preoperative symptoms, pain, stiffness, and higher rates of revision surgery. Indications: We present a case of a highly active 38-year-old woman who failed 1½ years of nonoperative management of a type IIB SLAP tear with extension to the posterior labrum. Her symptoms continued to limit her hobbies and work. Technique: A knotless single-anchor SLAP repair was performed along with debridement of the posterior frayed labrum. No biceps tenotomy or tenodesis was performed after full evaluation of the tendon failed to demonstrate evidence of synovitis, tendinopathy, or tear. The patient also did not have any concomitant shoulder pathology, including a rotator cuff tear or chondral lesion. Results: At 6 months, the patient had regained full range of motion similar to the contralateral side. She had returned to her normal activities and sports, including tennis. Discussion/Conclusion: Successful outcomes following SLAP repairs in patients over 35 years can be achieved, but treatment should be individualized with particular attention to concomitant pathology involving the rotator cuff, chondral surface, or biceps tendon which may require tenodesis or tenotomy.

scholarly journals Measurements of Tendon Movement Within the Bicipital Groove After Suprapectoral Intra-articular Biceps Tenodesis in a Cadaveric Model

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097753
Author(s):  
Brian J. Kelly ◽  
Alan W. Reynolds ◽  
Patrick J. Schimoler ◽  
Alexander Kharlamov ◽  
Mark Carl Miller ◽  
...  
Keyword(s):  
Biceps Tendon ◽  
Full Range ◽  
Elbow Flexion ◽  
Biceps Tenodesis ◽  
Bicipital Groove ◽  
Biceps Tenotomy ◽  
Flexion Extension ◽  
Before And After ◽  
Long Head ◽  
Scapular Motion

Background: Lesions of the long head of the biceps can be successfully treated with biceps tenotomy or tenodesis when surgical management is elected. The advantage of a tenodesis is that it prevents the potential development of a cosmetic deformity or cramping muscle pain. Proponents of a subpectoral tenodesis believe that “groove pain” may remain a problem after suprapectoral tenodesis as a result of persistent motion of the tendon within the bicipital groove. Purpose/Hypothesis: To evaluate the motion of the biceps tendon within the bicipital groove before and after a suprapectoral intra-articular tenodesis. The hypothesis was that there would be minimal to no motion of the biceps tendon within the bicipital groove after tenodesis. Study Design: Controlled laboratory study. Methods: Six fresh-frozen cadaveric arms were dissected to expose the long head of the biceps tendon as well as the bicipital groove. Inclinometers and fiducials (optical markers) were used to measure the motions of the scapula, forearm, and biceps tendon through a full range of shoulder and elbow motions. A suprapectoral biceps tenodesis was then performed, and the motions were repeated. The motion of the biceps tendon was quantified as a function of scapular or forearm motion in each plane, both before and after the tenodesis. Results: There was minimal motion of the native biceps tendon during elbow flexion and extension but significant motion during all planes of scapular motion before tenodesis, with the most motion occurring during shoulder flexion-extension (20.73 ± 8.21 mm). The motion of the biceps tendon after tenodesis was significantly reduced during every plane of scapular motion compared with the native state ( P < .01 in all planes of motion), with a maximum motion of only 1.57 mm. Conclusion: There was a statistically significant reduction in motion of the biceps tendon in all planes of scapular motion after the intra-articular biceps tenodesis. The motion of the biceps tendon within the bicipital groove was essentially eliminated after the suprapectoral biceps tenodesis. Clinical Relevance: This arthroscopic suprapectoral tenodesis technique can significantly reduce motion of the biceps tendon within the groove in this cadaveric study, possibly reducing the likelihood of groove pain in the clinical setting.

Results of concomitant rotator cuff and SLAP repair are not affected by unhealed SLAP lesion

2011 ◽  
Vol 20 (1) ◽  
pp. 138-145 ◽  
Author(s):  
Joo Han Oh ◽  
Sae Hoon Kim ◽  
Sang-ho Kwak ◽  
Chung Hee Oh ◽  
Hyun Sik Gong
Keyword(s):  
Rotator Cuff ◽  
Slap Lesion ◽  
Slap Repair

Debridement and Long Head of the Biceps Tenotomy in Revision Rotator Cuff Tears

2021 ◽  
pp. 75-81
Author(s):  
Daniel P. Berthold ◽  
Lukas N. Muench ◽  
Augustus D. Mazzocca ◽  
Knut Beitzel
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Biceps Tenotomy ◽  
Long Head

SLAP tears and return to sport and work: current concepts

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.

No Advantages in Repairing a Type II Superior Labrum Anterior and Posterior (SLAP) Lesion When Associated with Rotator Cuff Repair in Patients over Age 50

2007 ◽  
Vol 36 (2) ◽  
pp. 247-253 ◽  
Author(s):  
Francesco Franceschi ◽  
Umile Giuseppe Longo ◽  
Laura Ruzzini ◽  
Giacomo Rizzello ◽  
Nicola Maffulli ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Rotator Cuff Repair ◽  
Slap Lesion ◽  
Type Ii ◽  
Cuff Tear ◽  
Biceps Tenotomy ◽  
Group 2 ◽  
Cuff Repair ◽  
Group 1

Background Arthroscopic management has been recommended for some superior labrum anterior and posterior (SLAP) lesions, but no studies have focused on patients over 50 years of age with rotator cuff tear and a type II SLAP lesion. Hypothesis In patients over 50 years of age with an arthroscopically confirmed lesion of the rotator cuff and a type II SLAP lesion, there is no difference between (1) repair of both lesions and (2) repair of the rotator cuff tear without repair of the SLAP II lesion but with a tenotomy of the long head of the biceps. Study Design Randomized controlled clinical trial; Level of evidence, 1. Methods We recruited 63 patients. In 31 patients, we repaired the rotator cuff and the type II SLAP lesion (group 1). In the other 32 patients, we repaired the rotator cuff and tenotomized the long head of the biceps (group 2). Seven patients (2 in group 1 and 5 in group 2) were lost to final follow-up. Results At a minimum 2.9 years’ follow-up, statistically significant differences were seen with respect to the University of California, Los Angeles (UCLA) score and range of motion values. In group 1 (SLAP repair and rotator cuff repair), the UCLA showed a statistically significant improvement from a preoperative average rating of 10.4 (range, 6–14) to an average of 27.9 (range, 24–35) postoperatively ( P < .001). In group 2 (biceps tenotomy and rotator cuff repair), the UCLA showed a statistically significant improvement from a preoperative average rating of 10.1 (range, 5–14) to an average of 32.1 (range, 30–35) postoperatively ( P < .001) There was a statistically significant difference in total postoperative UCLA scores and range of motion when comparing the 2 groups postoperatively ( P < .05). Conclusions There are no advantages in repairing a type II SLAP lesion when associated with a rotator cuff tear in patients over 50 years of age. The association of rotator cuff repair and biceps tenotomy provides better clinical outcome compared with repair of the type II SLAP lesion and the rotator cuff.

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