Biceps Tenodesis vs SLAP Repair for Type II SLAP Tears

In active-duty military patients younger than 35 years with type II superior labral anterior-posterior tears, biceps tenodesis is more effective in improving pain and function than superior labral anterior-posterior repair, according to new study data.

“Biceps tenodesis has been suggested as a superior surgical technique compared with isolated labral repair for superior labral anterior-posterior tears in patients older than 35 years. The superiority of this procedure in younger patients, however, is yet to be determined,” the researchers of “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” wrote.

In the study, which was published online on October 21, 2021 in The American Journal of Sports Medicine, the researchers sought to compare the outcomes of arthroscopic superior labral anterior-posterior repair with those of arthroscopic-assisted subpectoral biceps tenodesis.

To do this, they compared preoperative and postoperative evaluations with a minimum 5-year follow-up. Critical score values included the visual analog scale, the Single Assessment Numeric Evaluation and the American Shoulder and Elbow Surgeons shoulder score. A total of 48 patients were included in the study.

Overall, the preoperative patient age (p = .3639), forward flexion (p = .8214), external rotation (p = .5134), visual analog scale pain score (p = .4487), single assessment numeric evaluation score (p = .6614), and American Shoulder and Elbow Surgeons shoulder score (p = .6519) did not vary significantly between the two groups.

By a minimum of 5 years post-op, both groups achieved statistically significant increases in function and reduction in pain, the data shows. However, the patients in the tenodesis group, had lower pain (1.3 vs. 2.6, respectively; p = .0358) and higher single assessment numeric evaluation score (84.0 vs. 63.3, respectively; p = .001) and American Shoulder and Elbow Surgeon (85.7 vs. 75.4, respectively; p = .0342) scores than the repair group.

In addition, the failure rate was 20.0% in the repair group versus 0.0% in the tenodesis group (p = .0234).

“Active-duty military patients younger than 35 years with type II superior labral anterior-posterior tears had more predictable improvement in pain, better functional outcomes, and lower failure rates after biceps tenodesis compared with superior labral anterior-posterior repair for type II superior labral anterior-posterior tears,” the researchers wrote.

“Overall, the results of this study indicate that arthroscopic-assisted subpectoral biceps tenodesis is superior to arthroscopic superior labral anterior-posterior tears in military patients younger than 35 years.”

The authors of the study included, Nata Parnes, M.D., Hunter Czajkowski, and Michael J. DeFranco, M.D. of Carthage Area Hospital in Carthage, New York as well as John C. Dunn, M.D., and John P. Scanaliato, M.D. of William Beaumont Army Medical Center in El Paso, Texas. Claire K. Green, B.S., of George Washington University School of Medicine in Washington, District of Columbia also contributed to the study.