High Rate of Return to Sporting Activity Among Overhead Athletes With Subpectoral Biceps Tenodesis for Type II SLAPTear. To evaluate the functional and athletic outcomes after primary subpectoral biceps tenodesis for type II SLAPtear in overhead athletes. All competitive elite athletes with type II SLAPtears undergoing biceps tenodesis by a single surgeon were isolated between 2007 and 2015 ). In the current series of competitive overhead athletes, 81% of patients returned to previous level of play at an average of 4.1 months postoperatively after subpectoral biceps tenodesis for symptomatic SLAPtear. Athletes reliably experienced significant decreased activity-related pain with athletic function. IV, case series.
SLAPTears: Treatment Algorithm. SLAP lesions can be significant pain generators in the shoulder. These injuries are the most common shoulder injury in overhead athletes, as repetitive overhead motion is the most common etiology of SLAP lesions. These lesions present a diagnostic and treatment challenge to patients and physicians. Factors to consider when discussing treatment options for SLAP
Editorial Commentary: Subpectoral Biceps Tenodesis Is a Safe Alternative to Arthroscopic Repair for Unstable SLAPTear in the Young Athlete: Should We Do the Last Operation First? The clinical significance of structural pathology affecting the biceps-superior labrum complex may be highly variable. Among younger, physically active patients with symptomatic superior labrum anterior-posterior (SLAP consensus for surgical best practice treatment. With the high rate of postoperative stiffness and revision reoperation and inconsistent functional outcomes after modern arthroscopic shoulder SLAP repair with knotless anchor technology, subpectoral biceps tenodesis may emerge as a primary alternative for treating the young athlete with unstable SLAPtears.
Biceps Tenodesis Demonstrates Lower Reoperation Rates Compared to SLAP Repair for Treatment of SLAPTears in a Large Cross-Sectional Population. To use a contemporary cross-sectional data set to evaluate trends in surgical treatment for superior labrum anterior and posterior (SLAP) tears and compare surgical outcomes with respect to 2-year revision surgery rates following index SLAP repair versus biceps tenodesis (BT). Patients diagnosed with a SLAPtear between 2010 and 2017 were queried using the Mariner PearlDiver database and stratified by demographic variables and surgical treatment with arthroscopic SLAP repair or arthroscopic/open BT. From 2015 to 2017, Current Procedural Terminology (CPT) and International Classification of Diseases 10th revision (ICD-10) codes were used to track
Decreased Trunk Rotation at Foot Contact in Professional Baseball Pitchers With Prior Conservatively Managed SLAPTears: A Propensity Score-Matched Analysis. To compare kinematic and kinetic parameters between a cohort of fully recovered professional pitchers with prior shoulder injury treated conservatively and a cohort with no prior shoulder injury. Twenty-six fully recovered professional , handedness, and ball velocity to pitchers with no prior injury history (control) at a ratio of 1:4. We compared 21 kinematic and 11 kinetic parameters between groups using appropriate parametric testing. Subanalysis comparisons of pitchers with prior SLAP injury as well as rotator cuff tendinitis were also performed. SLAPtears (n = 11, 42.3%) were the most frequently reported injury, followed by rotator
Open Subpectoral Biceps Tenodesis May Be an Alternative to Arthroscopic Repair for SLAPTears in Patients Under 30. The purpose of the current study is to compare the outcomes of open subpectoral biceps tenodesis (BT) to arthroscopic repair (AR) for SLAPtears in patients under the age of 30 years. A retrospective review of patients under the age of 30 years who underwent either isolated BT or AR for a diagnosis of a SLAPtear between 2011 and 2019 was performed. Patients were included if they were >16 years old at the time of surgery, had an isolated SLAPtear involving instability of the biceps-labral anchor (types II-IV), were skeletally mature, and had a minimum follow-up of 12 months. The American Shoulder & Elbow Surgeons score, visual analog scale, Subjective Shoulder Value
Return to Play After Biceps Tenodesis for Isolated SLAPTears in Overhead Athletes. Performing open subpectoral biceps tenodesis in overhead athletes with a superior labrum anterior to posterior (SLAP) tear may affect their ability to return to overhead sports. To investigate clinical outcomes in overhead athletes undergoing biceps tenodesis for the treatment of symptomatic, isolated SLAPtears involving the biceps-labral complex. Case series; Level of evidence, 4. A retrospective review of overhead athletes who underwent biceps tenodesis for a SLAPtear was performed. The American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) score for pain, subjective shoulder value (SSV), patient satisfaction, willingness to undergo surgery again, revision procedures, and return to play
Editorial Commentary: Which to Fix-the Biceps or the Labrum? The Shoulder SLAPTear Is Still Controversial. A type II SLAPtear in a young and active patient remains a controversial and challenging clinical entity. Arthroscopic repair is generally a successful procedure for type II SLAP lesions, but the results can be unpredictable. Biceps tenodesis has become increasingly popular
Treatment for Symptomatic SLAPTears in Middle-Aged Patients Comparing Repair, Biceps Tenodesis, and Nonoperative Approaches: A Cost-Effectiveness Analysis. To evaluate the cost-effectiveness of nonoperative management, primary SLAP repair, and primary biceps tenodesis for the treatment of symptomatic isolated type II SLAPtear. A microsimulation Markov model was constructed to compare 3 strategies for middle-aged patients with symptomatic type II SLAPtears: SLAP repair, biceps tenodesis, or nonoperative management. A failed 6-month trial of nonoperative treatment was assumed. The principal outcome measure was the incremental cost-effectiveness ratio in 2017 U.S. dollars using a societal perspective over a 10-year time horizon. Treatment effectiveness was expressed in quality-adjusted
An Age and Activity Algorithm for Treatment of Type II SLAPTears Type II SLAPtears predominantly occur in males between their third and fifth decades of life. The mechanism of injury is often repeated overheard activity but can also occur due to direct compression loads and traction injuries. The treatment options have changed over the years and include non-operative therapy, direct labral -biceps complex repair, and labral debridement with biceps tenodesis or tenotomy. To review the existing literature on the management of Type II SLAPtears and provide clinical recommendations based on patient age and activity level. A review of the existing literature through October 2017 investigating the management of Type II SLAPtears was performed. Emphasis was placed on distinguishing
Superior Capsular Release After Failed Combined Superior Labral Repair And Biceps Tenodesis For SlapTear Optimal treatment of type II superior labrum anterior and posterior (SLAP) tears is controversial. There has been a recent trend towards biceps tenodesis over SLAP repair in older patients. Few surgeons have performed combined biceps tenodesis and SLAP repair with inferior results. This case describes a 46-year-old patient who had persistent pain and stiffness after combined biceps tenodesis and SLAP repair for a type II SLAPtear. His pain and motion improved after arthroscopic superior capsular release. Failed SLAP repair is often multifactorial and a thorough workup is needed. Combined biceps tenodesis and SLAP repair can cause pain, stiffness, and dysfunction which can be successfully
A Treatment-Based Algorithm for the Management of Type-II SLAPTears The management of Type-II superior labral tears (SLAP) of the shoulder remains a controversial topic. Treatment ranges from non-operative management to surgical management including SLAP repair, biceps tenotomy, and biceps tenodesis. An optimal treatment algorithm has yet to reach universal acceptance. The goal of this paper was to provide a treatment algorithm for the management of Type-II SLAPtears based on current literature and expert opinion. Current literature was reviewed and expert opinion was reported to develop a comprehensive treatment protocol for patients based on age, activity level, and pathology. Operative management of type-II SLAPtears yields good to excellent outcomes when proper indications are followed
Arthroscopic Repair of Type II SLAPTears Using Suture Anchor Technique Arthroscopic SLAPtear repair has become an increasingly used treatment for patients presenting with symptomatic SLAPtears after failed nonoperative management. Debridement, SLAP repair, and open or arthroscopic biceps tenodesis or tenotomy have been used for the treatment of SLAPtears. Various techniques for repair have been described, and furthermore, there is a high incidence of concomitant pathology of the shoulder. Repair remains an excellent option in isolated SLAPtears amenable to repair, with excellent outcomes in well-indicated patients. We present a method for repairing a SLAPtear using standard suture anchor fixation, anterior and posterior portals, and an accessory portal of Wilmington. Adequate labral
Superior Labral Anterior-Posterior (SLAP) Tears in the Military: A Clinical Review of Incidence, Diagnosis, and Treatment Compared With the Civilian Population Given the notable physical demands placed on active members of the military, comprehension of recent trends in management and outcomes of superior labral anterior-posterior (SLAP) tears in this patient population is critical for successful treatment. Electronic databases, including PubMed, MEDLINE, and Embase, were reviewed for the years 1985 through 2016. Database review. Level 5. Active members of the military are at increased risk of sustaining shoulder injuries, particularly SLAPtears. Recent trends in management of SLAP lesions have shifted toward operative intervention. In the correct patient population, repairs of superior
Preliminary Development of a Clinical Prediction Rule for Treatment of Patients With Suspected SLAPTears. To use the clinical prediction rule process to identify patient variables, measured on initial clinical presentation, that would be predictive of failure to achieve satisfactory improvement, while following a rehabilitation program, in the modification of SLAP injury symptoms
SLAPtears: diagnosis using 3-T shoulder MR arthrography with the 3D isotropic turbo spin-echo space sequence versus conventional 2D sequences. The aim of this study was to determine the accuracy and reliability of shoulder magnetic resonance (MR) arthrography with three-dimensional (3D) isotropic intermediate-weighted turbo spin-echo (TSE) sampling perfection with application-optimised
lifting, pushing, and overhead motion * Physical exam demonstrating a positive response to at least ONE of the following tests: * O’Brien (active compression) test * Anterior slide test * Biceps load test (I and II) * Pain provocation test * Crank test * Jobe relocation test * Forced shoulder abduction and elbow flexion test * Resisted supination external rotation test * MRI demonstrating a SLAPtear ALL of the following criteria are met: * Pain in the front of the shoulder and/or clicking, popping or catching sensation when using the arm and shoulder * Clinical exam is consistent with long head of biceps pathology * MRI findings consistent with biceps tendinopathy OR when criteria for SLAPtear are met * Failure of at least 12 weeks of supervised conservative management OR at least 6 weeks when
criteria for SLAPtear are met * Failure of at least 12 weeks of supervised conservative management OR at least 6 weeks when criteria for another shoulder procedure are met OR * Symptomatic acute proximal biceps tear Exclusions Indications other than those addressed in this guideline are considered not medically necessary including, but not limited to, the following: * Subacromial (balloon) spacer
entrapment * Following acute trauma, with radiographic suspicion of a bony Bankart lesion (anteroinferior glenoid fracture) * Symptoms* AND physical exam findings** of SLAPtear, and failure of at least 6 weeks of conservative management *Symptoms are pain aggravated by heavy lifting, pushing, or overhead motion. **Physical exam demonstrating a positive response to ANY of following tests: * O’Brien (active in diagnosing and excluding labral tears. CT and MR arthrogram have comparable diagnostic accuracy in evaluation of superior labral anterior to posterior (SLAP) tears, Bankart lesions, and humeral head/Hill-Sachs fractures. CT arthrogram may have slightly better diagnostic accuracy for glenoid rim fractures and anterior labral periosteal sleeve avulsion fractures. In the absence of intra-articular contrast
and superior labrum anterior to posterior (SLAP) tears [33,43]. Another meta-analysis showed that MR arthrography is slightly more sensitive than noncontrast MRI for anterior labral tears but not statistically significant (87% versus 83%, P = .083) [44]. For SLAP lesions, 3T 2-D neutral MR arthrography was of similar sensitivity to 3T MRI (84% versus 83%, P = .575) but less specific (99% versus 92% P < .0001