Compared to a relatively older population over 30–40 years of age, the efficacy of biceps tenodesis for type II SLAP lesions in a younger population is not well studied. The purpose of this study was to compare outcomes between biceps tenodesis and labral repair for type II SLAP lesions in a young active population.
Patients aged 15–40 who underwent primary arthroscopic biceps tenodesis or SLAP repair for type II SLAP tears between 2009 and 2016 were included. Shoulders with intraarticular chondral damage, full thickness rotator cuff tear, rotator cuff repair, labral repair outside of the superior labrum, bony subacromial decompression, and acromioclavicular joint resection were excluded. Patient-reported outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) score, Disabilities of the Arm, Shoulder, and Hand Sports/Performing Arts Module (DASH-sport), visual analog scale (VAS) for pain, and satisfaction. Return to sport rates were also recorded.
Fifty-three patients (20 tenodesis, 33 repair) were available for minimum 2-year follow-up. Postoperatively, there were no significant differences in mean ASES, DASH-sport, VAS, and satisfaction between groups [ASES: tenodesis 86.3 vs. repair 86.4 (n.s.); DASH-sport: 11.0 vs. 22.5 (n.s.); VAS: 1.85 vs. 1.64 (n.s.); satisfaction: 8.50 vs. 8.00 (n.s.)]. Rate of return to pre-injury level of performance/competition in sport/physical activity was also similar between groups [tenodesis 63% vs. repair 50% (n.s.)].
In a young active population, primary arthroscopic biceps tenodesis is a viable surgical alternative to labral repair for type II SLAP lesions. The results of this study suggest that indications for arthroscopic tenodesis can safely be expanded to a younger patient group than has previously been demonstrated in the literature.
Level of evidence
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
American shoulder and elbow surgeons score
Disabilities of the arm, shoulder, and hand sports/performing arts module
Superior labral anterior to posterior
Visual analog scale
Alpantaki K, McLaughlin D, Karagogeos D, Hadjipavlou A, Kontakis G (2005) Sympathetic and sensory neural elements in the tendon of the long head of the biceps. J Bone Jt Surg Am 87:1580–1583
Alpert JM, Wuerz TH, O'Donnell TF, Carroll KM, Brucker NN, Gill TJ (2010) The effect of age on the outcomes of arthroscopic repair of type II superior labral anterior and posterior lesions. Am J Sports Med 38:2299–2303
Andrews JR, Carson WG Jr, McLeod WD (1985) Glenoid labrum tears related to the long head of the biceps. Am J Sports Med 13:337–341
Bey MJ, Elders GJ, Huston LJ, Kuhn JE, Blasier RB, Soslowsky LJ (1998) The mechanism of creation of superior labrum, anterior, and posterior lesions in a dynamic biomechanical model of the shoulder: the role of inferior subluxation. J Shoulder Elbow Surg 7:397–401
Boileau P, Parratte S, Chuinard C, Roussanne Y, Shia D, Bicknell R (2009) Arthroscopic treatment of isolated type II SLAP lesions: biceps tenodesis as an alternative to reinsertion. Am J Sports Med 37:929–936
Brockmeier SF, Voos JE, Williams RJ 3rd, Altchek DW, Cordasco FA, Allen AA (2009) Outcomes after arthroscopic repair of type-II SLAP lesions. J Bone Jt Surg Am 91:1595–1603
Brockmeyer M, Tompkins M, Kohn DM, Lorbach O (2016) SLAP lesions: a treatment algorithm. Knee Surg Sports Traumatol Arthrosc 24:447–455
Burns JP, Bahk M, Snyder SJ (2011) Superior labral tears: repair versus biceps tenodesis. J Shoulder Elbow Surg 20:S2–S8
Chalmers PN, Monson B, Frank RM, Mascarenhas R, Nicholson GP, Bach BR Jr et al (2016) Combined SLAP repair and biceps tenodesis for superior labral anterior-posterior tears. Knee Surg Sports Traumatol Arthrosc 24:3870–3876
Chalmers PN, Trombley R, Cip J, Monson B, Forsythe B, Nicholson GP et al (2014) Postoperative restoration of upper extremity motion and neuromuscular control during the overhand pitch: evaluation of tenodesis and repair for superior labral anterior-posterior tears. Am J Sports Med 42:2825–2836
Cooper DE, Arnoczky SP, O'Brien SJ, Warren RF, DiCarlo E, Allen AA (1992) Anatomy, histology, and vascularity of the glenoid labrum. An anatomical study. J Bone Jt Surg Am 74:46–52
Denard PJ, Ladermann A, Burkhart SS (2012) Long-term outcome after arthroscopic repair of type II SLAP lesions: results according to age and workers' compensation status. Arthroscopy 28:451–457
Denard PJ, Ladermann A, Parsley BK, Burkhart SS (2014) Arthroscopic biceps tenodesis compared with repair of isolated type II SLAP lesions in patients older than 35 years. Orthopedics 37:e292–297
Ek ET, Shi LL, Tompson JD, Freehill MT, Warner JJ (2014) Surgical treatment of isolated type II superior labrum anterior-posterior (SLAP) lesions: repair versus biceps tenodesis. J Shoulder Elbow Surg 23:1059–1065
Enad JG, Kurtz CA (2007) Isolated and combined Type II SLAP repairs in a military population. Knee Surg Sports Traumatol Arthrosc 15:1382–1389
Erickson BJ, Jain A, Abrams GD, Nicholson GP, Cole BJ, Romeo AA et al (2016) SLAP lesions: trends in treatment. Arthroscopy 32:976–981
Erickson J, Lavery K, Monica J, Gatt C, Dhawan A (2015) Surgical treatment of symptomatic superior labrum anterior-posterior tears in patients older than 40 years: a systematic review. Am J Sports Med 43:1274–1282
Franceschi F, Longo UG, Ruzzini L, Rizzello G, Maffulli N, Denaro V (2008) 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: a randomized controlled trial. Am J Sports Med 36:247–253
Friel NA, Karas V, Slabaugh MA, Cole BJ (2010) Outcomes of type II superior labrum, anterior to posterior (SLAP) repair: prospective evaluation at a minimum two-year follow-up. J Shoulder Elbow Surg 19:859–867
Gorantla K, Gill C, Wright RW (2010) The outcome of type II SLAP repair: a systematic review. Arthroscopy 26:537–545
Gottschalk MB, Karas SG, Ghattas TN, Burdette R (2014) Subpectoral biceps tenodesis for the treatment of type II and IV superior labral anterior and posterior lesions. Am J Sports Med 42:2128–2135
Grauer JD, Paulos LE, Smutz WP (1992) Biceps tendon and superior labral injuries. Arthroscopy 8:488–497
Handelberg F, Willems S, Shahabpour M, Huskin JP, Kuta J (1998) SLAP lesions: a retrospective multicenter study. Arthroscopy 14:856–862
Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29:602–608
Ide J, Maeda S, Takagi K (2005) Sports activity after arthroscopic superior labral repair using suture anchors in overhead-throwing athletes. Am J Sports Med 33:507–514
Kim SH, Ha KI, Kim SH, Choi HJ (2002) Results of arthroscopic treatment of superior labral lesions. J Bone Jt Surg Am 84-a:981–985
Kim TK, Queale WS, Cosgarea AJ, McFarland EG (2003) Clinical features of the different types of SLAP lesions: an analysis of one hundred and thirty-nine cases. J Bone Jt Surg Am 85-a:66–71
Knesek M, Skendzel JG, Dines JS, Altchek DW, Allen AA, Bedi A (2013) Diagnosis and management of superior labral anterior posterior tears in throwing athletes. Am J Sports Med 41:444–460
Laughlin WA, Fleisig GS, Scillia AJ, Aune KT, Cain EL Jr, Dugas JR (2014) Deficiencies in pitching biomechanics in baseball players with a history of superior labrum anterior-posterior repair. Am J Sports Med 42:2837–2841
Li M, Shaikh AB, Sun J, Shang P, Shang X (2019) Effectiveness of biceps tenodesis versus SLAP repair for surgical treatment of isolated SLAP lesions: a systemic review and meta-analysis. J Orthop Transl 16:23–32
Maffet MW, Gartsman GM, Moseley B (1995) Superior labrum-biceps tendon complex lesions of the shoulder. Am J Sports Med 23:93–98
McCormick F, Bhatia S, Chalmers P, Gupta A, Verma N, Romeo AA (2014) The management of type II superior labral anterior to posterior injuries. Orthop Clin N Am 45:121–128
McCulloch PC, Andrews WJ, Alexander J, Brekke A, Duwani S, Noble P (2013) The effect on external rotation of an anchor placed anterior to the biceps in type 2 SLAP repairs in a cadaveric throwing model. Arthroscopy 29:18–24
McFarland EG, Kim TK, Savino RM (2002) Clinical assessment of three common tests for superior labral anterior-posterior lesions. Am J Sports Med 30:810–815
Mollon B, Mahure SA, Ensor KL, Zuckerman JD, Kwon YW, Rokito AS (2016) Subsequent shoulder surgery after isolated arthroscopic SLAP repair. Arthroscopy 32(10):1954–1962
Morgan CD, Burkhart SS, Palmeri M, Gillespie M (1998) Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears. Arthroscopy 14:553–565
Musgrave DS, Rodosky MW (2001) SLAP lesions: current concepts. Am J Orthop (Belle Mead NJ) 30:29–38
Nair R, Kahlenberg CA, Patel RM, Knesek M, Terry MA (2015) All-arthroscopic suprapectoral biceps tenodesis. Arthrosc Tech 4:e855–861
Patterson BM, Creighton RA, Spang JT, Roberson JR, Kamath GV (2014) Surgical trends in the treatment of superior labrum anterior and posterior lesions of the shoulder: analysis of data from the American Board of Orthopaedic Surgery Certification Examination Database. Am J Sports Med 42:1904–1910
Pogorzelski J, Horan MP, Hussain ZB, Vap A, Fritz EM, Millett PJ (2018) Subpectoral biceps tenodesis for treatment of isolated type II SLAP lesions in a young and active population. Arthroscopy 34:371–376
Provencher MT, McCormick F, Dewing C, McIntire S, Solomon D (2013) A prospective analysis of 179 type 2 superior labrum anterior and posterior repairs: outcomes and factors associated with success and failure. Am J Sports Med 41:880–886
Ren YM, Duan YH, Sun YB, Yang T, Hou WY, Tian MQ (2019) Is arthroscopic repair superior to biceps tenotomy and tenodesis for type II SLAP lesions? A meta-analysis of RCTs and observational studies. J Orthop Surg Res 14:48
Rhee YG, Lee DH, Lim CT (2005) Unstable isolated SLAP lesion: clinical presentation and outcome of arthroscopic fixation. Arthroscopy 21:1099.e1–1099.e7
Richards RR, An KN, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG et al (1994) A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg 3:347–352
Schroder CP, Skare O, Reikeras O, Mowinckel P, Brox JI (2017) Sham surgery versus labral repair or biceps tenodesis for type II SLAP lesions of the shoulder: a three-armed randomised clinical trial. Br J Sports Med 51:1759–1766
Snyder SJ, Banas MP, Karzel RP (1995) An analysis of 140 injuries to the superior glenoid labrum. J Shoulder Elbow Surg 4:243–248
Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ (1990) SLAP lesions of the shoulder. Arthroscopy 6:274–279
Tashjian RZ, Deloach J, Green A, Porucznik CA, Powell AP (2010) Minimal clinically important differences in ASES and simple shoulder test scores after nonoperative treatment of rotator cuff disease. J Bone Jt Surg Am 92:296–303
Tayrose GA, Karas SG, Bosco J (2015) Biceps tenodesis for type II SLAP tears. Bull Hosp Jt Dis (2013) 73:116–121
Virk MS, Tilton AK, Cole BJ (2015) Biceps tenodesis and superior labrum anterior to posterior (SLAP) tears. Am J Orthop (Belle Mead NJ) 44:491–494
Wang KK, Yalizis M, Hoy GA, Ek ET (2018) Current trends in the evaluation and treatment of SLAP lesions: analysis of a survey of specialist shoulder surgeons. JSES Open Access 2:48–53
Yung PS, Fong DT, Kong MF, Lo CK, Fung KY, Ho EP et al (2008) Arthroscopic repair of isolated type II superior labrum anterior-posterior lesion. Knee Surg Sports Traumatol Arthrosc 16:1151–1157
The authors received no financial support for the research, authorship, and/or publication of this article.
Conflict of interest
Michael A. Terry MD receives consulting compensation and financial support for the sports medicine fellowship at Northwestern from Smith and Nephew. Vehniah K. Tjong MD receives consulting compensation from Smith and Nephew. No financial support was received for conducting this study. Kevin F. Dunne MD, Michael Knesek MD, Brett D. Riederman MD, Charles J. Cogan MD, Hayden P. Baker MD, Cynthia A. Kahlenberg MD, and Stephen Gryzlo MD declare that they have no conflict of interest.
Study protocol was approved by the Institutional Review Board (ID STU00200706, Northwestern University). Informed consent was obtained by each patient in the study. The study was done in agreement with the ethical standards of the Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Dunne, K.F., Knesek, M., Tjong, V.K. et al. Arthroscopic treatment of type II superior labral anterior to posterior (SLAP) lesions in a younger population: minimum 2-year outcomes are similar between SLAP repair and biceps tenodesis. Knee Surg Sports Traumatol Arthrosc 29, 257–265 (2021). https://doi.org/10.1007/s00167-020-05971-0
- Biceps anchor
- SLAP tear
- SLAP repair
- Biceps tenodesis
- Shoulder arthroscopy