38. OVERTIME: SLAP Tear Management - Repair or Tenodesis?

Welcome to Overtime with the Sports Docs. On each of these mini episodes, Catherine and I chat about a new topic or surgical technique in the field of sports medicine. We’ll give you our quick take on the most recent data ranging from operative indications, surgical approaches, post-op protocols and most importantly – patient outcomes.

Today we’re talking about SLAP tears – tears of the superior labrum from anterior to posterior. We have two great articles for you today that focus on the surgical management of SLAP tears – specifically whether we should be repairing SLAP tears or proceeding directly to biceps tenodesis. We will also discuss the different types of biceps tenodesis procedures – mainly arthroscopic suprapectoral versus open subpectoral.

Our first paper looks specifically at this patient population – young overhead athletes – and investigates the functional and athletic outcomes after primary subpectoral biceps tenodesis for type II SLAP tears. 

Brian Waterman and Tony Romeo published a case series in the January 2023 issue of Arthroscopy titled “High Rate of Return to Sporting Activity Among Overhead Athletes with Subpectoral Biceps Tenodesis for Type II SLAP Tear”. The authors reported that 81% of patients returned to their previous level of play at an average of 4 months post-op. There were also significant improvements in VAS and SANE scores post-op.

But how do repairs do in this population? The answer is… not great. Return to preinjury level of play after SLAP repair has been reported in the range of 54% to 63% of elite throwers. In one cohort study by Boileau, 60% of patients reported persistent shoulder pain after SLAP repair and 50% elected to undergo secondary surgery. Provencher published on his outcomes of SLAP repair in an active military population and reported a 37% failure rate and 28% revision rate at short to mid-term follow up.

Our second article focuses on this and is titled “No Difference in Clinical Outcomes for Arthroscopic Suprapectoral Versus Open Subpectoral Biceps Tenodesis at Midterm Follow-up.” Nikhil Verma – who will be joining us at AOSSM – and colleagues at Rush compared arthroscopic suprapectoral tenodesis versus open subpectoral tenodesis for long head of biceps tendon disease, so not SLAP tears. They reported no significant differences in patient reported outcomes or complications at any time point.